3. Proportion of Hepatitis C genotypes in
India
• 6 genotypes of HCV infection have been described and
Hepatitis C virus (HCV) genotypes help to tailor the
treatment response, but their influence on the disease
severity and association with hepatic steatosis is not well
understood.
• The prevalence of HCV genotypes determine their
correlation with the histopathological severity of liver
disease.
• Genotype 1 virus represents the most common cause of
HCV infection worldwide
• In India, Genotype 3 has been seen as the most prevalent
genotype in patients with chronic hepatitis C in North and
Central India and this is associated with significant hepatic
steatosis and fibrosis.
9. Therapy of Hepatitis B
• IFN-α and LAM have been approved for children
with hepatitis B virus (HBV) infection.
• 2 different treatment strategies are applicable in
both HBeAg-positive and negative CHB patients:
1. treatment with PEG IFN-α and
2. long-term treatment with NUCs [nucleoside
analogs].
• There are several treatment options for patients, making
rational choices for the first and second line treatment
sometimes difficult.
10. Therapy of Hepatitis C
• New guidelines for genotype 1-infected patients offers
increased SVR rates, shorter duration of therapy and the
potential for cure in previously difficult-to-treat patients
• The use of the current standard of care (SoC) is dual
therapy with pegylated IFN-α and ribavirin.
• The duration of combination depends of the genotype
and level of viraemia (A).
1. Patients infected with non-HCV 1 ( mostly genotype 2 or 3)
should be treated for 6 months irrespective of the level of
viraemia (A).
2. Patients infected with genotype 1 and low level viraemia ( <
2 million copies per ml) should be treated for 6 months
3. Patients infected with genotype 1 and high level viraemia ( 2
million copies per ml) (A) are recommended 12 months
treatment.
11. Therapy of Hepatitis C
• Patients unlikely to respond to IFN monotherapy
can be identified at 3 months by persistent
elevation of serum transaminase levels and the
persisting presence of HCV RNA by PCR in serum
• This enables 40–80% of patients to be cured –
1. A sustained virological response (SVR; undetectable
viral RNA 24 weeks after cessation of treatment),
2. Resolution of liver disease in non-cirrhotic patients
and
3. An improvement in the quality of life.
12. References
1. Soo Ryang Kim, Recent Advances in the
Management of Chronic Hepatitis B, Hepat
Mon. 2011 August 1; 11(8): 601–611.
2. Mukhopadhya A 2008 Hepatitis C in India; J.
Biosci. 33 465–473].
3. J C L Booth, J O'Grady, J Neuberger, Clinical
guidelines on the management of hepatitis C,
Compiled on behalf of the Royal College of
Physicians of London and the British Society of
Gastroenterology.
