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Hepatitis C virus genotype 4 therapy: progress and challenges

The hepatitis C virus genotype 4 (HCV‐4) is prevalent in Egypt, the Middle East and Africa. Recently, the epidemiology of HCV‐4 has changed and this genotype has begun to cross borders and spread to several regions in Europe through immigration and injection drug use. HCV‐4 has been considered a difficult‐to‐treat genotype based on the low sustained virological response (SVR) rates obtained with conventional interferon (IFN)‐based regimens. Pegylated interferons (PEG‐IFN) plus ribavirin therapy for chronic HCV‐4 has been associated with increased SVR rates of more than 60%. Shorter treatment of chronic HCV‐4 patients with rapid and early virological responses has been associated with high SVR rates, better compliance, fewer adverse events and lower costs. Despite this progress, the treatment of HCV‐4 non‐responders, injection drug users, patients coinfected with human immunodeficiency virus, thalassaemic patients, patients on haemodialysis and patients with HCV‐4 recurrence after liver transplantation still represents a significant therapeutic challenge. Treatment of HCV‐4 has markedly improved, with higher sustained response rates and the possibility of shorter regimens. Despite the recent progress in the treatment of HCV‐4, more research is required to optimize current therapy and include genotype 4 patients in clinical trials on emerging therapies such as specifically targeted antiviral therapy for HCV with protease and/or polymerase inhibitors.