Treatment Of Hcv Genotype 3 With Compensated Cirrhosis: Sofosbuvir Plus Ribavirin
SOF plus RBV for 12 weeks is not recommended for treatment of cirrhotic patients with HCV genotype 3 infections. The overall SVR rates in naive cirrhotic patients treated for 12 weeks ranged from 21 to 34% . Two trials found that SOF plus RBV for 12 weeks for naive patients with cirrhosis resulted in SVR rates of 21% and 34% (1212. Lawitz E, Mangia A, Wyles D, Rodriguez-Torres M, Hassanein T, Gordon SC, et al. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med 2013 368: 18781887, doi: 10.1056/NEJMoa1214853.,1313. Jacobson IM, Gordon SC, Kowdley KV, Yoshida EM, Rodriguez-Torres M, Sulkowski MS, et al. Sofosbuvir for hepatitis C genotype 2 or 3 in patients without treatment options. N Engl J Med 2013 368: 18671877, doi: 10.1056/NEJMoa1214854.
Among treatment-experienced patients with cirrhosis and HCV genotype 3 infection treated with SOF plus RBV for 12 weeks, the SVR rates are around 20%, similar to those observed in naive patients . Only one study, the Fusion trial, assessed SOF plus RBV for 12 weeks in treatment-experienced patients with cirrhosis, including 26 patients, and only 20% achieved SVR .
What Should I Do If I Think I Have Been Exposed To Viral Hepatitis
- If you may have been exposed to hepatitis A or B, your doctor may recommend getting a vaccine to keep you from getting the infection.22,23
- The CDC recommends that people who are exposed to hepatitis C, such as a health care worker after an accidental needle stick, get tested for hepatitis C infection.18 New antiviral medicines for hepatitis C cure most of the people who take them. If you have health insurance, ask about your copay and coinsurance and which medicines are covered under your plan.
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Challenges In Treating Genotype 3 Hepatitis C Virus
In the United States, an estimated 3 to 4 million people have chronic hepatitis C virus infection.1 Among the 6 known genotypes of HCV, genotype 1 is the most prevalent and accounts for three-quarters of cases.1 Between 13% and 15% of HCV cases are genotype 2 , and approximately 10% are genotype 3 .2,3 Globally, the distribution is different, with GT3 HCV accounting for 75% of HCV infections in South Asia, 25% in Western Europe, and 10% to 20% of all HCV infections in North America.4
Early clinical trials of interferon monotherapy or IFN plus ribavirin suggested that patients with GT2 and GT3 were easier to cure than individuals with GT1.5-7 However, these early trials of IFN-based regimens grouped patients with GT2 and GT3 together and reported pooled outcomes data.4 When clinical trials for the novel IFN-free direct-acting antiviral therapies assessed outcomes by genotype, the findings upended conventional wisdom and showed GT3 was actually more difficult to cure than the other genotypes.2,4
Treatment-Naive Patients Without Cirrhosis
For treatment-naive patients with GT3 who do not have cirrhosis, recently updated collaborative guidelines from the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases recommend starting with an 8-week course of Mavyret or with a 12-week course of Epclusa .8 Mavyret and Epclusa are fixed-dose combination oral tablets.
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Chronic Infection Of Hepatitis C
Chronic Hep C is generally considered to be any infection that has lasted more than six months. At this point, the viral load has built up in the bloodstream and is beginning to cause more noticeable damage to the liver. While some of the symptoms that are experienced can be attributed to toxins building up in the body, these are all as a direct result of a chronic infection of Hep C.
At this stage, patients will begin to recognize a basic feeling of being unwell and can also show other symptoms that are associated with the disease. These can include:
- Feeling sick
- Cognitive and memory problems
- Persistent aches in the joints
Research shows that continued progression of chronic infections of Hepatitis C can also lead to cirrhosis of the liver and liver cancer.
Hepatitis C With Decompensating Cirrhosis
Until recently, doctors considered a liver transplant to be the only effective treatment for decompensating cirrhosis.
