"> Mahmoud A. Khattab1,⇑, Peter Ferenci2, Stephanos J. Hadziyannis3, Massimo Colombo4,
Michael P. Manns5, Piero L. Almasio6, Rafael Esteban7, Ayman A. Abdo8, Stephen A. Harrison9,
Nazir Ibrahim10, Patrice Cacoub11, Mohammed Eslam1, Samuel S. Lee12
HCV has been classified into no fewer than six major genotypes and a series of subtypes. Each HCV genotype is unique with respect to its nucleotide sequence, geographic distribution, and response to therapy. Genotypes 1, 2, and 3 are common throughout North America and Europe. HCV genotype 4 (HCV-4) is common in the Middle East and in Africa, where it is responsible for more than 80% of HCV infections. It has recently spread to several uropean countries. HCV-4 is considered a major cause of chronic hepatitis, cirrhosis, hepatocellular carcinoma, and liver transplantation in these regions. Although HCV-4 is the cause of approximately 20% of the 170 million cases of chronic hepatitis C in
the world, it has not been the subject of widespread research. Therefore, this document, drafted by a panel of international experts, aimed to review current knowledge on the epidemiology, natural history, clinical, histological features, and treatment of HCV-4 infections.