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Suboptimal response in HCV genotype 4 in Egypt driven by noncompliance

Suboptimal treatment response in chronic HCV genotype 4 in Egypt was driven primarily by noncompliance as well as gaps in the health care system that lead to treatment discontinuation, according to recent findings published in Journal of Viral Hepatitis.

“In Egypt, the national program for HCV treatment has provided a rich pool of data which have led to the conduction of large population-based studies,” the researchers wrote. “This is one of the largest studies examining HCV treatment effectiveness.”

Nearly 9.8% of the Egyptian population is chronically infected with HCV, 91% of which is infected with genotype 4, the researchers wrote. In addition, there are relatively few data on real-world responses to interferon-based therapies for patients with genotype 4 infection.

The researchers assessed data of 6,198 IFN-naive patients with chronic HCV who had received pegylated-interferon and ribavirin (PEG-INF/RBV) therapy at Cairo-Fatemic hospital between 2009 and 2012.

They found that at week 12, 95.7% of patients had undetectable HCV RNA and by week 24, breakthrough was 6% and by week 48, breakthrough was 4%. However, 43.7% of patients discontinued treatment prematurely and intent-to-treat end-of-treatment response was 44.6%. In addition, 84.9% of 1,281 patients with available data had sustained response and hematological abnormalities were comparable in both groups.

Although previous studies have shown that HCV treatment has a sustained viral response between 42% and 60% for genotype 4, this study showed an SVR rate of 17.5%. However, the researchers could not properly assess SVR in this study due to high noncompliance. After administering a phone survey to 100 patients, the researchers determined the following main issues led to noncompliance: gaps in the health care system due to limited treatment centers leading to overcrowding, long lines and waiting hours, travelling long distances for treatment or follow-up appointments, lack of proper communication skills by the medical staff, and lack of call back systems when a patient missed a scheduled visit.

“Suboptimal response in HCV genotype 4 was mainly driven by noncompliance rather than side effects as well as gaps in the healthcare system leading to patients refraining from using healthcare services,” the researchers wrote. “Further efforts are needed to address the gaps in our healthcare systems which will improve the effectiveness of HCV treatment and ultimately reduce the burden of liver disease in Egypt.” – by Will Offit

Disclosure: One researcher reports being an advisory committee board member for Merck, Gilead and Bristol-Myers. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.