title: Re-treatment of patients with chronic hepatitis C virus genotype 4 infection with pegylated interferon and ribavirin: a meta-analysis.
abstract: BACKGROUND
  An estimated 170 million people worldwide are infected with hepatitis C virus (HCV). HCV genotype 4 (HCV-4)-the most prevalent hepatitis C strain in the Middle East and Africa-is difficult to treat, with an estimated sustained virological response (SVR) of 53% when using pegylated interferon and ribavirin (P/R) in treatment-naïve patients with HCV-4 infection. In regions where access to direct-acting antivirals is limited, re-treatment of patients who failed therapy with another course of P/R may be an option if the success rate is acceptable.
  
  
  OBJECTIVE
  We aimed to determine the SVR from retreatment with P/R in treatment-experienced patients with HCV-4 infection.
  
  
  METHODS
  We performed a meta-analysis using MEDLINE and EMBASE searches, and by reviewing article bibliographies and abstracts from recent Liver Society Meetings. Original studies featuring at least 10 adult, treatment-experienced patients with HCV-4 infection failing prior interferon-based therapy and receiving subsequent re-treatment with P/R were included.
  
  
  RESULTS
  3 studies were included. Overall pooled SVR was 32.7%, or 41/126 patients. No significant heterogeneity existed among the studies. One study reported higher SVR of 50% in previous relapsers, compared with 23% in previous non-responders.
  
  
  CONCLUSIONS
  As expected, treatment-experienced patients achieved lower rate of SVR compared with previously reported SVR for treatment-naïve patients with HCV-4 infection. The abysmal rate of success from re-treatment with P/R supports the use of direct-acting antivirals whenever re-treatment is considered, even in resource-limited regions.
authors.affiliation: School of Medicine, University of California, San Diego , La Jolla, California , USA.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhang
authors.affiliation: School of Medicine, University of California, San Diego , La Jolla, California , USA.
authors.forename: Nghia H
authors.initials: NH
authors.lastname: Nguyen
authors.affiliation: School of Medicine, University of California, San Diego , La Jolla, California , USA.
authors.forename: Brittany E
authors.initials: BE
authors.lastname: Yee
authors.affiliation: Department of Internal Medicine , University of California, Irvine , Orange, California , USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Yip
authors.affiliation: Division of Gastroenterology/Hepatology , Stanford University Medical Center , Palo Alto, California , USA.
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
keywords: GENOTYPE; HEPATITIS C; INTERFERON; META-ANALYSIS