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Hepatitis C virus genotype 3 infection may resolve spontaneously
  By Will Boggs, MD
NEW YORK (Reuters Health) - Infection with hepatitis C virus (HCV) genotype 3 often clears spontaneously, sparing the patient unnecessary treatment, German researchers report in the July issue of the Journal of Medical Virology.
Early treatment of patients with acute HCV infection has been advocated as an approach to preventing chronic infection, the authors point out, but many patients may clear the virus spontaneously and thus would not require treatment if they were identified beforehand.
As senior investigator Dr. Heiner Wedemeyer told Reuters Health, "patients should be genotyped. Wait and see for genotype 3, treat immediately for genotype 1."
Dr. Wedemeyer from Hannover Medical School and colleagues sought to determine whether HCV genotype differences could lead to different rates of spontaneous clearance of acute HCV infection. They studied serum from 92 anti-HCV-positive men in a German prison.
HCV genotype 3 was significantly more common among subjects who were HCV-negative than among those with HCV viremia, the authors report, and the prevalence of genotype 3 was even higher after men who were HIV- or hepatitis B-positive were excluded. Although acute HCV genotype 3 infection spontaneously resolved in many individuals, most patients (63%) still developed chronic infection. This rate of chronic HCV was, however, substantially lower than the rate of chronic HCV infection in those with genotype 1 (93%).
"Considering the high sustained virological response rates of pegylated interferons plus ribavirin combination therapy of chronic hepatitis C in patients with genotypes 2 and 3," the authors conclude, "different strategies for acute HCV infection may be appropriate for different HCV genotypes."
"Chronicity of acute HCV genotype 1 infection evolves in the vast majority of cases," Dr. Wedemeyer concluded. "However, unnecessary treatment can be avoided in genotype 3 infection."
J Med Virol 2004;73:387-391.


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