Hepatitis C genotypes/subtypes among chronic hepatitis patients in Saudi Arabia

The object of this study is to determine the molecular epidemiology of hepatitis C virus (HCV) in the Kingdom of Saudi Arabia (KSA). Four hundred and ninety-two histological proven chronic HCV patients prospectively recruited from all regions of KSA, between November 1999 and March 2002, were genotyped and subtyped using amplified products of specific primers from the 5-UTR region in a reverse transcription polymerase chain reaction (Roche Diagnostics, Switzerland) followed by a reverse hybridization technique (Innolipa HCV II [Innogenetics, Belgium]). Sixty-two percent of Saudis were found to be genotype 4. Other genotypes were 1 (24.1%); 2 (7.4%); 3 (5.9%); 5 (0.3%); and 10 (0.3%). There were no differences in distribution patterns between sexes and ages. All regions showed similar distribution except the Eastern region where subtype 2a/c seem to have emerged. Diabetic patients and those with a history of blood transfusion had the same pattern as those with community acquired HCV. Among the non-Saudis (mostly Egyptians), genotype 4 predominated (88%). We conclude that 86% of Saudi chronic hepatitis C cases are due to genotypes 1 and 4. Since these are considered "difficult to treat" an aggressive approach to management using combination therapy of pegylated interferon plus ribavirin for 48 weeks should be considered for all cases of chronic hepatitis C until genotyping proves otherwise.