Background: In the United States, genotype 4 infection accounts for only 1 to 2% of all hepatitis C infections. Globally, approximately 20% of all hepatitis C infections are caused by genotype 4. In addition, genotype 4 is the dominant HCV genotype in Egypt, North Africa, and sub-Saharan Africa. In Egypt, approximately 15% of the population has hepatitis C infection and genotype 4 infection accounts for more than 90% of the HCV infections in Egypt; most of these cases of hepatitis C were acquired via contaminated needles in the anti-schistosomiasis program or with contaminated blood transfusion. More recently, the prevalence of hepatitis C genotype 4 infection has increased significantly in Southern Europe, particularly in France, Italy, Greece, and Spain. Approximately 70% of patients with genotype 4 HCV have moderate to severe steatosis with or without sinusoidal fibrosis. For treatment-naive and treatment-experienced patients with genotype 4 infection, the cost of therapy for recommended and alternative regimens in the 2016 American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) guidance ranges from approximately $55,000 to $189,000 (Figure 1). The following discussion regarding initial treatment and retreatment of patients with genotype 4 chronic hepatitis C assumes patients and their clinicians have already made the decision to initiate hepatitis C therapy.
Medications used to Treat Hepatitis C: The HCV Medications section on this web site provides detailed information for each of the FDA-approved medications listed in the treatment recommendations, including links to the full prescribing information and to patient assistance programs. Adherence with the treatment regimen is extremely important. Thus, patients should receive detailed counseling regarding the importance of adherence prior to starting therapy, as well as intensive monitoring and follow-up during therapy.