Hepatitis C Management

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A 36-year-old woman with HCV genotype 3 was treated with the standard dosage of PEG-IFN and ribavirin for 24 weeks. Her biopsy showed some fibrosis and much fat. Her body mass index is 25. She had an excellent response, with normalization of liver tests and hepatitis RNA negativity at 3 and 6 months. However, she relapsed at 3 months post-treatment and her HCV RNA turned positive. What treatment should be recommended — retreatment with the same dosage and duration, or retreatment with same dosage but for a longer duration?

Recent data suggest that patients with genotype 3 disease may not respond as well as those with genotype 2. Other poor prognostic factors for HCV-3 response are presence of less than 5% fat in the liver biopsy, advanced fibrosis, and high baseline viral load. Typically, the recommendation is to retreat with PEG-IFN and weight-based ribavirin for 48 weeks.

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