The natural history and long-term outcomes in patients with chronic hepatitis C genotype 4 after interferon-based therapy

Background & Aims: Hepatitis C virus (HCV) genotype 4 (G4) infection iscommon in the Middle East. Post-treatment long-term outcomes have notbeen reported in these patients. This study evaluates these outcomes inpatients after interferon-based therapy. Patients and methods: A total of 157patients were followed from June 2001 to February 2012. Descriptive andanalytical statistics, cumulative outcomes and the independent predictors ofdisease progression were calculated. Results: The overall age was48.0 ± 11.8 years, 75 (47.8%) were males and 53 (70.7%) of 75 who weregenotyped had G4. The follow-up period was 63.8 ± 32.8 months. Sustainedvirological response (SVR) was achieved in 62 (39.5%) and 24 (45.3%)patients in the whole group and the G4 subgroup respectively. Among thewhole cohort and the G4 subgroup, disease progressed in 59 (37.6%) and 21(39.6%), respectively, with less progression in the SVR groups; 15/62(24.2%) and 3/24 (12.5%) compared with non-responders; 44 (46.3%) and18 (62.1%) with P = 0.01 and 0.001 respectively. Multivariate logistic regres-sion analysis showed that having diabetes mellitus (P = 0.03), higher baselineAPRI score (P = 0.00) and non-SVR (P = 0.00) were independent predictorsof disease progression. G4 patients showed similar results, but ‘non-SVR’(P = 0.00) was the only independent predictor of progression. Eight patientsdied and four developed HCC all among the non-SVR group only. Conclu-sions: This study describes, for the first time, the natural history and demon-strates the beneficial long-term effects of interferon-based therapy in HCVG4 patients.Hepatitis C virus (HCV) infects approximately 170 mil-lion people and is a major cause of chronic hepatitis,cirrhosis and hepatocellular carcinoma (HCC). The nat-ural history of HCV infection has been the subject ofseveral studies, reviews and editorials worldwide (1–9).The most widely quoted important studies were the EastGermany and Irish cohort studies, where patients wereinfected in the eighties by contaminated RH immuneglobulin (10). They were followed for 20 years and itwas found that 49% recovered spontaneously whereasonly one patient (3%) developed cirrhosis. However,comorbid conditions like diabetes mellitus (DM), obes-ity, alcohol intake and infection after the age of 40increased chances of developing advanced liver disease.A large meta-analysis estimated the progression ofchronic hepatitis C infection to cirrhosis to be in therange 4–12% after 20 years of infection (7). On theother hand, the natural history of chronic hepatitis Cinfection has been affected markedly by interferon treat-ment over the last two decades (11–16).