Can the new Hep C drugs be used if I have genotype 4?

[iana5252]

A reader asked the question on our recent "New Hep C Treatment Guidelines Spell Out Incivek and Victrelis Use" article http://www.hepmag.com/articles/incivek_victrelis_aasld_2501_21290.shtml

"Hello, I am seeking better info on hep c genome 4.(which i have)I have basically been on hold regarding treatment,waiting for my docs to say that the new meds can be used for genome 4 patients. I have been told that the rareness of genome 4 people means lack of testing results for them. Previous cancer issues(now cleared) indicate that the new drugs would allow me to have a safer and shorter course, but Im at a loss for answers. Any info you could share would help."

[Tim Horn]

The bad news is that we don't know a heck of a lot about the effectiveness of the recently approved protease inhibitors on genotype 4 HCV. The good news is that there are preliminary data suggesting that at least one of the drugs, Vertex's Incivek, is active against genotype 4 (feel free to download this document and show it to your doctor).

Depending on your cancer history, you may also be eligible to participate in clinical trials, actively enrolling genotype 4 patients, exploring the safety and effectiveness of even newer drugs. These include a not-yet-open study of BMS-790052 (click here to learn more) and a currently enrolling study of BMS-650032 (click here to learn more).

Hope this helps.

[dot3434]

Sorry if this is a dumb question but what is the difference betwn genotype 4 and other versions?

[fullof?]

and how many types are there?

[Tim Horn]

Think of it like this: Hepatitis C virus is a bit like a bird of prey. They all share many similar traits, but are genetically unique. Just as there are nine common birds of prey (eagles, ospreys, kites, hawks, buzzards, harriers, vultures, falcons and owls), there are 11 different genetic types, or genotypes, of HCV (genotypes 1 through 11).

Also like different birds of prey, there are different types--or subtypes--to know about. Just as there are East Hemisphere and Western vultures, there are distinct subtypes of HCV genotypes -- HCV genotype 1 is either subtype 1a or subtype 1b.

Also like birds of prey, some HCV genotypes and subtypes are more common in some parts of the world than others. Consider the following:

1a - mostly found in North & South America; also common in Australia
1b - mostly found in Europe and Asia.
2a - is the most common genotype 2 in Japan and China.
2b - is the most common genotype 2 in the U.S. and Northern Europe.
2c - the most common genotype 2 in Western and Southern Europe.
3a - highly prevalent in Australia and South Asia.
4a - highly prevalent in Egypt
4c - highly prevalent in Central Africa

... and so on.

As the list suggests, HCV genotype 1a is the most common in the United States. While genotypes 2, 3, and 4 aren't exactly rare in the U.S., they're prevalence isn't as high as genotype 1.

The genetic differences between these HCV types matter -- genotype 1 has the double distinction of being not only the most common in the U.S., but also the hardest to treat with interferon-based therapy, given that it is less sensitive to this particular form of treatment. Genotypes 2 and 3 are easier to treat, whereas genotype 4 is like genotype 1 in its response to treatment.

Over time, provided that the new drugs in development prove safe and effective, we'll be able to move away from interferon-based treatment. Once this happens, differences in treatment response rates, according to genotype, should begin to melt away.

Tim Horn  

[fullof?]

Thank you so much Tim. Really grateful for you spelling it out like that. Fingers crossed these new drugs work!

[DiamondsInGraves]

I have Genotype 3, Ive had it my whole life ,all 28 Years of it (found out at age 19) I dont drink/smoke and eat healthy *thankfully always have*.The only reason I did the treatment  from Nov 2006-May 2007 is because my viral load went up high enough to qualify. I think its a matter of body/age and viral load from what I learned and the questions I asked. Hope it helps.

                      -Jayme.