Hepatitis C virus genotype 4 (HCV4) is the most common type of hepatitis C virus (HCV) in the Middle East and Africa, in particular Egypt. Treatment with pegylated interferon and Ribavirin is still the standard regimen of care with overall response ranging between 50 and 60 %. New types of interferon (Y-shaped, Reiferon Retard,…), new DAAD (protease inhibitors, polymerase inhibitors, NS5A inhibitors….), and many off label drugs (Nitazoxanide, Vit.D…) may improve the treatment outcome of patients with HCV-4.