title: The neglected hepatitis C virus genotypes 4, 5 and 6: an international consensus report.
abstract: Abstract Hepatitis C virus (HCV) genotypes 4, 5 and 6 represent >20% of all HCV cases worldwide. HCV-4 is mainly seen in Egypt, where it represents 90% of all HCV cases. Antischistosomal therapy was the main cause of contamination there, followed by procedures performed by informal providers and traditional healers such as dental care, wound treatment, circumcision, deliveries, excision and scarification. It is also highly prevalent in sub-Saharan Africa and in the Middle East. In Europe, its prevalence has recently increased particularly among intravenous drug users and in immigrants. HCV-5 is mainly found in South Africa, where it represents 40% of all HCV genotypes, but four pockets of HCV-5 were found in France, Spain, Syria and Belgium and sporadic cases were found elsewhere. The mode of transmission is mainly iatrogenic and transfusion. HCV-6 is found in Hong Kong, Vietnam, Thailand and Myanmar and also in American and Australian from Asian origin. The response to treatment in HCV-4 is intermediate between HCV-1 and HCV-2 and HCV-3. A sustained viral response is achieved in 43-70% with pegylated interferon and ribavirin. It is higher in Egyptians than Europeans and Africans and is negatively related to insulin resistance and to the severity of fibrosis. It increases to >80% with 24 weeks of therapy only if a rapid virological response is achieved. In HCV-5, a sustained virological response is achieved in >60% with 48 weeks of therapy. HCV-6 is also considered an easy-to-treat genotype, leading to a response in 60-85% of cases.
authors.affiliation: Department of Gastroenterology and Hepatology, Saint Louis Hospital, Aleppo, Syria. antaki@scs-net.org
authors.forename: Nabil
authors.initials: N
authors.lastname: Antaki
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxi
authors.forename: Sanaa
authors.initials: S
authors.lastname: Kamal
authors.forename: Rami
authors.initials: R
authors.lastname: Moucari
authors.forename: Schalk
authors.initials: S
authors.lastname: Van der Merwe
authors.forename: Samir
authors.initials: S
authors.lastname: Haffar
authors.forename: Adrian
authors.initials: A
authors.lastname: Gadano
authors.forename: Nizar
authors.initials: N
authors.lastname: Zein
authors.forename: Ching Lung
authors.initials: CL
authors.lastname: Lai
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Pawlotsky
authors.forename: E Jenny
authors.initials: EJ
authors.lastname: Heathcote
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dusheiko
authors.forename: Patrick
authors.initials: P
authors.lastname: Marcellin
mesh_terms: D005838:Genotype; D016174:Hepacivirus / Q000145:classification / Q000235:genetics*; D006526:Hepatitis C / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D015995:Prevalence