Hepatitis C genotype 4: Genotypic diversity, epidemiological profile, and clinical relevance of subtypes in Saudi Arabia
Hamad I Al Ashgar1, Mohammed Q Khan1, Mohammed Al-Ahdal2, Sahar Al Thawadi3, Ahmad Salem Helmy4, Ahmed Al Qahtani4, Faisal M Sanai5
1 Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Centre (KFSH and RC), Riyadh, Saudi Arabia
2 Molecular Virology and Infectious Disease Section, Research Center, KFH and RC, Riyadh, Saudi Arabia
3 Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre (KFSH and RC), Riyadh, Saudi Arabia
4 Molecular Virology and Infectious Disease Section, Research Center, KFH and RC; Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
5 Liver Disease Research Center, King Saud University; Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Mohammed Q Khan
Section of Gastroenterology, Department of Medicine MBC: 46, King Faisal Specialist Hospital and Research Centre, PO Box: 3354, Riyadh - 11211
Source of Support: None, Conflict of Interest: Dr. Sanai is a consultant for, advises, is on the
speakersf bureau of, and received grants from Bristol.Myers Squibb.
He is a consultant for, and has advised Scherring.Plough and Merck
Sharp.Dohme, is on the speakersf bureau of, and received grants from
Roche and Glaxo Smith.Kline. Al.Ashgar is a consultant for, advises,
and is on the speakersf bureau of Bristol.Myers Squibb.
Background/Aim: Hepatitis C virus genotypes 4 (HCV-4) is the most prevalent genotype in Saudi Arabia, although it's various subtypes, mode and route of transmission remains unknown. The aim of this study was to analyze (i) the variability of the HCV-4 subtypes, the route and source of HCV transmission and (ii) the influence of HCV-4 subtypes on their therapeutic response. Patients and Methods : Sixty-four HCV-4 patients were analyzed retrospectively for the prevalence of various sub-genotypes and the possible mode of transmission, and it was correlated with their treatment response to pegylated interferon (PEG-IFN) α-2a and ribavirin therapy. Results: Positive history of blood or blood products transfusion was noted in 22 patients (34%), hemodialysis in 10 patients (15.6%), surgery in 7 patients (11%), and unknown etiology in 25 patients (39%). Prevalence of HCV-4 subtypes was 4a = 48.4% (31/64), 4d = 39% (25/64), 4n = 6.25% (4/64), and remaining combined (4m, 4l, 4r, 4o) 6.25% (4/64). No significant correlation between subtypes and the source of transmission was recognized ( P = 0.62). Sustained virological response in all HCV-4 patients was 64% (41/64), while in each subtypes separately it was 4a 77.4% (24/31), 4d 52% (13/25), and combined (4n, 4m, 4l, 4r, 4o) 62.5% (5/8) ( P = 0.046). Conclusion: No obvious cause for the mode of HCV transmission was noted in majority of the patients. No significant correlation was observed between HCV-4 subtypes and the source of HCV infection. 4a and 4d subtypes were the most common in Saudi Arabia, and patients infected with 4a subtype responded significantly better to combination therapy than to 4d subtype.