In patients with chronic hepatitis C virus (HCV) infection scheduled for a 48 week treatment period, premature discontinuation of treatment was previously recommended if HCV-RNA levels remained detectable at week 24 of therapy. Considering the number of side effects and treatment costs, measurement of initial viral decline during therapy may identify virologic nonresponse earlier than 24 weeks. Aim of work: To assess changes in the viral load at week 4 of treatment as a predictor for treatment outcome and to update genotype status of HCV. Patients and methods: We retrospectively analyzed 152 Egyptian patients treated with pegylated interferon alfa and ribavirin for 48 weeks. Early prediction of virologic response by HCV RNA decline at weeks 4 as well as clinical, biochemical, virologic, and histologic baseline parameters were analyzed by logistic regression and receiver operating characteristic (ROC) curves. Genotyping was also done in the 152 patients done using RT-PCR.Results: RVR was achieved by 16.4% of patients. Among patients who achieved RVR, PPV for ETR was high (88%) while NPV for ETR was very low (26.77%). Baseline factors predictive of rapid responders versus slow reponders and non responders included low baseline HCV RNA level, low ANC and high serum TSH level. Notably, a baseline viral load above 5.23 log10 IU/mL was predictive for non RVR in all patients. A baseline viral load above 5.5 log10 IU/mL was predictive for virologic nonresponse. Using univariate logistic regression analysis evaluating baseline demographic and virologic parameters, none of these parameters was significant independent factor of NR. Almost 97% of our patients were HCV genotype 4a. Conclusion: RVR most likely will not result in a stopping rule. However, it can be used to motivate patients for adherence to therapy.