However, a recent small-scale study found that a course of direct-acting antiviral medication may improve some peoples liver function enough to take them off the waiting list for a liver transplant. People with liver disease that was less severe had a higher likelihood of removal from the list.
However, recent Canadian guidelines warn that certain antiviral drugs may potentially be dangerous for people with severe decompensating cirrhosis. This is because the liver is less able to filter out toxic waste, meaning that the antiviral drugs could accumulate to toxic levels. Doctors must weigh up the benefits against the risks.
When a person is waiting for a liver transplant, a doctor will assess whether or not to pause antiviral treatment.
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Is Genotype 3 Of The Hepatitis C Virus The New Villain
Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
Potential conflict of interest: F.N. is consultant for Roche and MSD, is advising Gilead, Janssen, MSD, Novartis and Boehringer Ingelheim, and has received unrestricted research grants from Roche, Gilead and Novartis.
The authors’ quoted work is supported by Swiss National Science Foundation grant numbers 314730-130498 and 314730-146991 and by the Foundation for Liver and Gut Studies, Geneva, Switzerland.
Factors To Consider Prior To Choosing Initial Treatment Regimen
For persons chronically infected with genotype 3 hepatitis C, four factors should be considered when choosing the initial treatment regimen and duration: the presence of baseline NS5A-resistance-associated substitution Y93H , presence or absence of cirrhosis, drug interactions, and cost and/or insurance considerations.
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Efficacy And Safety Of Generic Daclatasvir + Sofosbuvir Ribavirin In Treatment Of Genotype 3 Infected Hepatitis C Patients
Muhammad Umar1 Tayyab Saeed Akhter1 Samar Saleem1 Shoaib Khokhar1
1Centre for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi Medical College and Allied Hospitals ,
Murree 47150, Pakistan .
Received:First Decision:Revised:Accepted:Science Editor:Copy Editor:Production Editor:
© The Author 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Hcv Genotype 3 And Liver Fibrosis Progression
Epidemiological evidence also shows that the genotype 3 is associated with increased rates of endstage liver disease in well-defined populations . In a large retrospective/prospective population-based cohort of Alaskans with chronic HCV infection, genotype 3 was an independent risk factor for endstage liver disease when compared to the genotype 2 infection with a hazard ratio of 3.3 . In another study, genotype 3 infection was associated with severe liver disease, as assessed by clinical, radiological, or histological means in HCV-infected drug users referred to hepatology centers in France between 2001-2007 with an OR of 1.6 in multivariate analysis. However, the latter study was cross-sectional, had a high rate of missing values, and did not require histological proof of liver disease, and therefore its conclusions must be cautiously interpreted in the light of further research demonstrating a similar effect.
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Clinical Significance Of Hepatitis C Genotypes
Genotype generally has not been found in epidemiological studies to play a large rolein liver disease progression due to HCV. Rather, genotype is of clinical importanceprincipally as a factor in selecting the appropriate HCV medications for treatment. Please see the HCV Treatment Considerations for more information.
Genotypes Of Hepatitis C
Which genotype of hepatitis C somebody has dictates what treatment is available to them. If you are living with genotype 3, then there is evidence that liver disease might progress more quickly.
The ability of the virus to mutate has resulted in the existence of different genetic variations of HCV. These are called genotypes. The different genotypes are often, but not exclusively, related to different parts of the world.
Genotypes 1, 2 and 3 have a worldwide distribution. Types 1a and 1b are the most common, accounting for about 60% of global infections. They predominate in Northern Europe and North America and in Southern and Eastern Europe and Japan. Genotype 2 is less frequently represented than type 1. Genotype 3 is endemic in south-east Asia. Genotype 4 is principally found in the Middle East, Egypt, and central Africa. Type 5 is almost exclusively found in South Africa. The most common genotypes found in the UK are 1 and 3.
It is still unclear whether or not the type of virus affects the progression of the disease. If it does it is not thought to present any real cause for concern. However, HCV genotype does influence response to treatment. If you are considering treatment it is very important to know which genotype you are actually infected with.
