6 Types of Hepatitis C (Genotypes)
There are 6 different genotypes of Hepatitis C. Genotypes refer to the nature of Hepatitis C Virus or HCV. Because the virus that is infecting your liver can be of 6 different kinds it is important to select the most appropriate medication for your genotype.
The optimal medication treatment (that offers the highest chance of cure) depends on the specific genotype a person has. While other treatments might well work, there is typically the best choice.
You will find good, up to date and reliable summaries on the best treatment for your genotype at either of:
- The European Association for the Study of the Liver (EASL) latest hepatitis C treatment guidelines
- Infectious Diseases Society of America (IDSA) HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C
The executive summary is (click link for full details)
- For genotype 1 Sofosbuvir + Ledipasvir OR Sofosbuvir + Daclatasvir +/- Ribavirin
- For genotype 2 Sofosbuvir + Ribavirin OR Sofosbuvir + Daclatasvir +/- Ribavirin
- For genotype 3 Sofosbuvir + Ribavirin OR Sofosbuvir + Daclatasvir +/- Ribavirin
- For genotype 4 Sofosbuvir + Ledipasvir OR Sofosbuvir + Daclatasvir +/- Ribavirin
- For genotype 5 Sofosbuvir + Ledipasvir OR Sofosbuvir + Daclatasvir
- For genotype 6 Sofosbuvir + Ledipasvir OR Sofosbuvir + Daclatasvir
We strongly recommend getting medical advice about your best treatment option. Your individual circumstances will suggest an optimal regimen.
Check which drugs you need for your Hepatitis C genotype
Determining the treatment for a specific Hepatitis C genotype depends on other factors for each individual patient. Here are some medical factors physicians use to pinpoint the most optimal treatment:
- Fibrosis stage
- Hepascore and ELF score
- Past treatments (failed treatment with interferon, for example)
- Presence of other medications taken by the patient
You can check which drugs are best for you with our up-to-date Hepatitis C calculator. The calculator takes into account the latest clinical studies of Hepatitis C drugs and, once your data is input, will give you a recommendation about which drugs to choose for treatment. Note: Input 'EASL' guidelines which are based on the most up-to-date clinical data. Every Hepatitis C patient can access the Hepatitis C treatment calculator here.
Why two drugs for Hepatitis C treatment?
You will notice that in all cases at least two drugs are required. The reason for this relates to a phenomenon called log kill. A single drug will only kill a percentage of the virus. While that percentage might be really high, say 99.999% there will be a few survivors, and these survivors will be resistant to that medication. That's where the second medication comes in to kill off these survivors using a different mechanism to the first drug and thus achieve complete removal of the virus.
If, on the other hand, the virus would not be completely removed (even if only 0.001% would survive), there are strong changes the Hepatitis C will come back when the virus start multiplying again. The second drug is there to make sure this does not happen.
Hepatitis C Treatment Success
Treatment success is defined as a zero viral load, and typically measured at 12 or 24 weeks after stopping treatment. This is called SVR12/SVR24 (Sustained Virological Response). Some people do relapse which really means that although we could not find any virus in testing there were still a few survivors. If a patient still has a viral load of 0 a year after treatment we can be pretty confident that they are cured.
We measure the presence of Hepatitis C virus by measuring the viral load. A successful treatment with sofosobuvir and ledipasvir, for example, will decrease viral load to 0. That means that there are no more detectable viruses in your blood. Some of the patients achieve this result after only 6 weeks during their 12-week treatment. It is important not to stop the treatment when viral load is 0. There still might be some viruses under the level of detection that could again manifest into Hepatitis C. In order to assure this does not happen, then full 12-week treatment regimen must be observed.
The Impact of Cirrhosis of Hepatitis C Treatment Success
The longer someone is infected with Hepatitis C, the more liver damage occurs. This damage is repaired with fibrous scar tissue and causes cirrhosis. Cirrhosis can lead to liver failure and death and increases the risk of developing liver cancer. We measure cirrhosis using a fibroscan machine and typically talk about it in terms of an "F" scale where F0 is good and F4 indicates the presence of cirrhosis.
In simple terms, cirrhosis decreases cure rates from around 95% to around 85%, so it's easier to treat a patient before this happens. Treatment duration may also need to increase from 12 weeks to 24 weeks. This relates to the difficulty of getting the medication into the fibrous tissue which has a relatively poor blood supply.
To Ribavirin or not to Ribavirin - that is the question
We know that each medications will exhibit a log kill and can observe that with HIV (also an RNA virus) that is one medication is good, two is better, and three can be better again. See ART and HAART.
On the 25th April 2015 at the International Liver Conference a paper was presented: http://www.eurekalert.org/pub_releases/2015-04/eaft-sce042415.php which suggests that adding Ribavirin to Sofosbuvir and Daclatasvir may well turn out to be beneficial however because of the small n sample size the margin of error on these rather encouraging results is large (10%).
Ribavirin is not as toxic as PEG Interferon but is does have substantially more side effects than Sofosbuvir, Daclatasvir and Ledipasvir.