Conclusions: In patients with HCV genotype 2 or 3 infection for whom treatment with peginterferon and ribavirin
Ribavirin
Ribavirin is used in combination with other antiviral medications to treat chronic hepatitis C, a viral infection of the liver.
Cirrhosis of the Liver
A degenerative disease of the liver resulting in scarring and liver failure.
What is the prognosis for hepatitis C?
Feb 18, 2021 · Treatment of HCV genotype 3 infection has emerged in the DAA era as the most treatment-refractory of all the HCV genotypes. Sustained virologic response rates at 12 weeks post-treatment (SVR12) with sofosbuvir plus weight-based ribavirin (given for 12 to 16 weeks) are substantially lower in persons with HCV genotype 3 than with HCV genotype 2.
What is Grade 2 Stage 3 chronic hepatitis?
Feb 18, 2021 · For initial treatment of HCV genotype 2 in adults with compensated cirrhosis, the recommended regimens are sofosbuvir-velpatasvir for 12 weeks or glecaprevir-pibrentasvir for 8 weeks. If the individual has HCV-HIV coinfection, and compensated cirrhosis, the glecaprevir-pibrentasvir treatment should be extended to 12 weeks.
What are the treatments for hepatitis C?
Feb 01, 2019 · The dose is the same, whether or not you have cirrhosis. Daclatasvir (Daklinza) and sofosbuvir (Sovaldi) This regimen is approved for hepatitis C genotype 3. It’s not approved to treat genotype 2,...
Is Hep C treatable?
Background: Patients chronically infected with hepatitis C virus (HCV) genotype 2 or 3 for whom treatment with peginterferon is not an option, or who have not had a response to prior interferon treatment, currently have no approved treatment options. In phase 2 trials, regimens including the oral nucleotide polymerase inhibitor sofosbuvir have shown efficacy in patients with HCV …
Which HCV genotype is easiest to treat?
Summary PointsIn the DAA era, HCV genotype 3 has emerged as the most difficult HCV genotype to treat.For treatment-naïve adults without cirrhosis, two regimens are recommended with equal evidence rating: (1) glecaprevir-pibrentasvir for 8 weeks, or (2) sofosbuvir-velpatasvir for 12 weeks.More items...•Feb 18, 2021
Is there a cure for Hep C genotype 3?
In the direct acting antiviral (DAA) era, cure rates for genotype 3 infection have lagged behind the other genotypes until the approval of daclatasvir and sofosbuvir in 2015 and more recently, the approval of the fixed dose combination sofosbuvir and velpatasvir[4, 5].
How long can you live with Hep C genotype 3?
Results. A total of 180 patients were enrolled. Of these, 86, 78, and 16 had genotype 1, genotype 2, and genotype 3 HCV-related HCC, respectively. The median age was 66.0 years, and the median overall survival was 28.6 months.Aug 20, 2019
Can all genotypes of Hep C be cured?
Although we can cure the majority of patients with genotypes 1, 2, and 4 in 12 weeks, many genotype 1 patients and all genotype 3 patients require 24 weeks of treatment.Jul 17, 2015
Is hepatitis 3 contagious?
Most noninfectious causes of hepatitis are not contagious. Hepatitis caused by alcohol poisoning, medications, or toxins or poisons are not transmitted from person to person.
How many HCV genotypes are there?
HCV has six genotypes, labeled 1 through 6. There are also subtypes labeled with letters, for example, genotypes 1a and 1b. Most people are infected by a single, dominant genotype, but it is possible to have more than one at the same time (called a mixed infection).
Which type of hepatitis is more severe?
Hepatitis Delta is considered to be the most severe form of hepatitis because of its potential to quickly lead to more serious liver disease than hepatitis B alone. Of the 292 million people living with chronic hepatitis B, approximately 15-20 million are also living with hepatitis D.Jan 9, 2019
Which hepatitis is not curable?
How to prevent hepatitis B. Hepatitis B is a liver infection caused by a virus (called the hepatitis B virus, or HBV). It can be serious and there's no cure, but the good news is it's easy to prevent.
