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Treatment for Hepatitis C Genotype 2

Nicole Cutler L.Ac.

January 4, 2013

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While the standard treatment has not yet changed for Hepatitis C genotype 2, better options are coming soon for this common viral strain.

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.

References:

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.

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Posted by Nicole Cutler L.Ac. on January 4, 2013

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  • KS

    I have HVC g2. I am in the last 3 weeks of Pegalated Interferon/Ribivirin treatment. I have been having more severe symptoms as the treatment progresses, chronic cough that seems to be untreatable, mouth sores, hair loss, and fatigue where it is hard to do the laundry or walk out to the mailbox. This treatment is doable but just barely. The Interferon may be the largest challenge.
    My hope is that PSI 7977 is an easier treatment for those that follow.

  • sonia maria goes

    Tenho 68 anos, fui diagnosticada aos 65. Nãouso retrovirais pela idade, Faço homeopatia. unicista e acompanho também ummedico cirurgião gastro. Mantenho cirrose leve, mas a taxa de plaquetas se mantém baixa. Faço dietas. O maior problema são as manchas tipo petéquias nas pernas..Sou enfermeira aposentada. Estou tentando levar a vida , mantendo repouso relativo, dieta, e ações que promovam alegria em minha vida,…Tenho edemas linfáticos posturais e os pés devido a idade, com pele fina, as veias as vezes devido a pressão leve dos sapatos fazem derrames..Viajo..quando posso, mas tenho até boa energia e fadiga quase nenhuma. …Monitorando exames cada 6 meses ou 3 meses quando viajo especialmente hemograma , tgo e tgp e eber tpAsplaeuqtas ficam entre 68,00 e as vezes vai quase a 80,000 no máximo. Dá para enviar um parecer….Sonia

    O fato de não beber mais nada, e não uso refrigerantes podem manter este padrão, ou não. Moro sozinha, tenho uma ajudante familiar e nunca tive que acessr atendimento hospitalar. Meidco heopatia unicista me atende por telefone, em situações especiais. No começo, quando batia as pernas fazia erisipela. Fiz 3 quadros sérios, que a homeopatia foram debelados e hoje nunca mais tive.Sonia…

  • Cynthia

    Finally hope for those of us with Genotype 2, there is always one bit of data that is lost in this discussion. Those of us who are African-American with Genotype 2 still face a high rate of failure at clearing the virus; I hope that this is included in the race to find us a cure as well.

  • Josie

    Hello! Hello! Are there any studies being done for Genotype 3? I keep hearing that 3 is “cured” more readily, if so, what drugs are “curing” it? I did treatment with Peg Intron and Ribavarin for 6 months in 2003. And relapsed 3 months later. How long do I have to wait?

    • Kamal

      Hi Josie

      I’m from India. Same happened with me. I took 72 weeks of treatment (due to RVR and EVR not achieved) and relapsed after 3 months. My doctor suggested me a drug about to be launched by Novartis and the name is “Debio 025″. You can google it for more information. You can contact me at kamalkkalra@gmail.com if you feel so.

  • john araneo

    J.A. Have chronic hcv. Been on treatment for 16, of 24 week regimen. Achieved rsr at 4 weeks. At week 16, hemoglobin dropped below 10.0. Doctor recommends drop of Ribavirin, from 1200mg./day, to 600mg./day. I don’t want to lose svr-RNA- undetectable. Have cut ribavirin to 600mg./day. Have 51/2 weeks left in treatment. Dr. wants me to go on erythropoietin, but, by the time it raises hemoglobin, I’ll be finished. What should I do? First try, with treatment. Hemoglobin at 9.0, 5 days ago, betore I dropped Ribavirin, 300 mg. HELP. John Araneo

  • john araneo

    John araneo, again. Forgot to mention, am genotype 2b. Was treatment niave’, when I started treatment, on 1/10/13. Also, hcv developed into Splenic marginal Zone Lymphoma. All cancer indicators improved dramatically, in blood tests (every 2-3 weeks), since treatment began. Cancer is indolent, and asymptomatic. Need to cure hcv, to treat cancer, if it remains, and ,at some point, becomes active. John Araneo

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