1. ‘Easy to treat’? Graham R Foster Professor of Hepatology Queen Marys University of London

2. Easy to treat? 54 year old man Genotype 3 HCV – Viral load 420,000 IU/ml ALT – 54, AST 79 Hb 11.2, WBC 3.8, Platelets – 90 US – Features of cirrhosis, no ascites

3. Easy to treat? What should we do before therapy?

4. Easy to treat? Starts Pegasys 180 ug plus ribavirin 800mg Is this the best dose of ribavirin?

5. Easy to treat? Four weeks after starting therapy HCV – RNA – undetectable Platelets 45

6. Easy to treat ? What should we do next?

7. Genotype 3 Audit of 639 patients treated with Peg+Riba Shoeb et al E J Gastro Hep 2011

8. Genotype 3 Audit of 639 patients treated with Peg+Riba Shoeb et al E J Gastro Hep 2011

9. Genotype 3 Audit of 639 patients treated with Peg+Riba Shoeb et al E J Gastro Hep 2011

10. Genotype 3 and cirrhosis Relapse is the commonest mode of treatment failure

11. Genotype 3 and cirrhosis Should we extend therapy? Should we increase the ribavirin dose? Should we consider telaprevir?

12. 03691215 Genotype 3 and Telaprevir Mean (SE) change in log10 HCV RNA 0 –1 –2 –3 –4 –5 –6 Time (days) –0.5 T mono (n=8) –4.5 PR (n=9) –4.7 T/PR (n=9)

13. ‘Easy to treat’ ? Patients with genotype 3 and cirrhosis are NOT easy to treat Early cessation is unwise The ideal regime is not yet clear