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stage 2

I was dignos with hep c in Jan of this year, and in august i had biopsy done..i am at stage 2 grade 2 mild active .  I am genotype 6 ( it rare) i wonder how seriouse is this and should i do the treatment now! my eye seen to be more yellowish then before.. ( jaundice) can someone give me some advise ! thanks you very much
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Avatar universal
thanks you so very much for the information, it help me understand more. I will start my treatment today. i will continue post up my experience with this treatment;  :)
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250701 tn?1320974765
I would start treatment as soon as you can. I was in stage two my last treatment in 2007 didn't clear the virus, and next four years I am in stage 3-4 four being cirrosis, I just wish they would have had the incivek when I was at stage 2 I know I would have cleared. God Bless and Merry Christmas
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446474 tn?1446347682
Reference: for above article...

T Chao, K Abe, and MH Nguyen. Systematic review: epidemiology of hepatitis C genotype 6 and its management. Alimentary Pharmacology and Therapeutics34(3): 286-296 (free full text). August 2011.

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2011.04714.x/full

Treatment

Hepatitis C virus genotype is recognised as a major independent predictor of response to anti-HCV therapy.25 Two primary measures of treatment response include end-of-treatment response (ETR), defined as undetectable hepatitis C RNA at the end-of-treatment, and sustained virological response (SVR), defined as undetectable hepatitis C RNA 24 weeks after the end-of-treatment.3, 20, 24

Prior studies have established that HCV genotypes 1 and 4 appear to be more resistant to therapy compared with genotypes 2 and 3.2 The few published treatment studies involving HCV genotype 6 generally suggest that genotype 6 behaves more similar to genotypes 2 and 32, 3, 46 and responds better to therapy than genotype 1.

Duration of treatment

With improved SVR achieved by patients infected with HCV genotype 6, consideration was given to whether 48 weeks of treatment was necessary or whether 24 weeks of treatment would be sufficient. A small retrospective study of Asian-American patients comparing 12 patients receiving a 48-week course of peginterferon and ribavirin with 23 patients receiving a shortened 24-week course reported that significantly higher SVR was achieved by the 48-week cohort compared with those in the 24-week cohort (75% vs. 39%).49 However, the analysis performed in this study was not by intention-to-treat analysis.50 More recently, results of a prospective randomized controlled study of 60 HCV genotype 6 patients treated for 24 weeks vs. 48 weeks suggest that these two patient groups have fairly similar SVR rates (70% vs. 79%; P = 0.45) (Table 3b).51 Larger studies, however, are needed to definitively determine the optimal treatment duration for these patients.

Hepatitis C virus genotypes clearly play a role in achieving SVR, but there is no significant difference in the frequency or types of side effects experienced among patients of genotypes 1, 2, 3 or 6.3, 25, 47 However, although the incidence and types of side effects caused by therapy with PEG IFN and RBV are similar among patients of different HCV genotypes, side effect profiles appear to differ among patients of different ethnicities. As almost all patients with HCV genotype 6 are from Asia, their side effect profile would probably mirror those of patients of similar heritage. In a study by Vutien et al., Asian patients were more likely than Caucasians to require ribavirin dose reduction and were more likely to discontinue treatment because of anaemia. In addition, they were also more likely to report fatigue, muscle aches, anorexia and insomnia.20 On the other hand, Caucasian patients were more likely to report side effects of fever, dyspnoea and depression, although it has been previously suggested that Asian patients are comparatively less likely to report depression because of the associated social stigma.3, 20, 52

