Most patients with genotype 1 of hepatitis C will be recommended one of four highly potent DAA (direct-acting antiviral) combination regimens.
The difference in recommendation will be based on several factors. These include the hepatitis C virus subtype, the presence or absence of baseline NS5A resistance-associated substitutions (RASs), and the presence or absence of compensated cirrhosis.
For certain regimens, patients with genotype 1a may have a higher chance of virologic failure than a patient who has genotype 1b. A genotype 1 infection that cannot be subtyped should be treated as a genotype 1a infection.
For patients that are infected with genotype 1 without prior exposure to NS5A inhibitors, about 10% to 15% have detectable NS5A RASs prior to treatment. There will be a different clinical impact of NS5A RASs depending on the regimen the patient is put on and the characteristics of the patient.
For example, in patients with genotype 1a infection, the presence of baseline NS5A RASs that cause a large reduction in the activity of the NS5A inhibitors will cause an adverse impact response to some NS5A inhibitor-containing regimens.
For genotype 1a-infected patients without cirrhosis, genotype 1b-infected patients without cirrhosis, genotype 1a-infected patients with compensated cirrhosis, and genotype 1b-infected patients with compensated cirrhosis, there are several recommended regimens. These include Elbasvir/Grazoprevir, Glecaprevir/Pibrentasvir, Ledipasvir/Sofosbuvir, and Sofosbuvir/Velpatasvir.
There are also alternative regimens for genotype 1a-infected patients without cirrhosis and for genotype 1b-infected patients without cirrhosis. These include Paritaprevir/Ritonavir/Ombitasvir + Dasabuvir and Ribavirin; Simeprevir + Sofosbuvir; and Daclatasvir + Sofosbuvir. Genotype 1b-infected patients with compensated cirrhosis also have the alternative regimen of Paritaprevir/Ritonavir/Ombitasvir + Dasabuvir available to them.
Talk to your doctor to figure out what highly potent direct-acting antiviral combination regimen is best for you. Your dosage and recommendation will be based on what kind of genotype 1 of hepatitis C virus you have contracted. Several treatments options may work for you but your doctor will find the one best suited to your needs.
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