Genotype 4 HCV infection is difficult to cure with pegylated interferon and ribavirin. Results from a Greek nationwide cohort study

Olga Anagnostou, S. Manolakopoulos, G. Bakoyannis, G. Papatheodoridis, A. Zisouli, M. Raptopoulou-Gigi, E. Manesis, I. Ketikoglou, G. Dalekos, C. Gogos, T. Vassiliadis, D. Tzourmakliotis, S. Karatapanis, S. Kanatakis, I. Zoumpoulis-Vafiadis, A. Hounta, S. Koutsounas, G. Giannoulis, N. Tassopoulos, G. Touloumi

Research output: Contribution to journalArticle

7 Scopus citations


Background and aim: 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.

Original languageEnglish (US)
Pages (from-to)57-64
Number of pages8
Issue number1
StatePublished - 2014



  • HCV treatment
  • Interferon
  • Pegylated-interferon
  • Viral hepatitis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Anagnostou, O., Manolakopoulos, S., Bakoyannis, G., Papatheodoridis, G., Zisouli, A., Raptopoulou-Gigi, M., Manesis, E., Ketikoglou, I., Dalekos, G., Gogos, C., Vassiliadis, T., Tzourmakliotis, D., Karatapanis, S., Kanatakis, S., Zoumpoulis-Vafiadis, I., Hounta, A., Koutsounas, S., Giannoulis, G., Tassopoulos, N., & Touloumi, G. (2014). Genotype 4 HCV infection is difficult to cure with pegylated interferon and ribavirin. Results from a Greek nationwide cohort study. Hippokratia, 18(1), 57-64.