What is the life expectancy of someone with hep C?
People with hepatitis C can live many years after diagnosis, but the range varies. A 2014 study showed that patients infected with hepatitis C virus died on average 15 years sooner than people who did not have the illness. With hepatitis C, the liver becomes seriously damaged due to inflammation.
Can HCV genotype change?
Six major genotypes of the hepatitis C virus (HCV) have been described; it is assumed to be uncommon for genotypes to change in chronically infected individuals.
What is the best drug to cure hep C?
Harvoni. Of the interferon-free treatment options for genotype 1 HCV, the fixed-dose combination drug Harvoni provides the simplest regimen and has demonstrated efficacy in patients with advanced liver disease, including decompensated cirrhosis.Feb 26, 2016
What does Hep C genotype 1a mean?
Background. Hepatitis C virus (HCV) genotype 1 is the most prevalent worldwide. Subtype 1a, compared with 1b, shows lower response rates and higher propensity to select for drug resistance to NS3 and selected NS5A and nonnucleoside NS5B inhibitors. Two distinct clades of subtype 1a have been described.
What are the factors that influence the choice of treatment for genotype 2?
For patients chronically infected with genotype 2 HCV, two key factors influence the choice and duration of therapy: cirrhosis status and prior treatment experience. In addition, the cost of the regimen, insurance coverage, concurrent medications, and patient and provider preference can play a major role in the regimen choice. The following treatment recommendations are based on the AASLD-IDSA HCV Guidance for initial treatment of adults with HCV genotype 2 and for retreatment of adults in whom prior therapy failed, including those with HCV genotype 2. [ 4, 5]
What is the SVR rate for HCV genotype 2?
Historically, in the interferon era, treatment of persons with HCV genotype 2 infection achieved higher sustained virologic response (SVR) rates than those with HCV genotype 1 infection, even with a shorter duration of therapy and lower doses of ribavirin. Prior to the availability of DAAs, the standard of care for treatment-naïve patients with HCV genotype 2 consisted of a 24-week course of peginterferon plus fixed-dose ribavirin, with SVR rates of 75 to 85%. [ 6, 7, 8, 9] In 2013, the combination of sofosbuvir with peginterferon and ribavirin showed greater than 90% SVR12 rates in HCV genotype 2 infection. [ 10] Later that year, the FDA approved a 12-week course with the all-oral regimen of sofosbuvir plus ribavirin for the treatment of HCV genotype 2 infection based on data from several studies showing SVR rates of approximately 92 to 97% with this regimen. [ 11, 12, 13] In 2015, daclatasvir plus sofosbuvir was FDA-approved as the first interferon- and ribavirin-free combination for HCV genotype 2 infection and this 12-week combination produced SVR rates of greater than 95%. [ 14, 15] Subsequently, SVR rates of 99% have been reported with sofosbuvir-velpatasvir or glecaprevir-pibrentasvir for initial treatment of individuals with HCV genotype 2. [ 16, 17, 18, 19]
What is the AASLD-IDSA HCV guidance?
The following is a summary of the AASLD-IDSA HCV Guidance for adults with HCV genotype 2 infection who failed prior DAA therapy , including those without cirrhosis and those with compensated cirrhosis. [ 24, 25, 26] For these purposes, compensated cirrhosis is defined as Child-Turcotte-Pugh class A and decompensated cirrhosis as Child-Turcotte-Pugh class B or class C. The AASLD-IDSA HCV Guidance for retreatment is no longer genotype specific, but instead emphasizes a pangenotypic approach to retreatment based on the prior treatment regimen. In addition, the AASLD-IDSA HCV Guidance no longer includes recommendations for the retreatment of persons who experienced prior treatment failure with interferon-based therapy, including interferon plus first-generation protease inhibitors ( telaprevir , boceprevir ); these individuals have robust cure rates with modern DAA regimens similar to that observed with treatment-naïve persons. The recommended retreatment regimens are based on prior regimen failure and listed by evidence level; when the evidence level is considered equivalent, the regimens are listed alphabetically.
What is genotype 2?
