Chronic hepatitis C. Genotypes and response to anti-viral therapy among Saudi patients.

Objective: The aim of this study is to compare the response of hepatitis C virus (HCV) genotype 4 with other genotypes to anti-viral treatment among Saudi patients in a prospective randomized trial.

Methods: The study was conducted in the Department of Hepatobiliary Sciences at King Abdul-Aziz Medical City, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia from March 1997 to January 2000. Sixty-two patients (33 males and 29 females) aged > or =18 with chronic hepatitis C not treated previously were tested for HCV genotype and randomly assigned to receive interferon (IFN) alfa 2b 3 million units 3 times per week alone or in combination with ribavirin 1000-1200 mg orally per day for 48 weeks. All patients were monitored for safety and efficacy of the therapy at 4 week intervals during treatment and followed up for at least 24 weeks after completion of treatment. The primary end point was loss of detectable HCV-RNA 24 weeks after treatment completion, defined as sustained virological response (SVR).

Results: Hepatitis C virus genotype 4 was seen among (64.5%) HCV Saudi patients. Hepatitis C virus genotype 1 was the next most common (30.6%). A SVR of 42.8% (9 out of 21) was seen in HCV genotype 4 and 40% (4 out of 10) among other HCV genotypes with combination therapy of IFN and ribavirin (p>0.1). With IFN alone the sustained response rate was 15.7% for genotype 4 and 16.6% for other genotypes mainly genotype 1 (p>0.1).

Conclusion: We concluded that HCV genotype 4 is the most prevalent genotype among HCV infected Saudi patients. Genotype 1 was the next most common while genotypes 2, 3 and 5 were least prevalent. There is no statistically significant difference in response rate of patients with HCV genotype 4 to either IFN alone or IFN plus ribavirin when compared with genotype 1 of HCV.