Tag: hep c genotype 1a with cirrhosis

5 minute read.

This is the ultimate hepatitis C genotypes guide in 2021.

You will learn all about genotypes that exist.

Without having to study microbiology.

Successful treatment starts with understanding hepatitis C virus (HCV) genotypes.

Author: Sara White, Doctor of Pharmacy, Masters in Public Health and is the resident expert on drug pricing, generics and healthcare accessibility.

What are hepatitis C genotypes?

First let’s define what hepatitis C genotypes are.

Second, why are they important in treating hepatitis C infections.

A genotype is a broad term to define the genetic makeup of any organism.

In this case it is the genetic code (RNA not DNA) of the hepatitis C virus or HCV.

HCV Genotypes and Subtypes

HCV has 7 genotypes and 142 subtypes according to the Center for Disease Control (CDC).

Genotypes are labeled as 1, 2, 3, 4, 5, 6 or 7.

For most folks with hepatitis C, you don’t need to worry about subtype.

This is just for general knowledge.

The genotype subtypes is usually a lower-case letter a, b, c and so on.

For example: genotype 1a, where a is the subtype.

Its important to note that each genotype subtype is a distinct hepatitis C virus.

Knowing your genotype lets your health care team know which treatment is best for you.

Why are hepatitis C genotypes important for treatment?

Genotypes tell us exactly what kind of hep C virus you have and the HCV treatment.

We don’t want to put a square peg in a round hole.

Treating hepatitis C is serious.

It needs to be done the right the first time.

Last thing you need is the HCV virus to be resistant to your treatment.

Then try again with another treatment option…if it exists.

Today, we are very lucky to have direct acting antivirals or DAAs.

DAAs work and they have a 95%+ cure rate for almost all hep C genotypes.

Why people have different hepatitis C genotypes?

Genotypes are not entirely based on ethnic or race or people.

With that said, some genotypes maybe more common in some race compared to others.

For example, African Americans, 90% have hep C genotype 1.

Compare that to European (Caucasian) Americans, 67% have genotype 1.

Over the years we have learned a few things about genotypes.

Genotypes 1b (b is the subtype) and 3 have a higher risk of liver cancer.

Development of cirrhosis is also common with genotype 1b compared to other genotypes.

The good news is hepatitis C can be cured with one oral tablet a day for 84 days.

Today, we have direct acting antivirals or DAAs that bind to the virus protein.

Once the antivirals bind to the virus protein, the virus life cycle is interrupted or stopped.

The virus cannot duplicate.

That’s the miracle of direct acting antivirals.

What are the most common genotypes?

We’re going to give you some numbers on HCV genotype distribution in the US.

Here is a a nice pie graph:

Over 70% of Americans have genotype 1.

The second most common are genotypes 2 or 3.

Overall, genotypes 1, 2 and 3 are found all over the world.

Genotypes 4, 5 and 6 make up less than 1.5% of the US  population

The 1.5% of the demographic are most probably new or 1st generation immigrants.

Folks who have their ancestry from Middle East and Africa, have genotype 4.

South Africans most often have genotype 5.

Whereas genotype 6 is mostly found in Southeast Asia.

Democratic Republic of Congo is predominantly genotype 7.

How do I find out my genotype?

What treatment works for each HCV genotypes?

• Epclusa – HCV genotypes 1, 2, 3, 4, 5, 6 & 7
• Sovaldi, Harvoni, Technivie, Olysio and Viekira XR – HCV genotypes 1, 2, 3 & 4
• Zepatier – HCV genotypes 1 or 4
  
• Sovaldi & Daklinza – HCV genotypes 2 or 3
• Harvoni – HCV genotypes 1, 4, 5 & 6

Sometimes weight based ribavirin is used with the treatments mentioned.

Ribavirin is known to cause serious birth defects and miscarriage in pregnant women.

Male partners of pregnant women should not use ribavirin.

Planning for pregnancy should only be done after stopping ribavirin for atleast 6 months.

This applies to both men and women.

Which hepatitis C genotypes are challenging to treat?

Hepatitis C genotype 3 is the second most common genotype in the world.

Unfortunately, it is also one of the most challenging hep C genotypes to treat.

Especially if the patient has cirrhosis, has tried treatment or has decompensated liver disease.

Decompensated liver disease can be life threatening and can lead to liver failure.

Hep Genotype 3 is also known to progress rapidly towards liver disease.

Also, cause steatosis (fatty liver disease) and hepatocellular carcinoma (cancer).

Overall, hep C genotype 3 requires longer treatment plans.

Cure rates can be low for patients with cirrhosis.

However, hep C genotype 3 can be cured.

Just requires more discipline and a positive mind set.

What do I need to do to find my hep C genotype?

First, get tested for hepatitis C virus with a blood draw or a fingerstick.

If you test positive, your doctor will find out the viral load and run blood tests for your genotype.

Genotype allows your health care team to determine which treatment plan is best.

Some HCV genotypes (1a and 1b) require more blood tests to see if the virus has any resistance.

Overall, hepatitis C treatment is much simpler and a lot safer than it was even 7 years ago.

Cure rates are very high but affordability of hep C treatment is out of reach.

What is the hep C genotype 1 life expectancy?

Hep C genotype 1 life expectancy is very high.

As long as you get treated right away.

90% of hepatitis C cases can be treated within eight to twelve weeks.

Hep C genotype 1 is the most common genotype in the world.

Also in the United States.

It is less than 0.01% that hep C genotype 1 cannot be cured.

Life expectancy of hep C genotype 1 is shortened for five reasons:

1. cirrhosis of the liver
2. compensated liver
3. decompensated liver
4. treatment noncompliance
5. not starting treatment

SVR (sustained virologic response) is 95% to 100% for hep C genotype 1.

This is good news after 8 to 12 of weeks of treatment.

The hepatitis C virus is not detectable for hep C genotype 1 after treatment.

What are hep C genotypes 1a treatment side effects?

 Hep C genotype 1a treatments are:

1. Harvoni or generic Harvoni (ledipasvir 90mg / sofosbuvir 400mg)

2. Viekiera Pak – ombitasvir-paritaprevir-ritonavir and dasabuvir plus ribavirin

3. Olysio – simprevir used with sofosbuvir or peginterferon-alfa and ribavirin.

How to reduce costs for hepatitis C genotypes treatments?

Hep C treatment costs need to come down considerably.

Some insurance make it affordable and accessible compared to others.

Affordability should not be an issue for treatments like Harvoni, Sovaldi, Daklinza and Epclusa.

These treatments are readily available and accessible at affordable prices.

Hepatitis C genotypes are important in understanding what hepatitis C virus strain you have.

Knowing your hep C  genotype increases your chance of successful treatment. 

The first time around.

Find out your hepatitis C genotype.

Share it with your doctor.

Find the correct hepatitis C treatment for your hep C genotype.

Follow through with your specific hep C treatment plan.

Stay disciplined.

Eat nutritionally.

Drink lots of water.

Get plenty of rest during this healing  process.

You will be cured.