In the United States, genotype 2 accounts for approximately 13 to 15% of all hepatitis C virus (HCV) infections. [ 1] In the era before direct-acting antiviral agents (DAAs), sustained virologic response rates at 12 weeks post-treatment (SVR12) were relatively higher in persons with genotype 2 HCV than those with genotype 1, 3, or 4 HCV. Thus, data regarding retreatment of individuals with genotype 2 in whom prior therapy failed are limited. The following discussion regarding initial treatment and retreatment of persons with genotype 2 chronic HCV assumes the individual and their clinician have already made the decision to proceed with hepatitis C therapy. This topic review does not address the treatment of HCV genotype 2 in persons with decompensated cirrhosis, severe renal impairment (or end-stage renal disease), or post-liver transplantation.
What are the factors that influence the choice of regimen and duration of therapy?
For initial treatment of persons with chronic HCV genotype 2 infection, three major factors influence the choice of regimen and duration of therapy: (1) the presence or absence of cirrhosis, (2) drug interactions, and (3) medication cost and/or insurance considerations.
Is genotype 2 retreatment less clinical experience than genotype 1?
Accordingly, less clinical experience exists with retreatment of patients with genotype 2 than with genotype 1 infection. In particular, very limited data exist with retreatment of genotype 2 patients with cirrhosis.
What percentage of people with hepatitis C have genotype 2?
In the United States, about 13 to 15 percent of people with hepatitis C have genotype 2. Genotype 1 is the most common. Trusted Source. and affects up to 75 percent of people with hepatitis C. Knowing your genotype impacts your treatment recommendations.
How many genotypes of hepatitis C are there?
Once you receive a hepatitis C diagnosis, and before you start treatment, you’ll need another blood test to determine the genotype of the virus. There are six well-established genotypes (strains) of hepatitis C, plus more than 75 subtypes. Blood tests provide specific information about how much of the virus is currently in your bloodstream.
What are the complications of genotype 2?
Serious complications can include cirrhosis, liver cancer, and liver failure. Statistics for complications of genotype 2 on its own are lacking. For all types of hepatitis C in the United States, the Centers for Disease Control and Prevention (CDC) Trusted Source. estimates that:
How long does it take to get rid of hepatitis C?
Often, you’ll take a combination of two antiviral drugs for 8 weeks or longer. There’s a good chance you’ll have a sustained virologic response (SVR) to oral drug therapy.
How long does it take for hepatitis C to show symptoms?
Most people with hepatitis C experience no symptoms or only mild symptoms, even when the liver is becoming damaged. The first six months after infection is defined as acute hepatitis C infection. This is true whether you have symptoms or not.
Why can't you repeat a blood test?
This test won’t have to be repeated because the genotype doesn’t change. Although it’s uncommon, it’s possible to be infected with more than one genotype. This is called a superinfection.
What does a follow up blood test reveal?
Follow-up blood testing will reveal how well you’re responding to treatment. Note: Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved. However, a doctor can still use the drug for that purpose.
What is genotype 3?
Genotype 3 is associated with a higher risk of liver cancer, faster development of fibrosis and cirrhosis, and mortality. Because of this, it’s important to determine which HCV genotype someone has if they’ve been diagnosed with the HCV infection.
How long does it take to get rid of HCV?
HCV usually isn’t treated with prescription medications unless it’s chronic. Treatment typically lasts between 8 and 24 weeks and includes combinations of antiviral drugs that attack the virus.
What is the cause of hepatitis C?
It’s caused by the hepatitis C virus (HCV). This disease has several genotypes, also called strains, each with a specific genetic variation. Some genotypes are easier to manage than others. In the United States, hepatitis C genotype 3 is less commonly contracted than genotype 1, but genotype 3 is also harder to treat.
What is viral load?
Your viral load refers to the amount of the virus that’s in your blood. Some people’s bodies may fight off HCV without treatment, while others may develop the chronic form of the disease. Genotype testing will also be part of the additional blood tests.
What does it mean when you have antibodies?
If antibodies are present, it indicates that you’ve been exposed to the virus at some point. But this doesn’t necessarily mean you have HCV. If you test positive for HCV antibodies, your doctor will order additional blood tests to determine if the virus is active and what your viral load is.
