Hepatitis C Genotype

There are 6 subtypes of hepatitis C. These are labeled types 1 through 6. In United States, type 1 is the most common. It is also the most difficult to treat. Types 2,3,4,5,6 are less common.

Many patients have difficulty with the concept of a genotype. To help explain, it is useful to think of a family. In families, there are parents and children. The children are all genetically related but behave somewhat differently. Indeed, this is the case with respect to Hepatitis C genotype. The family is HCV and the children are types 1 through 6. The separate genotypes are all genetically related but respond to therapy differently.

Hepatitis C Viral Load

Multiple studies have indicated that when a higher viral load is present, eradication of the virus is more difficult. Currently, a high viral load is defined as greater than 2.0 million copies per milliliter (ml) as determined by the PCR test. If the viral load is lower than 2.0 million copies per ml, Hepatitis C viral eradication is more likely.

Evaluation of the Patient with Hepatitis C

The goal of evaluation for patients with newly diagnosed hepatitis C is to assess the degree of hepatic damage present in that individual. Since the initial infection with hepatitis C is usually not associated with the development of jaundice, the time of the initial infection is unknown. Thus, physicians inquire regarding risk factors. They're particularly interested in knowing the onset and cessation of a particular risk factor. This allows the physician to begin to estimate the possible duration of infection in an individual. If a patient can report specific information regarding change in their liver function tests etc., this may be extremely important in assessing the duration of the disease.

The extent of liver disease is determined by a number of different tests. These include ultrasound of the liver, evaluation of co-morbid diseases, Hepatitis C viral load, Hepatitis C genotype, CBC, PT/PTT and alpha-fetoprotein. A liver biopsy is often used for further evaluation. Although the above information is quite useful liver biopsy is the gold standard by which the degree of liver damage is assessed. It has been clearly shown in studies that the degree of elevation of liver function tests (especially the ALT) does not correlate with the degree of liver disease. For these reasons, a liver biopsy is often advocated.

Once the extent of disease has been determined, the physician and patient review the data and determine which treat regimen is best. Sometimes this includes a research protocol or referral to a University for further advanced treatment options.

Treatment of Hepatitis C

1. General Information:

Therapy for chronic hepatitis C is indicated for patients who are between the ages of 18 and 60. Additional factors include persistently elevated liver function tests, confirmed virus within the serum, and evidence of chronic hepatitis on liver biopsy. Those patients who have cirrhosis, or have a history of complications associated with cirrhosis, may not be generally treated with currently available regimens. These patients may treated but this is usually in a clinical trial.

1. General Information

The treatment of Hepatitis C is based upon subclasses of patients. In general, patients are divided into groups. These are:

1. Acute Hepatitis C (patients with recently acquired HCV infection).


2. Chronic Hepatitis C infection:
1. Naive: divided patients who never had interferon based treatment past.


2. Relapsing patients: patients who responded interferon based protocols while on treatment but during follow-up have had recurrence other hepatitis C infection.
3. Non-responders: patients with been treated with interferon based regimens but have not cleared the virus.

Additional subgroups include patients with normal liver function tests, coexisting infection with HIV, blood disorders and hemodialysis.
2. Factors Affecting Response to Therapy

The primary factors affecting response to therapy include the following:

1. Young age


2. Female sex


3. Lower degree of fibrosis on liver biopsy.


4. Viral load.


5. Genotype.

Liver Biopsy is an extremely important component of assessing a patient with HCV. The liver biopsy is usually described by the pathologist according to Knodell's Criteria. Knodell's criteria are a series of characteristics that allow one pathologist to communicate with other physicians regarding the presence or absence of specific features in a liver biopsy.

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