High prevalence of HBV genotype D in Syria and the clinical characteristics of hepatitis B e antigen-negative chronic hepatitis B.

Hepatitis B virus (HBV) genotype D and hepatitis B e antigen (HBeAg) negative chronic hepatitis are the most prevalent in Mediterranean countries. No data have ever been published on their prevalence in Syria, a country of intermediate endemicity for HBV. The aims of the current study were to determine the HBV genotype distribution in Syria, the prevalence of HBeAg-positive and HBeAg-negative chronic hepatitis and to analyse the clinical characteristics of each group. A total of 220 patients were included. Ninety-seven percent of the patients were of genotype D, and 72% were HBeAg negative. The HBeAg-negative patients were older, had a lower viral load, had more cirrhosis and the mode of contamination was known less than for HBeAg-positive patients. These findings have major implications in understanding the natural history of the infection and are of great relevance in the choice of therapy.

The unexpected discovery of a focus of hepatitis C virus genotype 5 in a Syrian province.

Genotype 5 (G5) was initially discovered and is still mainly diagnosed in South Africa. No cases of G5 have ever been reported from the Middle East countries. The aim of the study was to determine the hepatitis C virus (HCV) genotype distribution in Syria and the prevalence of G5 in this country. Genotyping of HCV was performed in 636 consecutive HCV patients referred to eight medical centres in Syria over a 3-year period. Genotype 4 was the most frequent genotype (375 patients, 59%) followed by genotype 1 (181 patients, 28.5%) and G5 (64 patients, 10%). The majority of G5 patients (56 cases, 87%) live in the north of Syria, including 21 cases (33%) from Azaz, a small city close to Turkey. No obvious epidemiological reason for such high prevalence of G5 was found.

Efficacy of interferon plus ribavirin in the treatment of hepatitis C virus genotype 5.

Hepatitis C virus (HCV) genotype 5 has only been reported in a few countries and treatment response has not been well characterized. Our aim is to present the treatment outcome for HCV genotype 5 patients evaluated at three medical centres in Syria between January 2004 and June 2007. Medical records were reviewed retrospectively. Treatment consisted of ribavirin 1 000-1 200 mg daily plus interferon alpha-2a, 3 MU x 3/week or pegylated-interferon alpha-2a, 180 mug/week. Patients were treated for 24 or 48 weeks. Sustained viral response (SVR) was assessed at the end of a 6-month follow-up period. Twenty-six treatment-naïve patients with HCV genotype 5 have completed the course of anti-HCV therapy and a 6-month follow-up. An SVR was achieved in 54% (47% with standard interferon and 67% with pegylated interferon, P = 0.43). A trend towards better results was observed for younger patients, low viremia and mild fibrosis. SVR was similar for treatment course of 24 or 48 weeks. In summary, treatment of HCV genotype 5 with combination therapy resulted in SVR in 54% of patients. Twenty-four weeks of treatment might be adequate. Further research should evaluate the ideal duration of treatment.