Treatment of Chronic Hepatitis C, Genotype 4
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- Ferenci, P. Curr Hepatitis Rep (2013) 12: 246. doi:10.1007/s11901-013-0178-2
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HCV-genotype 4 is the predominant genotype in patients in North-East (especially in Egypt and Lybia) and Sub-Saharan Africa and in most Middle Eastern countries and is spread by migration and IVDU to Europe in the last years. Current treatment consists of peginterferon-alfa2 plus ribavirin (Peg/RBV) combination therapy using a response guided approach with sustained virologic response (SVR) rates about 60 %. Combination of Peg/RBV with drugs like nitazoxanide or silibinin appear to improve SVR rates, but they were not systematically studied. The first generation protease inhibitors have no activity in genotype 4 patients. In contrast, the second wave protease inhibitors (simeprevir, faldaprevir, r-danoprevir) and the NS5B NUC polymerase inhibitor Sofosbuvir are potent inhibitors of HCV replication, but have not been explored in phase 3 trials. Hopefully these drugs will become available for these patients.