title: The natural history and long-term outcomes in patients with chronic hepatitis C genotype 4 after interferon-based therapy.
abstract: OBJECTIVE
  Hepatitis C virus (HCV) genotype 4 (G4) infection is common in the Middle East. Post-treatment long-term outcomes have not been reported in these patients. This study evaluates these outcomes in patients after interferon-based therapy.
  
  
  METHODS
  A total of 157 patients were followed from June 2001 to February 2012. Descriptive and analytical statistics, cumulative outcomes and the independent predictors of disease progression were calculated.
  
  
  RESULTS
  The overall age was 48.0 ± 11.8 years, 75 (47.8%) were males and 53 (70.7%) of 75 who were genotyped had G4. The follow-up period was 63.8 ± 32.8 months. Sustained virological response (SVR) was achieved in 62 (39.5%) and 24 (45.3%) patients in the whole group and the G4 subgroup respectively. Among the whole 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%) and 18 (62.1%) with P = 0.01 and 0.001 respectively. Multivariate logistic regression analysis showed that having diabetes mellitus (P = 0.03), higher baseline APRI score (P = 0.00) and non-SVR (P = 0.00) were independent predictors of disease progression. G4 patients showed similar results, but 'non-SVR' (P = 0.00) was the only independent predictor of progression. Eight patients died and four developed HCC all among the non-SVR group only.
  
  
  CONCLUSIONS
  This study describes, for the first time, the natural history and demonstrates the beneficial long-term effects of interferon-based therapy in HCV G4 patients.
authors.affiliation: Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia. f_alfaleh@hotmail.com
authors.forename: Faleh Z
authors.initials: FZ
authors.lastname: Alfaleh
authors.forename: Khalid
authors.initials: K
authors.lastname: Alswat
authors.forename: Ahmed
authors.initials: A
authors.lastname: Helmy
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-hamoudi
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-sharkawy
authors.forename: Mohanned
authors.initials: M
authors.lastname: Omar
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shalaby
authors.forename: Mohaned A
authors.initials: MA
authors.lastname: Bedewi
authors.forename: Qais
authors.initials: Q
authors.lastname: Hadad
authors.forename: Safiyya M
authors.initials: SM
authors.lastname: Ali
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alfaleh
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Abdo
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010641:Phenotype; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D012367:RNA, Viral; D012254:Ribavirin; D007372:Interferons