The impact of race on treatment response

The effect of race and ethnicity in treatment of hepatitis C genotype 6 patients is not clearly defined. Multiple studies have demonstrated that African-American and Hispanic patients appear to respond more poorly to antiviral treatment for chronic hepatitis C compared with Caucasian patients.53–56 On the other hand, higher SVR rate in Asian patients with chronic hepatitis C compared with Caucasian patients has been reported by some authors.47, 57 Dev et al. reported higher SVR rate in Asian patients compared with Caucasian patients with genotype 1b. With recent studies reporting that INNO-LiPA HCV I may confuse HCV genotype 6 as genotype 1 because of a shared 5′-UTR sequence, the question was raised whether Asian patients with HCV genotype 1 were truly exhibiting better treatment response than their Caucasian counterparts or whether ‘easier-to-treat’ HCV genotype 6 patients who were mistyped by early INNO-LiPA assays were included in the genotype 1 cohort. In a more recent study of Caucasians and Asian-Americans with chronic hepatitis C by Vutien et al., Asian patients with HCV genotype 1 as diagnosed using INNO-LiPA assays demonstrated higher SVR to 48-week therapy of PEG IFN and RBV compared with Caucasian counterparts, but similar SVR rates when the Asian HCV genotype 1 group only included those who were diagnosed with HCV genotype 1 using core sequencing methods.20 Taken together, these observations suggest the earlier claims of improved treatment response in Asian patients with genotype 1 could be due to HCV genotyping error rather than ethnic differences, though in some cases improved responses can also be due to higher prevalence of treatment-responsive haplotype IL-28B in this population.20, 58

Predictors of SVR

As in studies of patients with chronic hepatitis C with other genotypes, treatment adherence was also found to be an independent favourable predictor for SVR in studies of patients with HCV genotype 6.3 Independent predictors of poor SVR in the patients with HCV genotype 6 include BMI > 25 and increased age.3

Rapid virological response (undetectable HCV RNA after 4 weeks of treatment) was found to be a statistically significant predictor of SVR in HCV genotype 6 patients on 48 weeks of antiviral treatment in a recent randomised controlled trial of patients with HCV genotype 6.51 However, this study as well as another study by Fung et al. did not find early virological response (undetectable HCV RNA at 12 weeks) to be associated with SVR in genotype 6 patients.25 The small sample sizes in both of these studies, however, limit their conclusions and further studies are needed.

Summary

Chronic hepatitis C is a significant worldwide health burden that is underappreciated among Asians and Southeast Asians, the latter carrying the greatest burden of HCV genotype 6 in Asia. Current literature suggests that Southeast and East Asian patients face different risk factors for HCV acquisition compared with Caucasian patients and are often exposed to HCV through nosocomial spread and other unsanitary medical practices rather than more traditional risk factors recognised in the United States such as intravenous drug use. HCV genotype 6 patients do not demonstrate any significantly different clinical characteristics compared with patients infected with HCV of other genotypes. Accurate diagnosis of HCV genotype 6 requires core sequencing assays or newer INNO-LiPA assays, as older line probe assays have been shown to mistake genotype 6 subtype variants as genotype 1. Patients infected with HCV genotype 6 can expect higher SVR compared with patients with HCV genotype 1 and their SVR to PEG IFN and RBV is probably similar to that of patients with HCV genotypes 2 and 3. SVR rates also appear to be similar in patients with HCV genotype 6 who receive 24 weeks of PEG IFN and RBV and those who receive 48 weeks of therapy, though additional studies are needed to recommend 24 weeks as the optimal treatment duration for these patients.


Helpful - 0
446474 tn?1446347682
Here is good info all about genotype 6 and its treatment....
Since it is a rare (in the US) genotype you may want to work with a hepatologist at a large teaching hospital who is familiar with treating "rare" genotypes or Asian-American immigrants with this genotype. The good news is that is is a highly curable form of hepatitis C virus.
"7 retrospective analyses found sustained virological response (SVR) rates to pegylated or conventional interferon plus ribavirin ranging from 62% to 92% for genotype 6, compared with 29% to 62% for genotype 1."
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Epidemiology and Management of HCV Genotype 6

http://www.hivandhepatitis.com/hepatitis-c/3190-epidemiology-and-management-of-hcv-genotype-6-2

Details
    Category: Hepatitis C
    Published on Wednesday, 24 August 2011 00:00

Prevalence of hepatitis C virus (HCV) genotype 6 may be as high as 50% in parts of Southeast Asia, according to a systematic review published in the August 2011 issue of Alimentary Pharmacology and Therapeutics. Compared with genotypes 1 and 4, genotype 6 responds better to interferon-based therapy.

HCV genotypes 1, 2, and 3 are most common in the U.S. and Western Europe and have been more extensively studied than the other major genotypes -- 4, 5, and 6.

