Once you receive a hepatitis C diagnosis, and before you start treatment, you’ll need another blood test to determine the genotype of the virus. There are six well-established genotypes (strains) of hepatitis C, plus more than 75 subtypes.
Blood tests provide specific information about how much of the virus is currently in your bloodstream.
This test won’t have to be repeated because the genotype doesn’t change. Although it’s uncommon, it’s possible to be infected with more than one genotype. This is called a superinfection.
Knowing your genotype impacts your treatment recommendations.
Knowing that you have genotype 2 offers important information about your treatment options and how likely they are to be effective.
Based on the genotype, doctors can narrow down which treatments are most likely to be effective and how long you should take them. This can prevent you from wasting time on the wrong therapy or taking medications longer than you have to.
Some genotypes respond differently to treatment than others. And how long you need to take medicine can differ based on your genotype.
However, the genotype can’t tell doctors how quickly the condition will progress, how severe your symptoms might get, or if an acute infection will become chronic.
It’s unclear why, but 15 to 25 percent of people clear the hepatitis C infection without any treatment. Since there isn’t a way of knowing who falls into this category, in an acute infection, your doctor will recommend waiting for 6 months to treat the virus, since it may clear spontaneously.
Hepatitis C is treated with antiviral drugs that clear your body of the virus and prevent or lessen damage to your liver. Often, you’ll take a combination of two antiviral drugs for 8 weeks or longer.
There’s a good chance you’ll have a sustained virologic response (SVR) to oral drug therapy. In other words, it’s highly curable. The SVR rate for many of the new hepatitis C drug combinations is as high as 99 percent.
When choosing drugs and deciding how long you should take them, your doctor will usually consider the following factors:
- your overall health
- how much of the virus is present in your system (viral load)
- whether or not you already have cirrhosis or other damage to your liver
- whether you already were treated for hepatitis C, and which treatment you had
Glecaprevir and pibrentasvir (Mavyret)
You might be prescribed this combination if you’re new to treatment or you’ve been treated with peginterferon plus ribavirin or sofosbuvir plus ribavirin (RibaPack) and it didn’t cure you. The dose is three tablets, once a day.
How long you’ll take the medication:
- if you don’t have cirrhosis: 8 weeks
- if you do have cirrhosis: 12 weeks
Sofosbuvir and velpatasvir (Epclusa)
This combination is another option for people who are new to treatment, or those who’ve been treated before. You’ll take one tablet a day for 12 weeks. The dose is the same, whether or not you have cirrhosis.
Daclatasvir (Daklinza) and sofosbuvir (Sovaldi)
This regimen is approved for hepatitis C genotype 3. It’s not approved to treat genotype 2, but doctors can use it off-label for certain people with this genotype.
The dose is one daclatasvir tablet and one sofosbuvir tablet once a day.
How long you’ll take the medication:
- if you don’t have cirrhosis: 12 weeks
- if you do have cirrhosis: 16 to 24 weeks
Follow-up blood testing will reveal how well you’re responding to treatment.
Note: Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care. Learn more about off-label prescription drug use.
How other genotypes are treated
Treatment for genotypes 1, 3, 4, 5, and 6 also depend on a variety of factors such as viral load and the extent of liver damage. Genotypes 4 and 6 are less common, and genotypes 5 and 6 are rare in the United States.
Antiviral medications may include these drugs or combinations of them:
- daclatasvir (Daklinza)
- elbasvir/grazoprevir (Zepatier)
- glecaprevir/pibrentasvir (Mavyret)
- ledipasvir/sofosbuvir (Harvoni)
- ombitasvir/paritaprevir/ritonavir (Technivie)
- ombitasvir/paritaprevir/ritonavir and dasabuvir (Viekira Pak)
- simeprevir (Olysio)
- sofosbuvir (Sovaldi)
- sofosbuvir/velpatasvir (Epclusa)
- sofosbuvir/velpatasvir/voxilaprevir (Vosevi)
Treatment length can vary by genotype.
If liver damage is serious enough, a liver transplant might be recommended.
Hepatitis C genotype 2 is often curable. But chronic infection can lead to serious complications.
Most people with hepatitis C experience no symptoms or only mild symptoms, even when the liver is becoming damaged.
The first six months after infection is defined as acute hepatitis C infection. This is true whether you have symptoms or not. With treatment, and sometimes without treatment, many people clear the infection during this time.
You’re unlikely to have serious liver damage during the acute phase, though in rare cases it’s possible to experience fulminant liver failure.
If you still have the virus in your system after six months, you have chronic hepatitis C infection. Even so, the disease generally takes many years to progress. Serious complications can include cirrhosis, liver cancer, and liver failure.
Statistics for complications of genotype 2 on its own are lacking.
For all types of hepatitis C in the United States, the Centers for Disease Control and Prevention (CDC) estimates that:
- 75 to 85 out of 100 infected people will go on to develop chronic infection
- 10 to 20 will develop cirrhosis of the liver within 20 to 30 years
Once people develop cirrhosis, they run a 1 to 5 percent risk of getting liver cancer each year.
The earlier you get treatment, the better your chances of preventing serious liver damage. In addition to drug therapy, you’ll need follow-up blood tests to see how well it’s working.
The outlook for hepatitis C genotype 2 is very favorable. That’s especially true if you start treatment early, before the virus has the chance to damage your liver.
If you successfully clear hepatitis C genotype 2 from your system, you’ll have antibodies to help protect you from future attacks. But you can still become infected with a different type of hepatitis or a different genotype of hepatitis C.