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Patients with Genotype 2 Have Less Severe Disease

May 21, 1996
Infectious Disease Weekly via Individual Inc. :
Patients with chronic hepatitis C involving genotype 2 have a more favorable outcome than those with genotype 1b, according to a report from Japan. Several recent investigators have reported that the HCV genotype is associated with the stage of type C chronic liver disease, but controversy remains regarding whether the prognosis differs among hepatitis C patients infected with different genotypes. In this study, researcher Masanori Kobayashi and colleagues compared the long-term histological outcome of chronic hepatitis in patients infected with HCV genotype 1 with that in patients infected with HCV genotype 2 to clarify the difference of pathogenicity between these genotypes. The researchers examined 140 patients with chronic hepatitis C. The HCV genotype was determined by the enzyme-linked immunosorbent assay (ELISA) based on genotypes 1 and 2 specific recombinant proteins; genotype 1 was found in 100 patients (96 were 1b and four were indeterminate) and genotype 2 in 36. The two groups showed no significant differences for any clinical background features. Deterioration of the grade of liver histology during the follow- up period was seen in 68 percent of the patients with genotype 1 as compared with 41.7 percent of those with genotype 2 (P<.001). Similarly, the deterioration of the stage of liver histology was more common in the former group than in the latter (63 percent and 38.9 percent, respectively). The mean serum HCV RNA titer was significantly higher in the patients with genotype 1 than in those with genotype 2, and multivariate analysis showed the titer was one of the independent factors of the deterioration of the stage. The authors concluded that this phenomenon may be related in part to the difference in pathogenicity between the two HCV genotypes. "Chronic hepatitis C is generally a slowly progressive disease that rarely subsides naturally," Kobayashi et al. wrote. "The grade and stage of liver histology deteriorated more frequently in the patients with genotype 1 than those with genotype 2, irrespective of the initial liver histology. The patients with genotype 1 also developed hepatocellular carcinoma more frequently than those with genotype 2. The authors also found that serum HCV RNA titer, which may reflect the replication of HCV, was significantly higher in patients with genotype 1b. This phenomenon, also reported by Yoshioka et al. (Hepatology 1992;16:293- 299) and Matsumoto et al. (C Dig Dis Sci 1994;39:1273-1280), may be related to the difference of pathogenicity between the genotypes. "Our multiple-regression analysis, which showed the initial serum HCV RNA titer as the independent factors of the deterioration of the stage of liver histology, confirms this hypothesis," Kobayashi et al. wrote. "But the initial serum HCV RNA titer is not correlated with the development of HCC, although HCV genotype is the independent factor in our analysis. Further study is needed to clarify the mechanism of higher HCV RNA titer in patients with genotype 1b and whether there is a difference between genotypes 1 and 2 in the deterioration of liver histology and the development of HCC."

The corresponding author for this study is Kendo Kiyosawa, The Second Department of Internal Medicine, Shinshu University School of Medicine, 3-1- 1 Asahi, Matsumoto 390, Japan. - by Salynn Boyles, Senior Editor [05-20-96 at 13:10 EDT, Copyright 1996, Charles Henderson, File: c0519805.3wh] Entire contents (C) 1996 by INDIVIDUAL, Inc., 8 New England Executive Park West, Burlington, MA 01803

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