• 1
    World Health Organization. Hepatitis C. Geneva, Switzerland: World Health Organization, 2000 WHO fact sheet 164. Available at Accessed 21 October 2008.
  • 2
    Nguyen MH, Keeffe EB. Prevalence and treatment of hepatitis C virus genotypes 4, 5, and 6. Clin Gastroenterol Hepatol 2005; 3 (Suppl. 2): S97101.
  • 3
    Simmonds P. Genetic diversity and evolution of hepatitis C virus – 15 years on. J Gen Virol 2004; 85 (Part 11): 317388.
  • 4
    Egyptian Ministry of Health Annual report. 2007 Available at Accessed: 12 October 2008.
  • 5
    Abdel-Aziz F, Habib M, Mohamed MK, et al. Hepatitis C virus (HCV) infection in a community in the Nile Delta: population description and HCV prevalence. Hepatology 2000; 32: 1115.
  • 6
    Ray SC, Arthur RR, Carella A, Bukh J, Thomas DL. Genetic epidemiology of hepatitis C virus throughout Egypt. J Infect Dis 2000; 182: 698707.
  • 7
    Angelico M, Renganathan E, Gandin C, et al. Chronic liver disease in the Alexandria governorate, Egypt: contribution of schistosomiasis and hepatitis virus infections. J Hepatol 1997; 26: 23643.
  • 8
    Shobokshi OA, Serebour FE, Skakni L, Al-Saffy YH, Ahdal MN. Hepatitis C genotypes and subtypes in Saudi Arabia. J Med Virol 1999; 58: 448.
  • 9
    Xu L-Z, Larzul D, Delaporte E, Bréchot C, Kremsdorf D. Hepatitis C virus genotype 4 is highly prevalent in central Africa (Gabon). J Gen Virol 1994; 75: 23938.
  • 10
    Ndjomou J, Pybus OG, Matz B. Phylogenetic analysis of hepatitis C virus isolates indicates a unique pattern of endemic infection in Cameroon. J Gen Virol 2003; 84: 233341.
  • 11
    Wansbrough-Jones MH, Frimpong E, Cant B, et al. Prevalence and genotype of hepatitis C virus infection in pregnant women and blood donors in Ghana. Trans R Soc Tropical Med Hyg 1998; 92: 4969.
  • 12
    Kamal S, Nasser I. Hepatitis C genotype 4: what we know and what we don't yet know. Hepatology 2008; 47: 137183.
  • 13
    Payan C, Roudot-Thoraval F, Marcellin P, et al. Changing of hepatitis C virus genotype patterns in France at the beginning of the third millennium: the GEMHEP GenoCII Study. J Viral Hepat 2005; 12: 40513.
  • 14
    Nicot F, Legrand-Abravanel F, Sandres-Saune K, et al. Heterogeneity of hepatitis C virus genotype 4 strains circulating in south-western France. J Gen Virol 2005; 86: 10714.
  • 15
    Ansaldi F, Bruzzone B, Salamaso S, et al. Different seroprelavence and molecular epidemiology pattern of hepatitis C virus infection in Italy. J Med Virol 2005; 76: 32732.
  • 16
    Katsoulidou A, Sypsa V, Tassopoulos NC, et al. Molecular epidemiology of hepatitis C virus (HCV) in Greece: temporal trends in HCV genotype-specific incidence and molecular characterization of genotype 4 isolates. J Viral Hepat 2006; 13: 1927.
  • 17
    Fernandez-Arcas N, Lopez-Siles J, Trapero S, et al. High prevalence of hepatitis C virus subtypes 4c and 4d in Malaga (Spain): phylogenetic and epidemiological analyses. J Med Virol 2006; 78: 142935.
  • 18
    Franco S, Tural C, Clotet B, Martínez MA. Complete nucleotide sequence of genotype 4 hepatitis C viruses isolated from patients co-infected with human immunodeficiency virus type 1. Virus Res 2007; 123: 1619.
  • 19
    Kamal SM, Fouly AE, Kamel RR, et al. Peginterferon alfa-2b therapy in acute hepatitis C: impact of onset of therapy on sustained virologic response. Gastroenterology 2006; 130: 6328.
  • 20
    Kamal SM, Moustafa KN, Chen J, et al. Duration of peginterferon therapy in acute hepatitis C: a randomized trial. Hepatology 2006; 43: 92331.
