Treatment of Chronic Hepatitis C Genotype 4 with Peginterferon alpha-2a plus Ribavirin

Background/Aim: Peginterferon plus ribavirin is the treatment of choice for chronic hepatitis C (HCV). HCV genotype 4 is considered difficult to treat and data regarding the efficacy of antiviral therapy for this genotype are scanty. The aim of the study was to asses the efficacy and tolerability of fixed dose peginterferon alpha 2a plus ribavirin for the treatment of HCV genotype 4. Methodology: A prospective open label study was done on 30 middle eastern treatment naive chronic hepatitis C patients. They were treated with 180 mcg of peginterferon alpha 2a subcutaneous weekly plus oral ribavirin of 1200 mg daily if body weight > 75 kg. The treatment was continued for 48 weeks and patients were followed up for 24 weeks post-treatment. The early and sustained virological responses were were defined as the absence of HCV RNA from serum at 12 weeks and 72 weeks respectively. The data was analyzed on an intention to treat basis. Results: The early and sustained virological responses were 83.3% and 63.3% respectively. The EVR in patients with minimal or absent fibrosis (96.6%). The SVR in patients with BMI=/>25 (81.8%) were not significantly different from those of patients with BMI < 25 (87.5%) even with the fixed dose peginterferon. Conclusion: Peginterferon alpha 2a in combination with ribavirin is effective in the treatment of HCV genotype 4 and treatment response is intermediate between that of genotype 1 and genotype 2 or 3.