Treatment Options for HCV Genotype-4

For the last three decades, HCV infection had been a challenging health problem due to high prevalence rate, fatal complications and till recently the lack of effective treatment. In the pre directly acting agents (DAAs) era, the interferon-ribavirin based treatment was of limited success in the clearance of the virus compounded by major side effects that caused significant morbidity and poor quality of life lasting several months based on the long duration of treatment. Patients with advanced hepatic fibrosis responded poorly to treatment and were far more susceptible to the side effects which at times proved fatal. The new DAAs with their high potency, tolerability and relative short duration of treatment are transforming the landscape of HCV management. The potential of HCV eradication over the coming decades has become a feasible target in many parts of the world. HCV genotype has always been an important predictor of response and an essential determinant for the duration of treatment. Genotype-4 is the predominant genotype in the Middle East particularly Egypt and Gulf region. Clinical trials on genotype-4 are limited especially in the era of directly acting antiviral agents. This review summarizes the treatment options for HCV genotype-4 infection based on available evidence and international HCV treatment guidelines.