  • 21
    Kamal SM, Graham CS, He Q, et al. Kinetics of intrahepatic hepatitis C virus (HCV)-specific CD4+T cell responses in HCV and Schistosoma mansoni coinfection: relation to progression of liver fibrosis. J Infect Dis 2004; 189: 114050.
  • 22
    Kamal SM, Turner B, He Q, et al. Progression of fibrosis in hepatitis C with and without schistosomiasis: correlation with serum markers of fibrosis. Hepatology 2006; 43: 7719.
  • 23
    Kamal SM, Rasenack JW, Bianchi L, et al. Acute hepatitis C without and with schistosomiasis: correlation with hepatitis C-specific CD4(+) T-cell and cytokine response. Gastroenterology 2001; 121: 64656.
  • 24
    Kamal S, Madwar M, Bianchi L, et al. Clinical, virological and histopathological features: long-term follow-up in patients with chronic hepatitis C co-infected with S. mansoni. Liver 2000; 20: 2819.
  • 25
    Kamal S, Kamary S, Shardell M, et al. Pegylated interferon alpha-2b plus ribavirin in patients with genotype 4 chronic hepatitis C: the role of rapid and early virologic response. Hepatology 2007; 46: 173240.
  • 26
    Abdel Hamid M, El Daly M, Molnegren V, et al. Genetic diversity in hepatitis C virus in Egypt and possible association with hepatocellular carcinoma. J Gen Virol 2007; 88: 152631.
  • 27
    Wali MH, Heydtmann M, Harrison RF, Gunson BK, Mutimer DJ. Outcome of liver transplantation for patients infected by hepatitis C, including those infected by genotype 4. Liver Transpl 2003; 9: 796804.
  • 28
    Zylberberg H, Chaix ML, Brechot C. Infection with hepatitis C virus genotype 4 is associated with a poor response to interferon-alpha. Ann Intern Med 2000; 132: 8456.
  • 29
    Kamal SM, Madwar MA, Peters T, Fawzy R, Rasenack J. Interferon therapy in patients with chronic hepatitis C and schistosomiasis. J Hepatol 2000; 32: 1724.
  • 30
    Koshy A, Marcellin P, Martinot M, Madda JP. Improved response to ribavirin interferon combination compared with interferon alone in patients with type 4 chronic hepatitis C without cirrhosis. Liver 2000; 20: 3359.
  • 31
    Alfaleh FZ, Hadad Q, Khuroo MS, et al. Peginterferon a-2b plus ribavirin compared with interferon a-2b plus ribavirin for initial treatment of chronic hepatitis C in Saudi patients commonly infected with genotype 4. Liver Int 2004; 24: 56874.
  • 32
    Esmat GH, Abouzied A, Abdel-Hamid M, et al. Results of a randomized clinical trial of genotype-4 infected subjects when treated with standard or pegylated interferon alfa-2b in combination with ribavirin. Hepatology 2003; 38 (Suppl.): 314A5A (abstract).
  • 33
    Shobokshi A, Serebour PE, Skakni L, et al. Combination therapy of peginterferon alfa-2a (40 KD) (PEGASYS®) and ribavirin (COPEGUS®) significantly enhance sustained virological and biochemical response rate in chronic hepatitis C genotype 4 patients in Saudi Arabia. Hepatology 2003; 38 (Suppl.): 636A (abstract).
  • 34
    Hasan F, Asker H, Al-Khaldi J, et al. Peginterferon alfa-2b plus ribavirin for the treatment of chronic hepatitis C genotype 4. Am J Gastroenterol 2004; 99: 17337.
    Direct Link:
  • 35
    Derbala MF, Al Kaabi SR, El Dweik NZ, et al. Treatment of hepatitis C virus genotype 4 with peginterferon alfa-2a: impact of bilharziasis and fibrosis stage. World J Gastroenterol 2006; 12: 56928.
  • 36
    Diago M, Hassanein T, Rodes J, Ackrill AM, Sedarati F. Optimized virologic response in hepatitis C virus genotype 4 with peginterferon-alpha2a and ribavirin. Ann Intern Med 2004; 140: 723.
  • 37
    Kamal SM, El Tawil AA, Nakano T, et al. Peginterferon alpha-2b and ribavirin therapy in chronic hepatitis C genotype 4: impact of treatment duration and viral kinetics on sustained virological response. Gut 2005; 54: 85866.
