- Previous: Interferon-Free Hep C Combos to Watch for in 2013
- Next: Discovery of Genetic Protein that Impacts Hepatitis C Recovery
Treatment for Hepatitis C Genotype 2
January 4, 2013
While the standard treatment has not yet changed for Hepatitis C genotype 2, better options are coming soon for this common viral strain.
By Nicole Cutler, L.Ac.
Infecting an estimated 170 million people worldwide, the Hepatitis C virus is a leading cause of chronic liver disease. Treatment for Hepatitis C has recently improved with the addition of two U.S. Food and Drug Administration (FDA)-approved medications; however, many don’t realize that the improved triple drug regimen is primarily intended for infection with Hepatitis C genotype 1. For those with Hepatitis C genotype 2, the standard treatment remains pegylated interferon and ribavirin – a drug combination that is intolerable for many people.
The Hepatitis C genotype describes the viral strain, and does not change after initial infection. There are 6 genotypes of Hepatitis C, half of which are common in the United States. The strains typically encountered in the U.S. are:
- Hepatitis C genotype 1
- Hepatitis C genotype 2
- Hepatitis C genotype 3
Differentiation is important because treatment responses and, thus medication recommendations, are different for each genotype. Because nearly three quarters of infected Americans have Hepatitis C genotype 1, this strain is the primary recipient of pharmaceutical research efforts. Constituting the next largest proportion of Hepatitis infections in the U.S., at least 10 percent of those with Hepatitis C have genotype 2.
Before protease inhibitors were added to the standard Hepatitis C treatment duo of pegylated interferon and ribavirin, the response rates between genotype 1 (g1) and genotype 2 (g2) were dramatic:
- Hepatitis C g1 was considered to be the hardest to treat with a 50 percent success rate on interferon and ribavirin treatment.
- Hepatitis C g2 was considered to be a better strain to be infected with since interferon and ribavirin helped 65 to 80 percent of those infected clear the virus.
- Another advantage of Hepatitis C g2 was that the course of treatment was typically half the amount of time required to treat Hepatitis C g1.
However, adding a third drug (a protease inhibitor) to Hepatitis C treatment has substantially improved the success odds for treating g1. The protease inhibitors attack the Hepatitis C virus directly and keep it from reproducing. Those with Hepatitis C g1 receiving treatment for the first time now have a 75 to 80 percent chance of clearing the virus on the triple drug regimen, comparable to the success rates for g2 on just interferon and ribavirin.
Unfortunately, the two protease inhibitors on the market, Victrelis (boceprevir) and Incevik (telaprevir), are approved to be combined with pegylated interferon and ribavirin – only for Hepatitis C g1. Omission of Hepatitis C g2 from triple drug therapy has prevented any major advances for this viral strain. However, research to improve treatment for g2 is finally catching up. The potential exists for off-label use of one of the protease inhibitors and improved treatments for all Hepatitis C genotypes appear to be on the rapidly-approaching horizon. Examples include:
- Data from a small, single, randomized trial suggest some efficacy of telaprevir against Hepatitis C g2.
- Still in development, the nucleotide analogue polymerase inhibitor PSI-7977 by Pharmasett demonstrated an extremely high efficacy against Hepatitis C g2 – without interferon.
For those with g2 waiting for advances in treating their Hepatitis C strain, the possibility of adding telaprevir to Hepatitis C treatment or a future approval of PSI-7977 may seem overly hopeful. Nonetheless, the medical community is finally recognizing the need for improving Hepatitis C treatment for all genotypes – including genotype 2.
http://gastroenterology.jwatch.org/cgi/content/full/2011/610/1, Telaprevir Isn’t Useful for All HCV Genotypes, Atif Zaman, MD, MPH, Retrieved December 29, 2012, Gastroenterology, June 2011.
http://www.healio.com/hepatology/chronic-hepatitis/news/print/infectious-disease-news/%7BDBBB5373-0A54-4D6C-A5BC-A0E145162A19%7D/Sofosbuvir-effectively-treated-patients-with-HCV-genotypes-2-3-in-phase-3-study, Sofosbuvir effectively treated patients with HCV genotypes 2, 3 in phase 3 study, Retrieved December 30, 2012, Healio, 2012.
http://www.hepatitis.va.gov/provider/guidelines/2012HCV-supplement.asp, Update on the Management and Treatment of Hepatitis C Virus Infection, Retrieved December 30, 2012, US Department of Veteran Affairs, 2012.
http://www.hepatitis.va.gov/patient/diagnosis/labtests-hepatitisC-genotype.asp, Hepatitis C Genotype, Retrieved December 29, 2012, US Department of Veteran Affairs, 2012.
http://www.hivandhepatitis.com/2010_conference/icaac/docs/1001_a.html, Three-quarters of People with Hepatitis C in the U.S. Have Hard-to-treat Genotype 1, Liz Highleyman, Retrieved December 30, 2012, hivandhepatitis.com, 2012.
http://www.mayoclinic.org/hepatitis-c/treatment.html, Hepatitis C – Treatment, Retrieved December 29, 2012, Mayo Foundation for Medical Education and Research, 2012.
http://www.ncbi.nlm.nih.gov/pubmed/22212584, What’s New in HCV Genotype 2 Treatment, Mangia A, et al, Retrieved December 29, 2012, Liver International, February 2012.
Posted by admin on January 4, 2013
Like this hepatitis article? Sign up today for our FREE Research & Treatment News e-newsletter from Hepatitis-Central.com! You'll receive the latest news on hepatitis treatments, clinical trials, social issues and important breakthroughs.
Some of our most commonly asked questions and our answers to them.
Learn about the Hepatitis C Virus (HCV).
Information about the transmission of Hepatitis C.
You'll find links to a comprehensive symptoms list, as well as various studies and discussions about Hepatitis C symptoms.
Learn about the conventional medical treatments used to fight Hepatitis C.
Numerous links to studies, info sheets, FAQs, and analysis of Ribavirin/Rebetron medicines.
Alternative methods of treatment due to side effects and dissatisfication with current medical treatments.
A number of herbal products useful in the management of liver disease.
Receive the latest news on hepatitis treatments, clinical trials, social issues and important breakthroughs.
Learn about Hepatitis C Genotypes and their variants.
A state-by-state and worldwide reference listing physicians who treat HCV, including an email link to submit your physician for inclusion.
Convenient links to other sites external to Hepatitis-Central.
A Bulletin Board for discussions on hepatitis, treatments, etc.
An easy way to get involved in urging our government to do more for Hepatitis C awareness and treatment research.
Numerous links to various Hepatitis B related information, including transmission, symptoms and treatment.
A comprehensive resource of information relating to the liver biopsy.
Many discussions and analyses of cirrhosis, including causes, complications, pathology, symptoms, and much more.
Commonly used medical terms and definitions.
What they are and what they mean. Helps you interpret & understand all the various hepatitis lab tests likely to be encountered.
Liver Cancer/Hepatocellular Carcinoma studies, info sheets, FAQs, and analysis.
An exhaustive list of links to studies, info sheets, FAQs, and analysis of the various drugs used to treat liver disease.
Provides detailed information on how to analyze and interpret viral load numbers as well as a link to a convenient Viral Load Chart.
Provides information regarding the best known liver supporting supplements.
Provides information regarding the best known milk thistle supplements.
Learn more about various Hepatitis C related topics, including HCV, Ascites, Biopsies, and much more.
Recommended reading for those interested in hepatitis information.