Abstract
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 started to cross borders and spread to several regions in Europe through immigration and injecting drug use. HCV‐4 has been considered a difficult‐to‐treat genotype based on the low SVR rates achieved with conventional interferon‐based regimen. Pegylated interferons (Peg‐IFN) plus ribavirin therapy for chronic hepatitis C genotype 4 was associated with higher sustained virologic response rates that exceeded 60%. Shorter treatment of chronic HCV‐4 patients with rapid and early virologic responses has been associated with high SVR rates, better compliance, fewer adverse events. and lower costs. Despite this progress, treatment of HCV‐4 non‐responders, injecting drug users, patients co‐infected with HIV, thalassemic patients, patients on hemodialysis, and patients with HCV‐4 recurrence after liver transplantation still represents significant therapeutic challenge. In conclusion, therapy of HCV‐4 has shown marked improvement with higher sustained response rates and possibilities for shorter duration. Despite the recent progress in the treatment of hepatitis C genotype 4, more research is required to optimize current therapy and include genotype 4 in clinical trials on emerging therapies such as specifically targeted antiviral therapy for HCV (STAT‐C) such as protease and/or polymerase inhibitors.