Treatment of hepatitis C virus genotype 3‐infection
- 23 December 2013
- journal article
- review article
- Published by Wiley in Liver International
- Vol. 34 (s1), 18-23
- https://doi.org/10.1111/liv.12405
Abstract
The treatment of hepatitis C virus (HCV) infection with pegylated interferon (PEG-IFN) alfa and ribavirin (800 mg daily) (RBV) is the standard of care (SOC) for hepatitis C virus genotype 3-infection leading to a sustained virological response (SVR) in around 65% of patients. A better understanding of the HCV life-cycle has recently resulted in the development of several potential direct-acting antiviral drugs (DAAs) targeting viral proteins (NS3/4A protease, NS5B nucleos(t)idic and non-nucleos(t)idic polymerase, NS5A viral replication complex). First generation protease inhibitors in combination with PEG-IFN/RBV are not efficient in genotype 3-infected patients. The combination of PEG-IFN/RBV with Daclatasvir, a NS5A inhibitor for 12-24 weeks results in a SVR in around 75% while the triple combination of PEG-IFN/RBV with the oral nucleotidic polymerase inhibitor Sofosbuvir (GS-7977) for 12 weeks in naïve patients results in a SVR in more than 95%. The results of the first oral combination of Sofosbuvir and RBV for 12 weeks in genotype 3-infected patients have been rather disappointing with a slightly lower SVR than after 24 weeks of PEG-IFN: around 60%, and only 30% in patients with cirrhosis. Extending treatment from 12 to 16 weeks in treatment experienced patients doubled the SVR rate and an 80% SVR rate is expected by extending treatment to 24 weeks. The best oral combination of new DAAs is probably the combination of Sofosbuvir and a NS5A inhibitor (Daclatasvir, Ledipasvir…) for 24 weeks, which resulted in a 100% SVR rate in a limited series. The use of cyclophilin inhibitors, a host-targeted antiviral, in association with DAAs and/or RBV may also be of interest. The oral combination of new DAAs (dual or triple combination of different antivirals) or of DAAs and host targets such as cyclophilin will probably become the SOC for genotype 3-infected treatment-naïve or -experienced patients.Funding Information
- Bristol-Myers Squibb
- Gilead
- Roche
- Merck/Schering Plough
This publication has 36 references indexed in Scilit:
- HCV genotype 3 is associated with a higher hepatocellular carcinoma incidence in patients with ongoing viral C cirrhosisJournal of Viral Hepatitis, 2011
- EASL Clinical Practice Guidelines: Management of hepatitis C virus infectionJournal of Hepatology, 2011
- Hepatitis C virus genotype 3 and the risk of severe liver disease in a large population of drug users in FranceJournal of Medical Virology, 2010
- Genotype 3 is associated with accelerated fibrosis progression in chronic hepatitis CJournal of Hepatology, 2009
- Meta‐analysis: the outcome of anti‐viral therapy in HCV genotype 2 and genotype 3 infected patients with chronic hepatitisAlimentary Pharmacology & Therapeutics, 2008
- HCV genotype 2 as a risk factor for reactivation of chronic HCV infectionGut, 2005
- Peginterferon alfa-2b plus ribavirin for treatment of chronic hepatitis C in previously untreated patients infected with HCV genotypes 2 or 3*1, *2Journal of Hepatology, 2004
- Peginterferon-α2a and Ribavirin Combination Therapy in Chronic Hepatitis CAnnals of Internal Medicine, 2004
- Peginterferon Alfa-2a plus Ribavirin for Chronic Hepatitis C Virus InfectionThe New England Journal of Medicine, 2002
- Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trialThe Lancet, 2001