Management of patients with hepatitis C virus genotype 2 or 3: Comments on updated american association for the study of liver diseases practice guidelines


  • Potential conflict of interest: Dr. Dalgard is a consultant for Schering-Plough.

Management of Patients with Hepatitis C Virus Genotype 2 or 3: Comments on Updated American Association for the Study of Liver Diseases Practice Guidelines

To the Editor:

It was with interest we read the updated American Association for the Study of Liver Diseases practice guidelines for hepatitis C management published in HEPATOLOGY.1 Because our groups have performed several trials of short treatment in patients with hepatitis C virus genotype 2 or 3, it was with special interest we read the proposals for this subgroup of patients.2-5 We found the discussion about short treatment interesting and well balanced but we disagree with your recommendation to treat all patients infected with genotype 2 or 3 for 24 weeks. This will, in our view, lead to unnecessary side effects and unreasonably high economical costs. Unfortunately, we found that important evidence concerning short treatment was not presented, and we would therefore like to highlight the following:

  • 1The issue of relapse. This is considered the main problem of a short course of treatment for patients with genotype 2 or 3. However, in our view, it might be overcome. As recently suggested, the exclusion of obese patients and those with advanced liver damage from a short course of treatment would lower the relapse rate significantly.5
  • 2Economical costs. With some surprise we noted that the Scandinavian randomized controlled trial of 14 versus 24 weeks treatment to patients with genotype 2 or 3 and rapid virological response (RVR) (n = 428) was not included in the authors' considerations.4 Especially, we think the economical analysis based on this trial should have been mentioned. In this analysis, we compared the economical costs of 14 weeks treatment with pegylated interferon-alfa2b (PEG-IFN-α2b) (1.5 μg/kg/week) and ribavirin (800-1400 mg/day) to all patients with genotype 2 or 3 and RVR and retreatment with the same dosages for 24 weeks of those who relapse with the price of 24 weeks PEG-IFN-α2b (1.5 μg/kg/week) and ribavirin (800 mg daily) to all. The price of the first strategy (short treatment and eventual retreatment) is according to our calculation U.S. $13,710 per treated patient as compared to U.S. $18,480 for the second strategy (24 weeks to all). The price for one case of sustained virological response was calculated to be U.S. $14,420 and U.S. $19,450 for the first and second strategy, respectively.

We believe that with the exception of obese patients and patients with cirrhosis, 12-14 weeks of hepatitis C virus treatment should be recommended for patients with genotype 2 or 3 and RVR. Those who relapse after short treatment should be offered retreatment for 24 weeks.

Olav Dalgard*, Alessandra Mangia†, * Infectious Disease Department, Ullevål University Hospital, Oslo, Norway, † Division of Gastroenterology, Hospital “Casa Sollievo della Sofferenza,” IRCCS,, San Giovanni Rotondo, Italy.