Hepatitis C Genotypes: A Definitive Guide (2021)

hepatitis c genotypes
              Sara White, PharmD

Author: Sara White, Doctor of Pharmacy, Masters in Public Health and is the resident expert on drug pricing, generics and healthcare accessibility.

5 minute read.

This is the ultimate hepatitis C genotypes guide in 2021.

You will learn all about genotypes without having to study microbiology.

So, if you’re looking to improve your chance of HCV treatment successfully, you will love this hepatitis C genotypes guide.

What is a hepatitis C genotype?

A genotype is a broad term to define the genetic makeup of any organism.

In this case it is the genetic code (RNA not DNA) of the hepatitis C virus or HCV.

HCV has 7 genotypes and 142 subtypes according to the Center for Disease Control (CDC).

Genotypes are labeled as 1, 2, 3, 4, 5, 6 or 7.

For most folks with hepatitis C, you don’t need to worry about subtype.

This is just for general knowledge.

The genotype subtypes is usually a lower-case letter a, b, c and so on.

For example: genotype 1a, where a is the subtype.

Its important to note that each genotype subtype is a distinct hepatitis C virus.

Knowing your genotype lets your health care team know which treatment is best for you.

Why are genotypes important for treatment?

Genotypes tell us exactly what kind of hep C virus you have and the right treatment.

We don’t want to put a square peg in a round hole.

Treating hepatitis C is serious and we need to get it right the first time.

You don’t want the hepatitis C virus to be resistant to treatment.

Then try again with another treatment option…if it exists.

Today, we are very lucky to have direct acting antivirals or DAAs.

DAAs work and have a 95%+ cure rate for almost all hep C genotypes.

Why people have different genotypes?

Genotypes are not entirely based on ethnic or race or people.

With that said, some genotypes maybe more common in some race compared to others.

For example, African Americans, 90% tend to be genotype 1.

Compare that to European Americans, 67% have genotype 1.

Over the years we have learned a few things about genotypes.

Genotypes 1b (b is the subtype) and 3 have a higher risk of liver cancer.

Development of cirrhosis is also common with genotype 1b compared to other genotypes.

The good news is hepatitis C can be cured with one oral tablet a day for 84 days.

Today, we have direct acting antivirals or DAAs that bind to the virus protein.

Once the antivirals bind to the virus protein, the virus life cycle is interrupted or stopped.

The virus cannot duplicate.

That’s the miracle of direct acting antivirals.

What are the most common genotypes?

We’re going to give you some numbers on HCV genotype distribution in the US.

Here is a a nice pie graph:

Over 70% of Americans have genotype 1.

The remaining Americans have genotypes 2 or 3 of the hepatitis C infection.

Overall, genotypes 1, 2 and 3 are found all over the world.

The other genotypes are genotypes 4, 5 and 6.

These genotypes make up less than 1.5% of the US population.

This 1.5% of the demographic are most probably new or 1st generation immigrants.

Folks have their ancestry from Middle East and Africa, have genotype 4.

South Africans most often have genotype 5.

Whereas genotype 6 is mostly found in Southeast Asia.

Democratic Republic of Congo is predominantly genotype 7.

How do I find out my genotype?

What treatment works for each HCV genotypes?

  • HCV genotypes 1, 2, 3, 4, 5, 6 & 7 – Epclusa
  • HCV genotypes 1, 2, 3 & 4 – Sovaldi, Harvoni, Technivie, Olysio and Viekira XR
  • HCV genotypes 1 0r 4 – Zepatier
  • HCV genotypes 2 or 3 – Sovaldi & Daklinza
  • HCV genotype 6 – Harvoni

Weight based ribavirin is used with the above mentioned treatments.

Ribavirin is known to cause serious birth defects and miscarriage in pregnant women.

Male partners of pregnant women should not use ribavirin.

Planning for pregnancy should only be done after stopping ribavirin for atleast 6 months.

Which hepatitis C genotypes are challenging to treat?

Hepatitis C genotype 3 is the second most common genotype in the world.

Unfortunately, it is also one of the most challenging to treat.

Especially if the patient has cirrhosis, has tried treatment or has decompensated liver disease.

Decompensated liver disease can be life threatening and can lead to liver failure.

Genotype 3 is also known to progress rapidly towards liver disease.

Also, cause steatosis (fatty liver disease) and hepatocellular carcinoma (cancer).

Overall, genotype 3 requires longer treatment plans.

Cure rates can be low for patients with cirrhosis.

What do I need to do to find my hep C genotype?

First, get tested for hepatitis C virus with a blood draw or a fingerstick.

If you test positive, your doctor will find out the viral load and run blood tests for your genotype.

Genotype allows your health care team to determine which treatment plan is best.

Some HCV genotypes (1a and 1b) require more blood tests to see if the virus has any resistance.

Overall, hepatitis C treatment is much simpler and a lot safer than it was even 7 years ago.

Cure rates are very high but affordability of hep C treatment is out of reach.

Hep C treatment costs need to come down considerably.

Some insurance make it affordable and accessible compared to others.

Affordability should not be an issue for treatments like Harvoni, Sovaldi, Daklinza and Epclusa.

These treatments are readily available and accessible at affordable prices.

Knowing your genotype increases your chance of precision with the right treatment.


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