Journal of Antivirals & Antiretrovirals
Open Access
ISSN: 1948-5964
ISSN: 1948-5964
Savvoula Savvidou, Dimitrios Chrysagis, George V Papatheodoridis, Spilios Manolakopoulos, Christos Triantos and John Goulis
Background: Prevalence of genotype 4 chronic hepatitis C is increasing in western countries, where response to current combination treatment is still in debate; reports from endemic areas of Middle East show favourable treatment outcomes, while European reports show the contrary. Aim of this retrospective study was to estimate sustained virological response (SVR) of genotype 4 HCV patients in Greece, and to examine possible differences in SVR determinants between genotypes 1 and 4, the two most difficult genotypes to treat.
Methods: Demographic, virological and histological data from 467 consecutive HCV patients from five centers of follow-up were recorded. All patients completed standard combination therapy with pegylated interferon alpha plus weight-based ribavirin, according to current guidelines.
Results: Genotype distribution was: 192(44.8%), 29(6.8%), 130(30.4%), 63(14.7%) and 14(3.3%) for 1, 2, 3, 4 and undefined genotypes, respectively. Baseline characteristics were: 245(57.2%) male, aged 44.8 ± 13.8 years-old, 422(98.6%) white Caucasians, 124(29%) former intravenous drug users, 49(12%) past alcohol abusers, 240(51.5%) overweight and 357(87.7%) naïve. Liver biopsy revealed advanced fibrosis in 58(15.1%) and hepatic steatosis in 133(35.6%) patients. Age (OR 2.1, p=0.007), genotype (OR 3.4, p<0.001), advanced fibrosis (OR 2.9, p=0.003) and naïve status (OR 0.3, p<0.001) were independent prognostic factors for non-response. Comparison between genotype 4 and 1 revealed significant differences in SVR (39.7% vs. 62%, Fisher’s exact test, p=0.002). No difference related to any of the demographic, virological or histological variable was able to explain the difference in treatment response.
Conclusion: Genotype 4 chronic hepatitis C in Greece has the worst prognosis in achieving SVR using current combination treatment for 48 weeks. These results challenge the notion, mainly from non-european studies, of a favorable response of genotype 4 compared to genotype 1. Further studies addressing the efficacy of the newer antivirals on the “difficult to treat” genotype 4 should be investigated in the future.