title: Genotype 4 HCV infection is difficult to cure with pegylated interferon and ribavirin. Results from a Greek Nationwide Cohort Study.
abstract: OBJECTIVE
  Patients with genotype 4 (G4) chronic hepatitis C (CHC) are considered a difficult to treat population, although current data on G4 treatment responsiveness and duration are controversial. Greece represents a country with an intermediate prevalence of G4 infections, offering an opportunity to compare treatment outcomes by genotype and to identify potential prognostic factors for sustained virologic response (SVR).
  
  
  METHODS
  All CHC patients from the HepNet.Greece, an ongoing nationwide cohort study on viral hepatitis, with known hepatitis C virus (HCV) genotype who received treatment with Peg-IFNa and ribavirin were analyzed.
  
  
  RESULTS
  From 4443 patients, 951 (61.7% males, 78.4% Greeks, median age 40.6 years, 10% cirrhosis) fulfilled the inclusion criteria. G4 was found in 125 (13.1%) patients. Genotype distribution was not significantly different between Greeks and immigrants. Patients with G4 had similar odds of SVR compared to G1 but significantly lower compared to G2/G3. Age, treatment discontinuation, presence of cirrhosis and previous history of HCV-treatment were associated with lower probabilities of SVR. Ethnicity did not affect SVR for all genotypes while response to treatment was similar between Greek and Egyptian patients groups (35.7% vs 40.9%, p=0.660%) with G4 infection. The relation between SVR and genotype did not substantially change after adjustment for age, gender, cirrhosis, treatment interruption and history of HCV-treatment.
  
  
  CONCLUSIONS
  The findings of this large cohort of CHC patients with a well balanced genotype distribution further supports the idea of considering G4 as a difficult to treat genotype. Further investigation is needed to identify genotype specific prognostic factors.
authors.affiliation: Department of Hygiene, Epidemiology & Medical Statistics, Athens University Medical School, Athens, Greece.
authors.forename: O
authors.initials: O
authors.lastname: Anagnostou
authors.affiliation: 2 Academic Department of Medicine, Hippokration General Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Manolakopoulos
authors.affiliation: Department of Hygiene, Epidemiology & Medical Statistics, Athens University Medical School, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Bakoyannis
authors.affiliation: 2 Academic Department of Medicine, Hippokration General Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Papatheodoridis
authors.affiliation: Office of Viral Hepatitis, Hellenic Center for Disease Control and Prevention, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Zisouli
authors.affiliation: 2nd Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Raptopoulou-Gigi
authors.affiliation: Division of Internal Medicine, Athens University Medical School, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Manesis
authors.affiliation: State Department of Internal Medicine, Hippokration General Hospital, Athens, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Ketikoglou
authors.affiliation: Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Dalekos
authors.affiliation: 1 Department of Internal Medicine, University of Patras, Medical School, Rio, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Gogos
authors.affiliation: 1 Propaedeutic Clinic of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: T
authors.initials: T
authors.lastname: Vassiliadis
authors.affiliation: Department of Gastroenterology, Polyclinic General Hospital, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Tzourmakliotis
authors.affiliation: Department of Internal Medicine, General Hospital of Rhodos, Rhodos, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Karatapanis
authors.affiliation: 1 Department of Internal Medicine, Red Cross Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Kanatakis
authors.affiliation: 1 Department of Propaedeutic Medicine, Athens University Medical School, ''Laiko'' Hospital, Athens, Greece.
authors.forename: -
authors.initials: -
authors.lastname: Zoumpoulis
authors.affiliation: 4 Department of Internal Medicine, General University Hospital "Attikon", Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Hounta
authors.affiliation: Hepatology Service, Foundation of Social Insurance (IKA), Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Koutsounas
authors.affiliation: 2 Department of Internal Medicine, Tzaneio Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Giannoulis
authors.affiliation: 1 Department of Internal Medicine, Western Attica General Hospital, Athens, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Tassopoulos
authors.affiliation: Department of Hygiene, Epidemiology & Medical Statistics, Athens University Medical School, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Touloumi
keywords: HCV treatment; Viral hepatitis; interferon; pegylated-interferon