Letter to the Editor

Shorter Treatment for Hepatitis C Genotype 4 May Be a Possibility

Authors: Shahzad Iqbal, MD, Mohamad Mansour, MD, Maurice A. Cerulli, MD, FACG

Abstract

To the Editor:


Hepatitis C Genotype 4 (HCV-4) is predominantly found in the Middle East and North Africa. It is now spreading in Europe and the USA, especially among drug users and HIV-positive individuals.1 Because most of the large randomized controlled trials of antiviral therapy for chronic hepatitis C were conducted in North America and Europe, little is known about management of patients with this particular genotype. Based on the available data, it is believed to be treatment-resistant, with a sustained viral response (SVR) comparable to HCV-1 (43%). It is treated with peginterferon-based combination therapy for 48 weeks.2 The poor response to treatment is believed to be due to slow viral dynamics of HCV-4. The viral dynamics parameters of HCV-4 appear similar to those of HCV-1 and slower than those of HCV-2.3

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References

1. Legrand-Abravanel F, Nicot F, Boulestin A, et al. Pegylated interferon and ribavirin therapy for chronic hepatitis C virus genotype 4 infection. J Med Virol 2005;77:66–69.
 
2. Alfaleh FZ, Hadad Q, Khuroo MS, et al. Peginterferon alpha-2b plus ribavirin compared with interferon alpha-2b plus ribavirin for initial treatment of chronic hepatitis C in Saudi patients commonly infected with genotype 4. Liver Int 2004;24:568–574.
 
3. Halfon P, Neumann AU, Bourliere M, et al. Slow viral dynamics of hepatitis C virus genotype 4. J Viral Hepat 2003;10:351–353.
 
4. Khuroo MS, Khuroo MS, Dahab ST. Meta-analysis: a randomized trial of peginterferon plus ribavirin for the initial treatment of chronic hepatitis C genotype 4. Aliment Pharmacol Ther 2004;20:931–938.
 
5. El-Zayadi AR, Attia M, Barakat EM, et al. Response of hepatitis C genotype-4 naive patients to 24 weeks of Peg-interferon-alpha2b/ribavirin or induction-dose interferon-alpha2b/ribavirin/amantadine: a non-randomized controlled study. Am J Gastroenterol 2005;100:2447–2452.