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Review article: HCV genotype 3 – the new treatment challenge
Author(s) -
Ampuero J.,
RomeroGómez M.,
Reddy K. R.
Publication year - 2014
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12646
Subject(s) - medicine , ribavirin , genotype , population , hepatitis c virus , hepatocellular carcinoma , hepatitis c , ns5a , immunology , oncology , bioinformatics , hepacivirus , biology , virus , genetics , gene , environmental health
Summary Background Over the past several years, hepatitis C therapy has been pegylated interferon and ribavirin based. Although protease inhibitor‐based therapy has enhanced response rates in genotype 1, the recent advances in therapy have demonstrated a challenge in genotype 3, a highly prevalent infection globally. Aim To provide a comprehensive summary of the literature evaluating the unique characteristics and evolving therapies in genotype 3. Methods A structured search in PubMed, the Cochrane Library and EMBASE was performed using defined key words, including only full text papers and abstracts in English. Results HCV genotype 3 is more prevalent in Asia and among intra‐venous drug users. Furthermore, it interferes with lipid and glucose metabolism, and the natural history involves a more rapid progression of liver disease and a higher incidence of hepatocellular carcinoma (HCC). New therapies with protease inhibitors have focused on genotype 1 largely and have demonstrated enhanced responses, but have limited activity against genotype 3. Thus far, in clinical trials, NS 5B and NS 5A inhibitors have performed more poorly in genotype 3, while a cyclophilin inhibitor, alisporivir, has shown promise. Conclusions As treatments for HCV have evolved, genotype 3 has become the most difficult to treat. Furthermore, genotype 3 has special characteristics, such as insulin resistance and alterations in lipid metabolism, which may partly explain the lower treatment responses. A great deal of emphasis on advancing therapy is needed in this population that appears to have a more rapid progression of liver disease and a higher incidence of HCC.