Opinion Statement
A small number of studies were done on Hepatitis C virus genotypes 4, 5, and 6; that is why limited data were available on the most effective management for these patients. In the past, treatment of this kind of patients depended on the use of the suboptimal regimen of interferon with ribavirin achieving moderate efficacy with numerous side effects. However, with the introduction of the new directly acting antiviral drugs (DAAs), multiple agents became available for treatment showing high success rates, excellent tolerability, and few adverse events.
Similar content being viewed by others
References and Recommended Heading
Papers of particular interest, published recently, have been highlighted as: • Of importance
Frank C, Mohamed MK, Strickland GT, et al. The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet. 2000;355(9207):887–91.
Sterling RK, Bralow S. Extrahepatic manifestations of hepatitis C virus. Curr Gastroenterol Rep. 2006;8(1):53–9.
Bonkovsky HL, Mehta S. Hepatitis C: a review and update. J Am Acad Dermatol. 2001;44(2):159–82.
NIH Consens State Sci Statements. 2002; 19(3):1–46.
Robertson B, Myers G, Howard C, Brettin T, Bukh J, Gaschen B, et al. Classification, nomenclature, and database development for hepatitis Cvirus (HCV) and related viruses: proposals for standardization. International Committee on Virus Taxonomy. Arch Virol. 1998;143:2493–503.
Hnatyszyn HJ. Chronic hepatitis C and genotyping: the clinical significance of determining HCV genotypes. Antiviral Ther. 2005;10:1–11.
Arase Y, Kobayashi M, Suzuki F, Suzuki Y, Kawamura Y, Akuta N, et al. Effect of type 2 diabetes on risk for malignancies includes hepatocellular carcinoma in chronic hepatitis C. Hepatology. 2013;57:964–73.
Van der Meer AJ, Veldt BJ, Feld JJ, Wedemeyer H, Dufour JF, Lammert F, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA. 2012;308:2584–93.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatitis C virus infection. J Hepatol. 2011;55:245–64.
Antaki N, Craxi A, Kamal S, Moucari R, Van der Merwe S, Haffar S, et al. The neglected hepatitis C virus genotypes 4, 5, and 6: an international consensus report. Liver Int. 2010;30:342–55.
Poordad F, Dieterich D. Treating hepatitis C: current standard of care and emerging direct-acting antiviral agents. J Viral Hepat. 2012;19:449.
Nguyen MH, Keeffe EB. Prevalence and treatment of hepatitis C virus genotypes 4, 5, and 6. Clin Gastroenterol Hepatol. 2005;3 Suppl 2:S97–101.
Abdel-Razek W, Waked I. Optimal therapy in genotype 4 chronic hepatitis C: finally cured? Liver Int. 2015;35 Suppl 1:27–34.
Gentile I, Borgia F, Buonomo AR, et al. A novel promising therapeutic option against hepatitis C virus: an oral nucleotide NS5B polymerase inhibitor sofosbuvir. Current Med Chem. 2013;20:3733–42.
Hassanein T, Lawitz E, Crespo I, Davis M, DeMicco MP, Nelson DR. Once daily sofosbuvir (GS-7977) plus PEG/RBV: high early response rates are maintained during post-treatment follow-up in treatment-naive patients with HCV genotype 1, 4, and 6 infection in the ATOMIC study. Hepatology. 2012;56:307A.
Rodriguez-Torres M, Lawitz E, Kowdley KV, Nelson DR, Dejesus E, McHutchison JG. Sofosbuvir (GS-7977) plus peginterferon/ribavirin in treatment-naïve patients with HCV genotype 1: a randomized, 28-day, dose-ranging trial. J Hepatol. 2013;58:663–8.
Mathias A, Cornpropst M, Clemons D, Denning J, Symonds WT. No clinically significant pharmacokinetic drug–drug interactions between sofosbuvir (GS-7977) and the immunosuppressants, cyclosporine a or tacrolimus in healthy volunteers. Hepatology. 2012;56:1063A–4.