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What Is The Prognosis For Someone Who Has Hepatitis C
You can continue to lead an active life even if you are diagnosed with hepatitis C. People with the disease can work and continue their regular daily activities. However, it is very important that you see a specialist as soon as you are diagnosed with hepatitis C. There are many treatments available that can cure the virus.
To maintain a healthy lifestyle, patients should:
Which Genotype Do You Have
In the U.S., genotype 1 is the most common. It makes up about 75% of all U.S. cases. The other 25% are mostly genotypes 2 or 3. A few Americans may have genotypes 4, 5, or 6. Genotype 4 is most common in Africa, while genotype 6 is most common in Southeast Asia.
Your doctor can test your blood to find out whether you have hepatitis C and which genotype it is. Most people have one. But some have more than one. Your doctor might call this âmixed infection.â
Youâre more likely to have a mixed infection if you:
- Got blood products like platelets, plasma, red cells, or whole blood many years ago
- Received blood products in a place that doesnât check blood for hep C
- Are on kidney dialysis
- Inject drugs with shared or unsterilized needles
Keep in mind that you might carry the hep C virus even if you donât have symptoms of hepatitis. Once you know your status and genotype, you and your doctor can decide on a treatment plan.
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Hepatitis C: What Is It
Hepatitis means inflammation of the liver. Hepatitis C is a viral infection that causes inflammation that results in fibrosis, or scar tissue in the liver. This virus not only involves the liver, but it affects the patients entire body and may cause extra-hepatic manifestations such as kidney disease, issues with skin problems, cryoglobulinemia, vascular disease, insulin resistance and many other systemic health conditions.
When a person is exposed to the virus, his body will develop antibodies. Approximately 15-40% of patients have immune systems that fight off the disease in this acute stage without any treatment. The majority, however, progress to chronic hepatitis C which may last a lifetime unless treated. Once exposed, even when cured, the patient will have antibodies for life. Unfortunately these antibodies are not protective and if the person is exposed to the virus again, he may become infected all over again.
Severity Of Hepatitis C Virus Infection Positively Correlates With Circulating Microrna
1Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
2Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Introduction. Hepatitis C virus causes acute and chronic hepatitis infection predomination in India. The infectious phase of the virus requires various host factors for its survival and subsequent viral particle production. Small RNA molecules like microRNA-122 are one such factor mostly present in the liver and play a supportive role in viral replication. Objective. In this study, diagnostic potential of miR-122 is evaluated in the sera of chronic hepatitis C patients. Methods. miRNAs were isolated from the sera samples of patients as well as controls and miR-122 expression was quantified by real-time PCR. Results. A significant augmentation was observed in the level of circulating miR-122 in patients compared to controls with ROC value of . Interestingly, miR-122 level also depicted a significant positive correlation with serum ALT , AST , and viral load . . The study thus unveiled the role of miR-122 as a plausible diagnostic biomarker during HCV genotype-3 infection in India.
2. Materials and Methods
2.1. Study Subjects
2.2. Detection of Anti-HCV Antibody in Patients Serum
2.3. Liver Function Tests of Patient Samples
2.4. miRNA Isolation and Detection
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How Is Viral Hepatitis Prevented
Prevention of hepatitis involves measures to avoid exposure to the viruses, using immunoglobulin in the event of exposure, and vaccines. Administration of immunoglobulin is called passive protection because antibodies from patients who have had viral hepatitis are given to the patient. Vaccination is called active protection because killed viruses or non-infectious components of viruses are given to stimulate the body to produce its own antibodies.
Avoidance of exposure to viruses
Prevention of viral hepatitis, like any other illness, is preferable to reliance upon treatment. Taking precautions to prevent exposure to another individuals blood , semen , and other bodily secretions and waste will help prevent the spread of all of these viruses.