How many subtypes are there in each genotype?
Each genotype has its own subtypes — totaling more than 67 overall. Because each genotype may be treated with different medications for different durations, it’s important to identify which genotype a person has. The genotype of the infecting virus doesn’t change.
Is it important to know what genotype of HCV is?
With the HCV infection, it’s important to know which genotype a person has. This will allow a healthcare provider to give the best care by creating a treatment plan specific to the type of HCV. Overall, this is a relatively new component of HCV treatment.
What is the significance of genotypes in hepatitis C?
Rather, genotype is of clinical importance principally as a factor in selecting the appropriate HCV medications for treatment.
What is the genotype of HCV?
An important variable for all patients with chronic hepatitis C virus ( HCV) is the "genotype" of HCV with which they are infected. This is the strain of the virus to which they were exposed when they were infected, often many years prior to their evaluation, and it is determined by a simple blood test. Genotypes of HCV are genetically distinct groups of the virus that have arisen during its evolution. ( 1) Approximately 75% of Americans with HCV have genotype 1 of the virus (subtypes 1a or 1b), and 20-25% have genotypes 2 or 3, with small numbers of patients infected with genotypes 4, 5, or 6. ( 2) Most patients with HCV are found to have only one principal genotype, rather than multiple genotypes. ( 3, 4, 5) Genotype 4 is much more common in Africa than in many other parts of the world, genotype 6 is common in Southeast Asia, and each area of the world has its own distribution of genotypes. ( 6)
What is the best treatment for hepatitis C?
Liver transplantation. If you have developed serious complications from chronic hepatitis C infection, liver transplantation may be an option. During liver transplantation , the surgeon removes your damaged liver and replaces it with a healthy liver.
What to do if you have hepatitis C?
If you receive a diagnosis of hepatitis C, your doctor will likely recommend certain lifestyle changes. These measures will help keep you healthy longer and protect the health of others as well:
How old do you have to be to get tested for hepatitis C?
The U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C, even those without symptoms or known liver disease. Screening for HCV is especially important if you're at high risk of exposure, including: Anyone who has ever injected or inhaled illicit drugs.
How long does it take for hepatitis C to clear?
The goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after you complete treatment.
How to prevent liver damage?
Avoid medications that may cause liver damage. Review your medications with your doctor, including over-the-counter medications you take as well as herbal preparations and dietary supplements. Your doctor may recommend avoiding certain medications. Help prevent others from coming in contact with your blood.
How long does it take to cure hepatitis C?
As a result, people experience better outcomes, fewer side effects and shorter treatment times — some as short as eight weeks.
How to prepare for a liver appointment?
Because appointments can be brief and because there's often a lot to discuss, it's a good idea to be well prepared. To prepare, try to: Review your medical record. This is particularly important if you are seeing a liver specialist (hepatologist) for the first time after finding out you have hepatitis C.
What are the factors that affect the choice of treatment for HCV genotype 1?
For individuals with chronic HCV genotype 1 infection, the main factors that influence the choice and duration of therapy are cirrhosis status and prior treatment experience . With the use of certain regimens for persons with HCV genotype 1a, namely elbasvir-grazoprevir, the genotype 1 subtype (1a or 1b) also impacts the choice of therapy, as elbasvir-grazoprevir is only recommended for persons with HCV genotype 1a who do not have baseline NS5A resistance-associated substitutions (RASs). In addition, the HCV RNA level and the patient’s HIV status can impact the duration of ledipasvir-sofosbuvir, but does not affect the duration of other regimens. Finally, the cost of the regimen, insurance coverage, and provider preference can play a major role in the regimen choice. The following treatment recommendations are based on the AASLD-IDSA HCV Guidance for initial treatment of adults with HCV genotype 1 and for retreatment of adults in whom prior therapy failed, including those with HCV genotype 1. [ 4, 5]
What are the factors that influence the choice of treatment for HCV?
