Hepatitis C Management

Ask The Experts

Question:

Can you please explain the difference in stopping rules for genotypes 2 and 3? Why aren’t they the same as genotype 1? Aren’t we wasting money and resources this way?

Official clinical practice guidelines currently recommend treating patients with these genotypes for 24 weeks, without checking viral response and without using the stopping guidelines for genotype 1. These original recommendations were made using studies that showed patients still had some chance (25%) of SVR with these genotypes, even if there was not the standard 2 log drop by 12 weeks.

However, I suspect there will be changes made to clinical practice guidelines in the coming years. There have been many more studies looking at this issue and practices seem to be evolving with the new data. It also appears that patients with genotype 3 and a high viral load may be significantly more difficult to treat than patients with G3 and a low viral load or G2 and a high viral load. This is leading some clinicians to treat these patients as though they have genotype 1 from the beginning of their treatment.

You will also see data suggesting that longer treatment (48 weeks) can be considered for certain patients based on their early viral kinetics.

Stay tuned for changes!