Murakami E, Tolstykh T, Bao H, Niu C, Steuer HM, Bao D, et al. Mechanism of activation of PSI-7851 and its diastereoisomer PSI-7977. J Biol Chem. 2010;285(45):34337–47.
Lawitz E, Freilich B, Link J, et al. A phase 1, randomized, dose-ranging study of GS-5816, a once-daily NS5A inhibitor, in patients with genotype 1–4 hepatitis C virus. J Viral Hepat. 2015;22:1011–9.
Feld JJ, Jacobson IM, Hézode C, et al. Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection. N Engl J Med. 2015;373(27):2599–607.
J Hepatol. 2015; 63:j 199–236
Abergel A, Asselah T, Metivier S, Kersey K, Jiang D, Mo H, et al. Ledipasvir-sofosbuvir in patients with hepatitis C virus genotype 5 infection: an open-label, multicentre, single-arm, phase 2 study. Lancet Infect Dis. 2016;16(4):459–64. doi:10.1016/S1473-3099(15)00529-0.
Kohli A, Kapoor R, Sims Z, et al. Ledipasvir and sofosbuvir for hepatitis C genotype 4: a proof-of-concept, single-centre, open-label phase 2a cohort study. Lancet Infect Dis. 2015;15(9):1049–54.
Charlton M, Everson GT, Flamm SL, et al. Ledipasvir and sofosbuvir plus ribavirin for treatment of HCV infection in patients with advanced liver disease. Gastroenterology. 2015;149(3):649–59 (Limited regimens are available for patients with decompensated liver disease, results of this study showed high efficacy for the use of Sofosbuvir/Ledipasvir in this type of patients.).
Poordad F et al. Daclatasvir with sofosbuvir and ribavirin for hepatitis C virus infection with advanced cirrhosis or post-liver transplantation recurrence. Hepatology. 2016;63(5):1493–505. doi:10.1002/hep.28446.
V. De Ledinghen, et al. Safety and efficacy of sofosbuvir-containing regimens in the French observational cohort ANRS CO22 HEPATHER. 2015; 62:631–2
Lawitz E, Sulkowski MS, Ghalib R, Rodriguez-Torres M, Younossi ZM, Corregidor A, et al. Simeprevir plus sofosbuvir, with or without ribavirin, to treat chronic infection with hepatitis C virus genotype 1 in non-responders to pegylated interferon and ribavirin and treatment-naive patients: the COSMOS randomised study. Lancet. 2014;384:1756–65.
El-Khayat HR, Fouad YM, Maher M, El-Amin H, Muhammed H. Efficacy and safety of sofosbuvir plus simeprevir therapy in Egyptian patients with chronic hepatitis C: a real-world experience. Gut. 2016. doi:10.1136/gutjnl-2016-312012. Sofosbuvir/Simeprevir, despite still being not FDA approved for genotype 4, results shown hold promising success rate.
Hanno A, Elwazzan D, Ibrahim M, Hafez R. A real life study on treatment of Egyptian patients with HCV genotype IV with simeprevir and sofosbuvir. Health. 2016;8:780–6. Sofosbuvir/Simeprevir, despite still being not FDA approved for genotype 4, results shown hold promising success rate.
Carrion AF, Gutierrez J, Martin P. New antiviral agents for the treatment of hepatitis C:ABT-450. Expert Opin Pharmacother. 2014;15:711–6.
Hezode C, Asselah T, Reddy KR, Hassanein T, Berenguer M, Fleischer-Stepniewska K, Marcellin P, et al. Ombitasvir plus paritaprevir plus ritonavir with or without ribavirin in treatment-naive and treatment-experienced patients with genotype 4 chronic hepatitis C virus infection (PEARL-I): a randomised, open-label trial. Lancet 2015.