For treatment-naïve adults with chronic HCV genotype 1 infection, the main factors that influence the choice and duration of therapy are (1) presence or absence of cirrhosis, and (2) medication cost or insurance considerations. In the case of elbasvir-grazoprevir use, the HCV genotype 1 subtype (1a or 1b) is also important, as the presence of specific baseline NS5A RASs significantly reduces SVR12 rates in persons with HCV genotype 1a. [ 10, 11, 12] In cases where the genotype 1 subtype is not known, the individual should be treated as HCV genotype 1a. The baseline HCV RNA level generally does not influence the treatment choice or duration, except in treatment-naïve noncirrhotic patients in whom 8 or 12 weeks of ledipasvir-sofosbuvir is being considered. [ 13] Additional data from the HCV-TARGET registry and the Veterans Affairs National Healthcare System demonstrated comparable SVR rates of 94 to 98% for adults without cirrhosis treated with either 8 or 12 weeks of ledipasvir-sofosbuvir if the baseline HCV RNA levels were less than 6 million IU/mL. [ 14, 15, 16] In addition to the factors noted above, drug interactions may also influence the choice of therapy, particularly for individuals with HIV coinfection who are taking antiretroviral medications. Of note, individuals with HCV and HIV coinfection, depending on their specific antiretroviral therapy, are eligible for most of the same regimens for initial treatment of genotype 1 as for persons with HCV monoinfection, except that persons with HIV should not receive (1) any 8-week option of ledipasvir-sofosbuvir, or (2) the 8-week option of glecaprevir-pibrentasvir if cirrhosis is present. [ 11, 12, 17, 18]
What is the AASLD-IDSA HCV guidance?
The following is a summary of the AASLD-IDSA HCV Guidance for adults with HCV genotype 1 infection who are treatment experienced and failed prior DAA therapy , including those without cirrhosis and those with compensated cirrhosis. [ 5, 28, 29, 30] For individuals with cirrhosis, the AASLD-IDSA HCV Guidance defines compensated cirrhosis as Child-Turcotte-Pugh class A and decompensated cirrhosis as Child-Turcotte-Pugh class B or class C. The AASLD-IDSA HCV Guidance for retreatment is no longer genotype specific, but instead emphasizes a pangenotypic approach to retreatment based on the prior treatment regimen. In addition, the AASLD-IDSA HCV Guidance no longer includes recommendations for the retreatment of persons who experienced prior treatment failure with interferon-based therapy, including interferon plus first-generation protease inhibitors ( telaprevir, boceprevir ); these individuals have robust cure rates with modern DAA regimens similar to that observed with treatment-naïve persons. The recommended regimens in the tables below are based on prior regimen failure and listed by evidence level; when the evidence level is considered equivalent, the regimens are listed alphabetically.
What is genotype 1?
In the United States, genotype 1 hepatitis C virus (HCV) accounts for approximately 70 to 75% of all HCV infections. [ 1] . Accordingly, treatment of genotype 1 has the most extensive data and highest clinical relevance for hepatitis C treatment issues in the United States. In recent years, multiple studies using direct-acting antiviral (DAA) ...
What is the phase 3 of POLARIS-2?
POLARIS-2: In this phase 3, open-labeled trial, individuals with chronic HCV genotype 1, 2, 3, or 4 infection who were naïve to DAA therapy (prior peginterferon and ribavirin allowed) were randomized to receive either 8 weeks of sofosbuvir-velpatasvir-voxilaprevir or 12 weeks of sofosbuvir-velpatasvir. [ 27] Among the 941 participants, 18% had compensated cirrhosis and 49% had HCV genotype 1 infection. Sustained virologic response (SVR) occurred in 95% and 98% in sofosbuvir-velpatasvir-voxilaprevir and sofosbuvir-velpatasvir arms, respectively. Notably, SVR occurred in 90% of persons with cirrhosis in the 8-week arm compared with 99% in the 12-week sofosbuvir-velpatasvir arm. [ 27] The investigators concluded that this study did not establish sofosbuvir-velpatasvir-voxilaprevir for 8 weeks was noninferior to sofosbuvir-velpatasvir for 12 weeks. [ 27]