D.T. Chao from Michigan State University and colleagues performed a comprehensive review of the medical literature on HCV genotype 6.

HCV genotype 6 is most often seen in Southeast Asia and the surrounding areas including China, which have a high overall prevalence of hepatitis C (up to 6%-7%, as compared with about 2% in the U.S.) as well as hepatitis B. Nearly one-third of immigrants from Southeast Asia, China, and Hong Kong to the U.S. who test positive for chronic hepatitis C have HCV genotype 6, the study authors noted as background.

Older tests may have misclassified HCV genotype 6 as genotype 1, but newer line probe assays can more accurately and reliably determine genotype, they noted.

The researchers searched the PubMed database for "hepatitis C AND genotype 6." Their search returned a total of 47 articles, of which 33 were determined to be relevant to the review. Additional articles were identified using the reference lists from these 33 articles.

Results

*    The prevalence of HCV genotype 6 was estimated to be as high as 50% in some regions of Southeast Asia.
*    Risk factors for HCV genotype 6 among Asian patients are similar to those for other HCV genotypes, with a majority of people not recalling specific exposure risks.
*    Asian patients tend to have different risk factors for HCV acquisition than Caucasians, often being exposed through unsanitary medical procedures.
*    Genotype 6 infection rates are high among injection drug users (IDUs) and people with thalassemia major (an inherited form of anemia), who often require blood transfusions; studies have shown that genotype 6 is the most common type among IDUs in Southeast Asia.
*    Only 1 published study addressed clinical characteristics of HCV genotype 6, finding that people with HCV genotype 1 and 6 had somewhat higher baseline viral load than those with genotypes 2 and 3.
*    Genotype 6 patients "did not otherwise demonstrate any significant differences" with regard to host factors (e.g. age, family history of chronic hepatitis C, hepatitis B, or hepatocellular carcinoma), baseline laboratory values (e.g. ALT, bilirubin, white blood cell count, platelet count), or liver histology compared with other HCV genotypes.
*    Overall, studies found that patients with HCV genotype 6 responded better to interferon-based therapy than those with genotype 1.
*    7 retrospective analyses found sustained virological response (SVR) rates to pegylated or conventional interferon plus ribavirin ranging from 62% to 92% for genotype 6, compared with 29% to 62% for genotype 1.
*    1 study found that sustained response rates were similar for genotype 6 patients treated for 24 weeks (the standard duration for genotypes 2 and 3) or 48 weeks (the standard duration for genotype 1).

*   As is the case with other genotypes, predictors of poor response among patients with genotype 6 included suboptimal treatment adherence, high body mass index, and older age.
*    Rapid virological response (undetectable HCV RNA at week 4 of treatment) was found to be a significant predictor of SVR for genotype 6 patients, but the predictive value of early virological response at week 12 is unclear.
*    The effect of race/ethnicity on genotype 6 treatment response is "not clearly defined"; however, prior reports of better response among Asians vs Caucasians with genotype 1 may be due to the fact that some Asians with easier-to-treat genotype 6 were misclassified as having genotype 1.
*    Frequency and types of side effects of interferon-based therapy were similar for people with genotype 6 and other HCV genotypes.

Based on these findings, the study authors summarized, "HCV genotype 6 patients do not demonstrate any significantly different clinical characteristics compared with patients infected with HCV of other genotypes."

"Patients infected with HCV genotype 6 can expect higher SVR compared with patients with HCV genotype 1 and their SVR to [pegylated interferon] and [ribavirin] is probably similar to that of patients with HCV genotypes 2 and 3," they continued. "SVR rates also appear to be similar in patients with HCV genotype 6 who receive 24 weeks of [pegylated interferon] and [ribavirin] and those who receive 48 weeks of therapy, though additional studies are needed to recommend 24 weeks as the optimal treatment duration for these patients."

In conclusion, the authors recommended, "Future studies should seek to clarify issues regarding early predictors for treatment response in patients with HCV genotype 6, and the impact of ethnic and genotypic factors to treatment response in HCV genotype 6 patients."

Investigator affiliations: College of Human Medicine, Michigan State University, East Lansing, MI; Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA.
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Hector
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