Use of immunoglobulins
Immune serum globulin is human serum that contains antibodies to hepatitis A. ISG can be administered to prevent infection in individuals who have been exposed to hepatitis A. ISG works immediately upon administration, and the duration of protection is several months. ISG usually is given to travelers to regions of the world where there are high rates of hepatitis A infection and to close or household contacts of patients with hepatitis A infection. ISG is safe with few side effects.
Individuals at increased risk of acquiring hepatitis A are:
Some local health authorities or private companies may require hepatitis A vaccination for food handlers.
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Hepatitis C Cure Rate Tops 90% In Hard
The sofosbuvir-based therapy was reviewed in a real-life Scandinavian study
Hepatitis C patients with hard-to-treat genotype 3 showed sustained virologic response of greater than 90% in a real-life study of a therapy based on the direct-acting antiviral drug sofosbuvir
HCV genotype 3 has been linked to increased risk of developing cirrhosis and hepatocellular carcinoma compared to other versions of the virus, previous studies have found.
Chronic hepatitis C virus genotype 3 infection with advanced liver disease has emerged as the most challenging to treat, researchers led by Olav Dalgard , MD, Ph.D. at Akershus University Hospital in Oslo, Norway noted in their study.
The research team from Norway, Denmark, Finland and Sweden chose patients from those four countries for the retrospective cohort study. About 100,00 people in Scandinavia are infected with HCV and half of them have genotype 3, according to the paper.
Genotype 3 is common all over Scandinavia and in the UK, Dalgard told MD Magazine in an email. We dont know why, but genotype 3 has its origin in South Asia and both the UK and Norway and Denmark have large immigrant populations from Pakistan.
Only a few studies have reported the effect of sofosbuvir-based treatment in genotype 3 patients with advanced liver disease in a real-life setting, the authors said.
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Sofosbuvir Plus Pegylated Interferon/ribavirin
The combination of SOF plus PegIFN/RBV for 12 weeks is the only interferon based therapy recommended by the EASL and AASLD guidelines for the treatment of HCV genotype 3 infection .
In naive non-cirrhotic patients, SOF plus PegIFN/RBV for 12 weeks resulted in an overall SVR of 92-100% . However, efficacy data is scarce: few patients were included in clinical trials and only three studies evaluated the SVR rates in this population. The phase II study included 25 naive non-cirrhotic patients treated with SOF plus PegIFN/RBV for 12 weeks, reaching an overall SVR rate of 92%, but no SVR data according to specific genotype is available 70033-1.). Another phase II study included 17 patients treated with SOF plus PegIFN/RBV for either 12 or 8 weeks and the overall SVR rate was 100% in both arms . The Boson phase III study included 71 naive non-cirrhotic patients with HCV genotype 3 infection treated with SOF plus PegIFN/RBV for 12 weeks, achieving an overall SVR rate of 96% .
In non-cirrhotic patients, including naive and with previous failure to PegIFN/RBV, SOF plus PegIFN/RBV for 12 weeks resulted in high SVR rates . It must be noted that non-significant differences in SVR rates were observed among naive and treatment-experienced patients, but these data need to be cautiously analyzed, since only small cohorts were included in the studies.
Contaminated Needles And Infected Blood
You can get hepatitis C from sharing contaminated needles, syringes and other injecting equipment during recreational drug use. Banknotes and straws used for snorting may also pass the virus on.
Being exposed to unsterilised tattoo and body piercing equipment can also pass hepatitis C on. Occasionally, you can get it from sharing a towel, razor blades or a toothbrush if there is infected blood on them.
Hepatitis C infection is also passed on in healthcare settings, from needle stick injuries or from medical and dental equipment that has not been properly sterilised. In countries where blood products are not routinely screened, you can also get hepatitis C by receiving a transfusion of unscreened blood and blood products.
You can prevent hepatitis C by:
- never sharing needles and syringes or other items that may be contaminated with infected blood
- only having tattoos, body piercings or acupuncture in a professional setting, where new, sterile needles are used
- following the standard infection control precautions, if youre working in a healthcare setting.
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