Direct antiviral therapy in patients with HCV: evidence from Saudi Arabia
Published in Microbiology, Genetics & Genomics, and Public Health
It is well established that the primary goal of treatment for chronic hepatitis C is to achieve a sustained virologic response (SVR)—the absence of detectable hepatitis C virus RNA for at least 12 weeks (SVR12) or 24 weeks (SVR24)—and to reduce overall mortality and liver-related complications, including end-stage liver disease, hepatocellular carcinoma, and morbidity and mortality associated with extrahepatic manifestations of chronic hepatitis C virus infection. Achieving an SVR significantly reduces hepatic and extrahepatic complications associated with HCV, improves quality of life and prevents HCV transmission.
According to the latest data for 2016, approximately 0.5% of the Saudi population was actively infected with hepatitis C, of which approximately 20% had been previously diagnosed, and approximately 50% of these patients had been treated. Furthermore, 50% of treated hepatitis C patients were cured with standard therapy using pegylated interferon and ribavirin. An additional 5,000 people were treated with new direct-acting antiviral (DAA) drugs, with a cure rate of >90%.
In this study, we aimed to evaluate the real-world outcomes of treating Saudi patients infected with HCV with DAAs as part of a national campaign to eliminate this disease in Saudi Arabia. Unlike previous reports, we aimed to provide complete follow-up data (SVR12 and SVR24) and identify proportion of unspecified genotypes, which would contribute to understanding current diagnostic and therapeutic options in clinical practice.
The study included a sample of 144 Saudi patients infected with hepatitis C virus who were treated as outpatients and received DAA therapy between January 2016 and December 2023. All patients completed therapy and achieved SVR at 12 and 24 weeks. We attributed this to strict adherence monitoring, free therapy under the national program, and comprehensive follow-up protocols that minimized treatment discontinuations.
The most common genotype was GT4 (38.9%), followed by GT1(a and b) (20.1%). We also referenced previous studies describing the regional distribution of HCV genotypes and thus hypothesized that GT4 is the dominant genotype in Middle Eastern countries. In addition to examining known HCV genotypes, we also discovered a novel pattern in the Saudi population: of n = 144 patients, n = 42 (29.2%) had an unknown genotype. To our knowledge, this is the first study to report such a large proportion of cases with an unknown genotype. However, since this study was retrospective, we proposed further study of this genotype in prospective genetic studies.
Another finding that requires further study in prospective studies was that despite successful completion of the treatment course with 100% sustained virologic response, resulting in a significant reduction in mean liver enzyme levels—alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP)—the level of conjugated bilirubin did not change.
With the World Health Organization projecting a 90% reduction in new hepatitis cases and a 65% reduction in deaths between 2016 and 2030, these emerging data from Saudi Arabia are worth considering. We believe that new studies should consider a thorough investigation of unknown genotypes and examination of associated risk factors that may lead to liver fibrosis, as well as the association of age and gender with HCV genotypes with the inclusion of a larger population. Moreover, research based on these data will provide a deeper understanding of the effectiveness and durability of treatments, which may not only improve patient care but also inform health policy and recommendations, ultimately leading to improved health outcomes.
Follow the Topic
-
BMC Infectious Diseases
This journal is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology, and epidemiology.
Related Collections
With Collections, you can get published faster and increase your visibility.
Personalized medicine in infectious diseases
BMC Infectious Diseases invites submissions for a Collection on Personalized medicine in infectious diseases.
The field of personalized medicine is rapidly advancing, particularly among infectious diseases, where the traditional ‘one-size-fits-all’ treatment approaches are increasingly inadequate. As our understanding of the genetic, environmental, and lifestyle factors influencing disease susceptibility and treatment response grows, this Collection aims to explore innovative strategies and technologies that can enhance the application of personalized medicine in combating infections.
Recent advancements in genomics, pharmacogenomics, and bioinformatics are transforming the application of personalized approaches for infectious diseases. These developments have enabled the identification of specific biomarkers that inform individualized treatment strategies, improving patient outcomes and minimizing adverse effects. In parallel, advances in molecular diagnostics and tailored antimicrobial therapies offer new opportunities to address the escalating challenge of antimicrobial resistance.
Improved understanding of host-pathogen interactions and the genetic determinants of infections may support the development of targeted antiviral and antimicrobial strategies that enhance their effectiveness, while limiting the emergence of resistance. Research in this area may also enable personalized antimicrobial dosing and optimized treatment guidelines that balance individual patient benefits with broader public health considerations.
This Collection welcomes original research articles on topics including but not limited to:
- Tailored antimicrobial therapy in infectious diseases
- Patient-specific interventions to improve clinical outcomes
- Personalized strategies to address antimicrobial resistance
- Precision medicine approaches in antiviral therapy
- Novel methodologies for disease modelling and therapeutic targeting
- Precision diagnostics, including biomarker validation and metagenomic sequencing
- Model-informed personalized dosing in infectious diseases
- Therapeutic drug monitoring in anti-infective therapy
This Collection supports and amplifies research related to SDG 3 (Good Health and Well-being).
All manuscripts submitted to this journal, including those submitted to collections and special issues, are assessed in line with our editorial policies and the journal’s peer review process. Reviewers and editors are required to declare competing interests and can be excluded from the peer review process if a competing interest exists.
Publishing Model: Open Access
Deadline: Dec 16, 2026
Tuberculosis and co-infections: diagnostics, management, and treatment
BMC Infectious Diseases invites submissions for a Collection on Tuberculosis and co-infections: diagnostics, management, and treatment.
Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide, particularly in regions with high prevalence rates and co-infections. The interplay between TB and various co-infections (including bacterial, viral, parasitic and fungal), complicates diagnosis and treatment strategies. Advances in molecular diagnostics and imaging techniques have improved our understanding of how these co-morbidities affect TB pathogenesis and treatment outcomes. However, the challenge of managing drug-resistant TB adds an additional layer of complexity, necessitating a comprehensive approach that integrates the latest research findings with clinical practice.
Research into TB of all stages and its co-infections is crucial for addressing the rising incidence of drug resistance and improving patient outcomes. Recent studies have identified critical biomarkers for early detection and prognosis, highlighting the role of rapid diagnostic tools in the clinical setting. Additionally, understanding the mechanisms of co-infections has led to tailored treatment regimens that maximize efficacy while minimizing adverse effects. Nonetheless, gaps remain in our knowledge of optimal management strategies for these complex cases, emphasizing the need for ongoing research in this field.
Future research endeavors should focus on the development of more effective diagnostic techniques and treatment protocols that consider the multifaceted interactions between TB and its co-infections. Innovations in personalized medicine may lead to targeted therapies that address specific pathogen interactions, ultimately enhancing patient recovery rates. Moreover, collaborative efforts between public health entities and research organizations could pave the way for comprehensive TB surveillance systems, fostering the identification of emerging trends in co-infection patterns.
This Collection welcomes original research articles on topics including but not limited to:
- Diagnostic innovations for Tuberculosis and co-infections
- Management strategies for drug-resistant Tuberculosis
- Interaction between Tuberculosis and HIV
- Tuberculosis and diabetes comorbidity
- Tuberculosis in the context of viral hepatitis and COVID-19
This Collection supports and amplifies research related to SDG 3 (Good Health and Well-being).
All manuscripts submitted to this journal, including those submitted to collections and special issues, are assessed in line with our editorial policies and the journal’s peer review process. Reviewers and editors are required to declare competing interests and can be excluded from the peer review process if a competing interest exists.
Publishing Model: Open Access
Deadline: Jan 27, 2027