Asselah T, Hassanien T, Qaqish RB, et al. P1345: A randomized, open-label study to evaluate efficacy and safety of ombitasvir/paritaprevir/ritonavir co-administered with ribavirin in adults with genotype 4 chronic hepatitis C infection and cirrhosis. Journal of Hepatology. 2015;62:S861.
Esmat GE, Shiha G, et al. Ombitasvir, paritaprevir and ritonavir plus ribavirin for chronic hepatitis C virus genotype 4 infection in Egyptian patients with or withour compensated cirrhosis (AGATE-II) a multicentre, phase 3, partly randomized open-label trial. The Lancet. 2016;1(1):36–44.
Keating GM. Elbasvir/grazoprevir: first global approval. Drugs. 2016;76(5):617–24. doi:10.1007/s40265-016-0558-3.
Asselah T, Hendrick W, Reesink, et al. High efficacy of elbasvir and grazoprevir with or without ribavirin in 103 treatment-naïve and experienced patients with HCV genotype 4 infection: a pooled analysis. 66th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). 2015; San Francisco, CA
Zeuzem S, Ghalib R, Reddy KR, Pockros PJ, Ari ZB, Zhao Y, et al. Grazoprevir-elbasvir combination therapy for treatment-naive cirrhotic and noncirrhotic patients with chronic hepatitis C virus genotype 1, 4, or 6 infection: a randomized trial. Ann Intern Med. 2015;163(1):1–13. doi:10.7326/M15-0785.
Smuts HE, Kannemeyer J. Genotyping of hepatitis C virus in South Africa. J Clin Microbiol. 1995;33:1679–81.
Mellor J, Walsh EA, Prescott LE, Jarvis LM, Davidson F, Yap PL, et al. Survey of type 6 group variants of hepatitis C virus in Southeast Asia by using a core-based genotyping assay. J Clin Microbiol. 1996;34(2):417–23.
Wong KA, Worth A, Martin R, et al. Characterization of hepatitis C virus resistance from a multiple-dose clinical trial of the novel NS5A inhibitor GS-5885. Antimicrob Agents Chemother. 2013;57(12):6333–40.
Kohler JJ, Nettles JH, Amblard F, et al. Approaches to hepatitis C treatment and cure using NS5A inhibitors. Infect Drug Resist. 2014;7:41–56.
Hyland RH, An D, Svarovskaia E, Pang PS, Brainard D, Stedman CA. Efficacy of ledipasvir and sofosbuvir, with or without ribavirin, for 12 weeks in patients with HCV genotype 3 or 6 infection. 2015;149:1454–61.
Brown A, Hezode C, Zuckerman E et al. C-SCAPE: Efficacy and safety of 12 weeks of grazoprevir +/− elbasvir +/_ ribavirin in patients with HCV GT2, 4, 5 or 6 infection [Abstract #P0771]. 50th Annual Meeting of the European Association for the Study of the Liver (EASL). April 22–26, 2015; Vienna, Austria.
G Esmat, M El Raziky, A Gomaa, et al. High virologic response rate in Egyptian HCV-geno- type 4 patients treated with ravidasvir (PPI-668) and sofosbuvir: results of a large multicenter phase 3 registrational trial. AASLD Liver Meeting. San Francisco, November 13–17, 2015. Abstract LB-4.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Dr. Mohamed B. Hashem, Dr. Tamer Elbaz, Dr. Mohamed El-kassas, and Dr. Gamal Esmat declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
With regard to the authors’ research cited in this paper, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. In addition, all applicable international, national, and/or institutional guidelines for the care and use of animals were followed.
Additional information
This article is part of the Topical Collection on Hepatitis C
Rights and permissions
About this article
Cite this article
Hashem, M.B., Elbaz, T., El-kassas, M. et al. Management of Hepatitis C Virus—Genotypes 4, 5, and 6 Using Direct Antiviral Agents: Review of Current Status. Curr Treat Options Infect Dis 8, 368–378 (2016). https://doi.org/10.1007/s40506-016-0094-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40506-016-0094-4