Epidemiological Characteristics and Response to Hepatitis C Treatment
Epidemiological Characteristics and Response to Hepatitis C Treatment
Summary: Hepatitis C virus genotype 4 (HCV-4) infection is progressing in Europe, where epidemiology and sustained virological response (SVR) seem to be different than in the Middle East. We analysed epidemiological features and SVR rates in a retrospective study of 1532 HCV-4-infected patients, including 1056 patients infected in France, 227 immigrants infected in Egypt and 249 in sub-Saharan Africa. SVR rates were assessed in 242 naive patients of the 1532, who received peginterferon plus ribavirin for 48 weeks. HCV subtype 4a or 4d was the most common among patients infected in France, where the predominant route of transmission was intravenous drug abuse. The 4a subtype was largely predominant (93%) among patients infected in Egypt, where transmission was mostly because of parenteral treatment for schistosomiasis. More than seven different subtypes and no predominant route of infection were found in patients infected in sub-Saharan Africa. Liver fibrosis was significantly less severe in patients infected in France and Africa than in patients infected in Egypt. SVR rates were higher in patients infected in Egypt, compared with those infected in France or Africa (54.9%, 40.3% and 32.4%, respectively, P < 0.05). An overall better response was observed in patients infected with the 4a subtype. In multivariate analysis, two factors were associated independently with SVR: the Egyptian origin of transmission and the absence of severe fibrosis. In conclusion, the distribution of HCV-4 subtypes varies with the geographical origin of transmission and affects the SVR following antiviral treatment.
Chronic infection with the hepatitis C virus (HCV) afflicts about 170 million individuals worldwide, with 20-30% of infected patients eventually developing cirrhosis and its complications. In low-prevalence areas, such as Europe and North America, the incidence rate of anti-HCV ranges from 0.5% to 1.1%, whereas it reaches more than 20% in high-prevalence areas such as Egypt.
Among the six major HCV genotypes, genotypes 1-4 account for nearly 90% of HCV-infected cases in western countries. HCV genotype 4 (HCV-4) is the most prevalent genotype in the Middle East and sub-Saharan Africa, with a prevalence ranging from 73% to 90% in Egypt. In contrast, HCV-4 infection is rare in western countries, although its prevalence has recently increased to nearly 10% in some European countries, mainly through spreading among intravenous drug (IVD) users. Little epidemiological information concerning HCV-4 infection in Europe is available.
Genotypes are of considerable clinical importance, because they affect response to antiviral therapy. While patients infected with HCV genotypes 2 and 3 respond much better to combination therapy with pegylated interferon alpha (PEG-IFNα) plus ribavirin than those infected with genotype 1, data regarding HCV-4 response rates are limited and controversial. In Egypt and the Middle East, high sustained virological response (SVR) rates (67-70%) have been reported in patients infected with HCV-4 and treated with PEG-IFNα plus ribavirin for 48 weeks. This resembles the rates of patients infected with genotypes 2 and 3. Similar findings have been reported for the subgroup of HCV-4-infected patients (n = 27), included in two international pivotal trials. By contrast, a lower SVR rate (32%) was observed in a recent study where French patients were treated for 48 weeks. Altogether, these results suggest that SVR rates could differ in HCV-4-infected patients according to the geographical origin of the infection.
The aims of the present observational study were to examine epidemiological and liver histological features in a large series of patients referred to French hospitals and infected by HCV-4 in France, Egypt or sub-Saharan Africa, and to assess the SVR rate in a subgroup of patients treated with PEG-IFNα plus ribavirin.
Abstract and Introduction
Abstract
Summary: Hepatitis C virus genotype 4 (HCV-4) infection is progressing in Europe, where epidemiology and sustained virological response (SVR) seem to be different than in the Middle East. We analysed epidemiological features and SVR rates in a retrospective study of 1532 HCV-4-infected patients, including 1056 patients infected in France, 227 immigrants infected in Egypt and 249 in sub-Saharan Africa. SVR rates were assessed in 242 naive patients of the 1532, who received peginterferon plus ribavirin for 48 weeks. HCV subtype 4a or 4d was the most common among patients infected in France, where the predominant route of transmission was intravenous drug abuse. The 4a subtype was largely predominant (93%) among patients infected in Egypt, where transmission was mostly because of parenteral treatment for schistosomiasis. More than seven different subtypes and no predominant route of infection were found in patients infected in sub-Saharan Africa. Liver fibrosis was significantly less severe in patients infected in France and Africa than in patients infected in Egypt. SVR rates were higher in patients infected in Egypt, compared with those infected in France or Africa (54.9%, 40.3% and 32.4%, respectively, P < 0.05). An overall better response was observed in patients infected with the 4a subtype. In multivariate analysis, two factors were associated independently with SVR: the Egyptian origin of transmission and the absence of severe fibrosis. In conclusion, the distribution of HCV-4 subtypes varies with the geographical origin of transmission and affects the SVR following antiviral treatment.
Introduction
Chronic infection with the hepatitis C virus (HCV) afflicts about 170 million individuals worldwide, with 20-30% of infected patients eventually developing cirrhosis and its complications. In low-prevalence areas, such as Europe and North America, the incidence rate of anti-HCV ranges from 0.5% to 1.1%, whereas it reaches more than 20% in high-prevalence areas such as Egypt.
Among the six major HCV genotypes, genotypes 1-4 account for nearly 90% of HCV-infected cases in western countries. HCV genotype 4 (HCV-4) is the most prevalent genotype in the Middle East and sub-Saharan Africa, with a prevalence ranging from 73% to 90% in Egypt. In contrast, HCV-4 infection is rare in western countries, although its prevalence has recently increased to nearly 10% in some European countries, mainly through spreading among intravenous drug (IVD) users. Little epidemiological information concerning HCV-4 infection in Europe is available.
Genotypes are of considerable clinical importance, because they affect response to antiviral therapy. While patients infected with HCV genotypes 2 and 3 respond much better to combination therapy with pegylated interferon alpha (PEG-IFNα) plus ribavirin than those infected with genotype 1, data regarding HCV-4 response rates are limited and controversial. In Egypt and the Middle East, high sustained virological response (SVR) rates (67-70%) have been reported in patients infected with HCV-4 and treated with PEG-IFNα plus ribavirin for 48 weeks. This resembles the rates of patients infected with genotypes 2 and 3. Similar findings have been reported for the subgroup of HCV-4-infected patients (n = 27), included in two international pivotal trials. By contrast, a lower SVR rate (32%) was observed in a recent study where French patients were treated for 48 weeks. Altogether, these results suggest that SVR rates could differ in HCV-4-infected patients according to the geographical origin of the infection.
The aims of the present observational study were to examine epidemiological and liver histological features in a large series of patients referred to French hospitals and infected by HCV-4 in France, Egypt or sub-Saharan Africa, and to assess the SVR rate in a subgroup of patients treated with PEG-IFNα plus ribavirin.
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