Treatment regimens for chronic hepatitis C virus genotypes 4, 5, and 6 infection in adults
- Andrew J Muir, MD, MHS
Andrew J Muir, MD, MHS
- Chief of Gastroenterology at Duke University
Six major genotypes of the hepatitis C virus (HCV) have been discovered around the world. All HCV genotypes can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure, and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. (See "Clinical manifestations and natural history of chronic hepatitis C virus infection".)
The goal of treatment is to eradicate HCV RNA, which is predicted by the achievement of a sustained virologic response (SVR), defined by the absence of HCV RNA by polymerase chain reaction 12 weeks after stopping treatment. An SVR is associated with a 99 percent chance of being HCV RNA negative during long-term follow-up and can therefore be considered cured of the HCV infection . Achievement of an SVR has also been associated with improved clinical outcomes. (See "Overview of the management of chronic hepatitis C virus infection" and "Patient evaluation and selection for antiviral therapy for chronic hepatitis C virus infection", section on 'Rationale for treatment'.)
HCV drug development has predominantly focused on genotypes 1, 2, and 3, which are the most common genotypes in Europe and North America. With the advent of direct-acting antiviral agents with broad coverage against all genotypes, patients with genotypes 4, 5, and 6 also have new treatment options.
This topic will review the antiviral treatment of patients with chronic HCV genotypes 4, 5, and 6 infections. General management of chronic HCV infection, evaluation and selection of patients for antiviral treatment, antiviral treatment of patients with other genotypes, and the treatment of acute HCV infection are discussed elsewhere:
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- EPIDEMIOLOGY OF GENOTYPES 4, 5, AND 6
- DECIDING WHEN TO TREAT
- SELECTION OF TREATMENT REGIMENS
- Genotype 4
- Genotype 5
- Genotype 6
- TREATMENT CONSIDERATIONS IN SPECIFIC POPULATIONS
- Patients with cirrhosis
- - Compensated
- - Decompensated
- Prior failure of direct-acting antiviral regimens
- Recurrence after liver transplantation
- Patients with renal impairment
- HIV-HCV co-infection
- MONITORING DURING INTERFERON-FREE REGIMENS
- ADMINISTRATION OF INTERFERON CONTAINING REGIMENS
- FOLLOW-UP AFTER TREATMENT
- SUMMARY AND RECOMMENDATIONS