الفهرس 
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Abstract
According to the prevalence of HCV infection, HCV genotype-4 infected individuals constitute around 20% of the world’s HCV-infected population (Fried et al., 2002).Egypt faces the worldwide highest prevalence of CHC (" ~ "13.8%) with about 91% with HCV genotype 4 (Arafa et al., 2005; Abdel-Wahab et al., 2007).
This genotype is prevalent also in the Middle East and Africa and recently this genotype has begun to spread to several regions in Europe. HCV-4 has been considered a difficult-to-treat genotype based on the low SVR rates obtained with conventional interferon based regimens. Pegylated interferon plus ribavirin therapy for chronic HCV-4 has been associated with increased SVR rates of more than 60% (Kamal, 2011).
Nonetheless, patients with genotype 4 were underrepresented in clinical trials conducted mostly in the West where genotype 4 is rare. Establishing responsiveness of this genotype 4 to Peg-IFN and RBV has obvious economic and public health implications in the developing countries of the Middle East. The only limitation of Peg-IFN is based on its cost that goes beyond the reach of the financial circumstances of the Egyptians and not devoid of side effects.
The National Program for Treatment of HCV in Egypt has adopted pegylated interferon alpha in combination with ribavirin for a 48 week course for eligible patients according to its selection criteria (Kamal, 2011).
Because of the newly approved direct antiviral drugs, this combination regimen has been replaced by either dual therapy of sofosbuvir and ribavirin or