  • 38
    Khuroo MS, Khuroo MS, Dahab ST. Meta-analysis: a randomized trial of peginterferon plus ribavirin for the initial treatment of chronic hepatitis C genotype 4. Aliment Pharmacol Ther. 2004; 20: 9318.
  • 39
    Zayadi A-R, Attia M, Barakat EMF, et al. Response of hepatitis C genotype-4 naive patients to 24 weeks of peg-interferon-a2b/ribavirin or induction-dose interferon-a2b/ribavirin/amantadine: a non-randomized controlled study. Am J Gastroenterol 2005; 100: 244752.
  • 40
    Ferenci P, Laferl HAustrian Hepatitis Study Group et al. Peginterferon alfa-2a and ribavirin for 24 weeks in hepatitis C type 1 and 4 patients with rapid virological response. Gastroenterology 2008; 135: 4518.
  • 41
    Jessner W, Gschwantler M, Formann E, et al. Very early viral kinetics on interferon treatment in chronic hepatitis C virus genotype 4 infection. Antiviral Ther 2008; 13: 5819.
  • 42
    Martín-Carbonero L, Puoti M, García-Samaniego J, et al. Response to pegylated interferon plus ribavirin in HIV-infected patients with chronic hepatitis C due to genotype 4. J Viral Hepat 2008; 15: 7105.
  • 43
    Poordad F, Reddy KR, Martin P. Rapid virologic response: a new milestone in the management of chronic hepatitis C. Clin Infect Dis 2008; 46: 7884.
  • 44
    Roulot D, Bourcier VObservational VHC4 Study Group et al. Epidemiological characteristics and response to peginterferon plus ribavirin treatment of hepatitis C virus genotype 4 infection. J Viral Hepat 2007; 14: 4607.
  • 45
    Kamal SM. Improving outcome in patients with hepatitis C virus genotype 4. Am J Gastroenterol 2007; 102: 25828.
    Direct Link:
  • 46
    El Ray A, Asselah T, Ripault M-P, et al. Rapid drop of HCV RNA level under therapy and better sustained response rate in Egyptian patients versus non-Egyptian patients with HCV genotype 4, 2006. EASL, Austria, abstract 571.
  • 47
    Trapero-Marugan M, Moreno-Monteagudo JA, Garcia-Buey L, et al. Clinical and pathological characteristics and response to combination therapy of genotype 4 chronic hepatitis C patients: experience from a Spanish center. J Chemother 2007; 19: 4237.
  • 48
    Poynard T, Ratziu V, Charlotte F, et al. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis C. J Hepatol 2001; 34: 7647.
  • 49
    Poynard P, Mathurin CL, Lai D, et al. A comparison of fibrosis progression in chronic liver diseases. J Hepatol 2003; 38: 25765.
  • 50
    Koshy A, Madda JP, Marcellin P, et al. Treatment of hepatitis C virus genotype 4-related cirrhosis: ribavirin and interferon combination compared with interferon alone. J Clin Gastroenterol 2002; 35: 825.
  • 51
    Soriano V, Nunez M, Sanchez-Conde M, et al. Response to interferon-based therapies in HIV-infected patients with chronic hepatitis C due to genotype 4. Antiviral Ther 2005; 10: 16770.
  • 52
    Legrand-Abravanel F, Nicot F, Boulestin A, et al. Pegylated interferon and ribavirin therapy for chronic hepatitis C virus genotype 4 infection. J Med Virol 2005; 77: 669.
  • 53
    Kamal SM, Ismail A, Graham CS, et al. Pegylated interferon a therapy in acute hepatitis C: relation to hepatitis C virus specific T cell response kinetics. Hepatology 2004; 39: 1721.
  • 54
    Hasan F, Al-Khaldi J, Asker H, et al. Peginterferon alpha-2b plus ribavirin with or without amantadine [correction of amantidine] for the treatment of non-responders to standard interferon and ribavirin. Antiviral Ther 2004; 9: 499503.
  • 55
    Inati A, Taher A, Ghorra S, et al. Efficacy and tolerability of peginterferon alpha-2a with or without ribavirin in thalassaemia major patients with chronic hepatitis C virus infection. Br J Haematol 2005; 130: 6446.
  • 56
    Kamal S, Fouly A, Mohamed S, et al. Peginterferon alfa-2b therapy with and without ribavirin in patients with thalassemia: a randomized study. Presented at the 41st Annual Meeting of the European Association for the Study of the Liver, 26–30 April 2006, Austria Center, Vienna, Austria, abstract 585.