Chronic hepatitis C genotype 1 treatment roadmap for resource constrained settings

Figure 1 Treatment week 4 (A), hepatitis C virus RNA negative (B) and hepatitis C virus RNA positive (C). A: All patients eligible for PR therapy regardless of whether they are treatment naïve, previous treatment failures or cirrhotics. Patients who achieve RVR after 4 wk lead-in either have detectable or undetectable HCVRNA. Those with undetectable HCVRNA have SVR > 86% while those with detectable HCVRNA have SVR 34%-41.7%; B: These patients have a high possibility of SVR so PR therapy can be shortened to 24 wk if they have baseline viral load < 400000 IU/mL). If they do not have good baseline predictors, therapy can also be shortened by addition of boceprevir (4 wk lead-in, 24 wk boceprevir + PR). If they also have IL28B CC genotype, telaprevir and PR can be used for 12 wk as well. Alternatively, they can continue on to 48 wk PR; C: These patients have a low possibility of SVR (41.7%) hence the alternative is to extend PR to 72 wk (53% SVR) or to add boceprevir (61%-66% SVR). TW: Treatment week; HCV: Hepatitis C virus; PR: Pegylated interferon and ribavirin; SVR: Sustained virological response.