Genotype 4

[Boobert]

Hello Everyone, I've been reading and not posting since I joined this forum.I was diagnosed in 2002 with HCV Genotype 4 stage 1 grade 2. As of yet I have chosen not to treat, I do take Milk Thistle,Selenium,NAC, and some others. I have had 2 Biopsies the first 2002 which was stage 1-2 grade 2 and then again in 2007 which showed stage 1 grade 1. It actually improved, my GI was never a believer in herbs and such but over the years with all my test results getting better and better has since recommended milk thistle and others to his other patients, Anyways my genotype being 4 does anybody know anything about it{how does it treat] or anything. This is 1 heck of a good forum and I'm so glad I found it.

[portann]

I also took a phone call and both Bill and Apache beat me to it. Here's an old study that may lead you to more recent ones by these authors:

Hepatitis C genotype 4: What we know and what we don't yet know
Sanaa M. Kamal 1 2 *, Imad A. Nasser 1 2
1Department of Gastroenterology and Liver Disease, Ain Shams Faculty of Medicine, Cairo, Egypt
2BIDMC, Boston, MA

email: Sanaa M. Kamal (Sanaa.***@****)

*Correspondence to Sanaa M. Kamal, Ain Shams Faculty of Medicine, 22 Al Ahram Street, Roxy, Heliopolis, Cairo, Egypt

Potential conflict of interest: Nothing to report.

Abstract
Hepatitis C virus genotype 4 (HCV-4) is the most common variant of the hepatitis C virus (HCV) in the Middle East and Africa, particularly Egypt. This region has the highest prevelance of HCV worldwide, with more than 90% of infections due to genotype 4. HCV-4 has recently spread in several Western countries, particularly in Europe, due to variations in population structure, immigration, and routes of transmission. The features of HCV-4 infection and the appropriate therapeutic regimen have not been well characterized. This review discusses the virology, epidemiology, natural history, histology, clinical data, and treatment options for patients with HCV-4 infections. Early reports on the treatment of patients with chronic HCV-4 with conventional interferon (IFN)- monotherapy indicated poor rates of sustained viral response (SVR), which improved slightly when combined with ribavirin. Pegylated IFN and ribavirin combination therapy has dramatically improved the response rates, with recent clinical trials showing rates that exceed 60%. These data can now be used as a platform for further research to define optimal treatment duration and predictors of SVR in patients with HCV-4 infection. Conclusion: HCV-4 infection is spreading beyond its strongholds in Africa and the Middle East. Recent clinical trials show that HCV-4 is not difficult to treat, as the response to treatment may be at an intermediate level compared with genotype 1 and genotypes 2 or 3. Tailored treatment options that are comparable to the treatment approaches for genotype 1, 2, and 3 patients to optimize treatment for each patient are now being developed. (HEPATOLOGY 2008.)

http://www3.interscience.wiley.com/journal/117901669/abstract?CRETRY=1&SRETRY=0

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As for treating, and given the relatively good profile you have, I personally would wait for newer protocols. These will add protease and/or polymerase inhibitors to the current therapy, increase your chance of treatment success and very likely shorten your treatment time.   They should be available outside trials by 2011 or 2012.

[apache1]

Bill, you beat me to it, lol. Took a phone call at the office and then finished my post.

Sorry did not mean to be repetitive.

apache

[apache1]

Since genotype 4 is mostly found in Egypt and the mid east, most here do not know a lot about it.  G4 is considered similar to G1 for treatment.
G4 soc is 48 wks peg interferon ribaivirin therapy, with the same tx guidelines as G1

One Alina study was done on a large number of G4 patients in Egypt, with great success.

Some studies do say it is easier to treat than G1 and responds better to INF therapy. Many studies put G4 in the middle between G2,G3 and G1, for ease of treatment success.

At stage 1-2 consulate with your Dr about maybe waiting for the new PI drugs to come next year. The cure success rate is higher for these new drugs now in clinical trials. Also treating duration could be shorter with the new PI hcv drugs.

good luck, jmo
apache

[Boobert]

Thank you Bill for the Welcome and words. Unfortunetly I'm not treating at this time because of chronic fatigue. I don't know how much more I can take, but right now I'm watching my labs I'll have another byopsy in 2012{ every 5 years} and with the new Meds coming out in a few years I'll probably treat. I Want this Dragon off my back. I'm a recovering alcoholic and drug abusing[sobor 7 1/2 years] but have had this virus for over 20 years. Thank you for your comments.

[Bill1954]

Perhaps you won’t progress and might be able to avoid treatment altogether? Good luck to you on that front!

If you do eventually choose to treat, my understanding is that GT-4 responds more poorly to interferon than GT-2 and 3, but better than GT-1. I believe it is treated with the same protocol as genotype 1, but is somewhat more responsive. You probably already know that it isn’t studied as thoroughly as the other more common genotypes; although there has been quite a bit of data coming out of Egypt, where I understand it is endemic.

Have you looked at the HIV and Hep C site? This should link you to some GT-4 info; be sure to bookmark the HCV section of this site for future reference:

http://tinyurl.com/ksnfpq

Welcome to the discussion group and good luck—

Bill