Page 51 - The Flying Publisher Guide to Hepatitis C Treatment

Antiviral therapy in non-responders, relapsers and special populations | 51

(Zeuzem 2008). However, in a meta-analysis (Andriulli 2008), an
overall SVR rate of 80-89% for HCV genotype 2, but only 66-80%
for genotype 3 was reported, with an estimated 8.7% difference
in SVR rates between the two genotypes after a 24-week course
of PegIFN alfa-2b plus RBV. Reduced response in genotype 3 is
associated with a higher incidence and degree of steatosis and
higher rate of post-treatment relapse.

Retreatment of HCV genotype 2 and 3 patients
Retreatment with PegIFN/RBV for 48-52 weeks in genotype 2 or
3 patients, who have failed previous therapy, can achieve SVR in
more than 60% of previous relapsers and in more than 30% of
previous non-responders (Zeuzem 2008, Shiffman 2007). On the
basis of these findings, retreatment with a 48-52 week course
of PegIFN/RBV is clearly recommended in genotypes 2/3
relapsers, partial responders or non-responders to the
previous 24-weeks course of SoC.
Recently, it has been suggested that patients with genotype 3
HCV infection and advanced liver fibrosis or cirrhosis should be
treated from the very beginning for at least 48 weeks, based on
the observation than many of them relapse after therapy
discontinuation when treated for only 24 weeks (Mangia 2009).
Despite the fact that most DAAs against HCV have been designed
to target patients with genotype 1 infection (the largest pool of
patients who fail to respond to currently available therapies),
some of these new compounds may be active also on non-1
genotypes. For example, telaprevir and other investigational
protease inhibitors (for details, see chapter 4) have been recently
shown to have significant antiviral activity against genotype 2,
but not genotype 3.