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.
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.
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.
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.
References1. 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 OGrady, 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.