Background: In the United States, fewer than 2% of hepatitis C infections involve genotype 5 or 6 infection. Genotype 5 hepatitis C infection (HCV) is endemic to South Africa where up to 40% of individuals with chronic hepatitis C from that geographic region have genotype 5 infection. Scattered pockets of genotype 5 HCV have also been isolated among regions in Europe. Genotype 6 hepatitis C infection has been found primarily in China, Korea, Taiwan, and Southeast Asia, including Thailand, Vietnam, Singapore, and Malaysia. Almost all the cases of genotype 6 in the United States occur in immigrants from Asia and Southeast Asia. Available data suggest that patients with genotype 6 infection have a similar natural history as those with genotype 1. The following discussion regarding initial treatment and retreatment of patients with genotype 5 or 6 chronic hepatitis C assumes the patient and their clinician have already made the decision to initiate hepatitis C therapy. Because of the low prevalence of genotype 5 and 6 in the United States, relatively little is known about the optimal treatment of genotype 5 or 6 infection. The estimated cost for the recommended regimens in the 2016 American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) guidance for genotype 5 or 6 infection ranges from approximately $75,000 to $95,000 (Figure 1).
Medications used to Treat Hepatitis C: The HCV Medications section on this web site provides detailed information for each of the FDA-approved medications listed in the treatment recommendations, including links to the full prescribing information and to patient assistance programs. Adherence with the treatment regimen is extremely important. Thus, patients should receive detailed counseling regarding the importance of adherence prior to starting therapy, as well as intensive monitoring and follow-up during therapy.