Predictive Factors for Sustained Virological Response after Treatment with Pegylated Interferon α-2a and Ribavirin in Patients Infected with HCV Genotypes 2 and 3

Background: Previous trials have often defined genotype 2 and 3 patients as an "easy to treat'' group and guidelines recommend similar management. Aims: The present study looks for differences between the two genotypes and analyzes predictive factors for SVR. Methods: Prospective, community-based cohort study involving 421 physicians throughout Germany. The analysis includes 2,347 patients with untreated chronic HCV genotype 2 (n = 391) and 3 (n = 1,956) infection treated with PEG-IFN alpha-2a plus ribavirin between August 2007 and July 2012. Results: When compared with genotype 2 patients, those with genotype 3 were younger, had a shorter duration of infection, lower values of total cholesterol, LDL cholesterol and BMI, a higher frequency of drug use as infection mode and male gender (p<0.0001, respectively), and a higher APRI score (p<0.005). SVR was higher in genotype 2 when compared with genotype 3 (64.7% vs. 56.9%, p = 0.004). By multivariate analysis of genotype 2 patients, low baseline gamma -GT and RVR predicted SVR. In genotype 3 age <= 45 years, cholesterol>130 mg/dl, a low APRI score, and a gamma-GT >= 3-times ULN, RVR, and RBV starting dose were associated with SVR by multivariate analysis. Conclusions: The present study corroborates that liver fibrosis is more pronounced in genotype 3 vs. 2. SVR is higher in genotype 2 versus genotype 3 partly because of follow-up problems in genotype 3 patients, in particular in those infected by drug use. Thus, subgroups of genotype 3 patients have adherence problems and need special attention also because they often have significant liver fibrosis.