Optimism for patients with genotype 4 HCV infection: clinical trials with direct-acting antivirals finally available.

Among the 170 million HCV-infected subjects worldwide (around 34 million) HCV-G4 accounts for approximately 20% of those infected. This population accounts for most new infections, with limited access to therapy. While in the US HCV-G4 is responsible for 1–2% of HCV infection, in the Middle East and Sub-Saharan African regions it is the main cause of HCV infection, with Southern Europe also detecting an increase in cases [4]. However, only limited country-specific estimates of HCV prevalence are available to guide decision making treatments. In Egypt, where the prevalence of HCV is the highest in the world, the reuse of glass syringes during the parenteral therapy campaigns to control endemic schistosomiasis is widely held to be responsible for a large number of iatrogenic transmissions [5]. HCV-G4 has been considered ‘‘difficult to treat’’ with pegylated interferon (PegIFN) and ribavirin (RBV) treatment, with sustained virological response (SVR) rates around 50%. A major predictor of response to PegIFN-RBV therapy in patients with HCV-G4 was the IL28B genotype [6]. SVR rates for IL28B rs12979860 CC patients