A European single centre experience of management of hepatitis C virus genotype 4 infection with pegylated-interferon and ribavirin

New direct acting antiviral agents are revolutionising hepatitis C virus (HCV) treatment. However, to date limited clinical trial data exists for outcomes in genotype 4 (GT4) HCV patients. GT4 HCV is more common in Africa, the Middle East, and Asia, and limited data exists to date for outcomes in Europe. We report the first real-life sustained virological response (SVR) outcomes using pegylated interferon and ribavirin for HCV GT4 in the UK, and the largest European single centre cohort. HCV GT4 patients treated at a London, UK centre between 2002 and 2014 were assessed for SVR outcomes. Patient age, sex, region of origin, co-infection with HIV, pre-treatment liver biopsy histological assessment, genotype subtyping, treatment duration, and dose reductions were compared against SVR outcomes on univariate analysis. Multivariate analysis was performed on results with P<0.1. A total of 118 patients were treated with HCV GT4 during the study period, 57 achieved SVR (48%). On univariate analysis age 45 (P<0.0001), high viral load (P<0.0001), Ishak staging 5-6 (P<0.0001), and non-Egyptian Africans (P=0.0059) were all negatively associated with SVR. Eastern Europeans appeared to have higher SVR (P<0.0001). Using multivariate correlation viral load (P=0.0005); Ishak staging (P=0.0031) and age (P=0.0003) were associated with SVR but not country of origin (P=0.0645). Outcomes with pegylated interferon and ribavirin for HCV GT4 in this real-life setting were sub-optimal especially in the context of newer regimens. Patients with older age, high viral loads, and advanced disease need prioritisation for alternative treatments. J. Med. Virol. 87:1716-1721, 2015. (c) 2015 Wiley Periodicals, Inc.