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Current Management of Patients with HCV Genotype 2

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Hepatitis C: Care and Treatment

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Abstract

Treatment landscape for virus hepatitis C (HCV) has continuously evolved in the last 5 years. The current standard of care is a pangenotypic direct-acting antiviral (DAA) regimen including the fixed-dose combination of the NS5B inhibitor sofosbuvir plus the NS5A inhibitor velpatasvir (SOF/VEL), or the combination of the pangenotypic NS3 and NS5 inhibitors glecaprevir and pibrentasvir (Gle/Pib). Sustained virological response (SVR) rates reported with these regimens are higher than 95%, regardless of genotype. The main advantage of a pangenotypic regimen is a reduced risk of treatment failure in case of incorrect genotyping or in the presence of chimera genotype 1–2 virus. Given the pre-existing differences related to the need of extending or intensifying treatment in patients with cirrhosis or Interferon experienced, the advantage of SOF/VEL is SVR rates of 100% in genotype 2 (GT2) patients including treatment naïve or experienced and patients with or without cirrhosis. With Gle/Pib SVR of 98% are associated with only 8 weeks of treatment in non-cirrhotic patients.

Two difficult to treat populations remain. Firstly, the subgroups of decompensated cirrhotics for whom the addition of ribavirin to SOF/VEL for 12 weeks is necessary, while Gle/Pib cannot be used. Secondly, subjects who have failed a previous DAA course. In the latter population, the combination of sofosbuvir/voxilaprevir/velpatasvir recently approved will solve the issue.

For GT2 patients, the revolution of oral DAA started with the availability of sofosbuvir and ribavirin. This treatment is now considered suboptimal and for patients with cirrhosis and a history of previous failure, however, the true shift has arrived with pangenotypic regimens. Of interest, real-life results confirm those of registration studies. As we have now the tool to go straight from diagnosis to care, next challenge will be to perform screening and increase the access to and the delivery of care, regardless of genotype.

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Authors and Affiliations

  1. Liver Unit, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy

    Alessandra Mangia & Valeria Piazzolla

Authors
  1. Alessandra Mangia
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  2. Valeria Piazzolla
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Editors and Affiliations

  1. Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Angelos Hatzakis

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Mangia, A., Piazzolla, V. (2021). Current Management of Patients with HCV Genotype 2. In: Hatzakis, A. (eds) Hepatitis C: Care and Treatment . Springer, Cham. https://doi.org/10.1007/978-3-030-67762-6_6

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