BlueCross BlueShield of Tennessee Medical Policy Manual

Genotyping for Chronic Hepatitis C

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It is estimated that nearly four million Americans have hepatitis C. Of these, 70% have chronic hepatitis and 15% to 20% will develop cirrhosis. Cirrhosis related to hepatitis C is now the most common indication for liver transplantation.

There are at least six distinctive HCV genotypes (genotypes 1 – 6), and more than 50 subtypes have been identified. Genotype is determined by analysis of protein, RNA or DNA. The prevalence of genotypes varies geographically with types one, two and three found most commonly in the United States. Genotype 1 is the most common HCV genotype in the United States, accounting for 74% of prevalent cases. Genotypes do not change during the course of infections, and therefore retyping is unnecessary. Hepatitis C genotyping is helpful in defining the epidemiology of hepatitis C and in making recommendations regarding appropriate treatment regimens. For those who meet criteria for pharmaceutical treatment, the drug(s) used and the duration will depend on the genotype. For individuals with genotypes 2-6, a 24-week course of combination treatment with alpha interferon and ribavirin is usually adequate. For individuals with genotype 1, which is associated with a higher frequency of cirrhosis and abnormal serum aminotransferases than the other genotypes, a 48-week course is recommended.

POLICY

IMPORTANT REMINDERS

SOURCES

American Association for the Study of Liver Diseases. (2009). Diagnosis, management, and treatment of hepatitis C: an update. Retrieved August 3, 2017 from http://gi.org/guideline/diagnosis-management-and-treatment-of-hepatitis-c-an-update/.

Centers for Disease Control and Prevention. (2017). Hepatitis C FAQs for health professionals. Retrieved August 3, 2017 from https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#d5.

National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Hepatitis C. Retrieved August 3, 2017 from https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-c.

U.S. Food and Drug Administration. (2017, March). Center for Devices and Radiological Health. Pre-market approval decisions for March 2017. P160016. Retrieved August 3, 2017 from https://www.fda.gov/downloads/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/pmaapprovals/ucm551042.pdf.

ORIGINAL EFFECTIVE DATE:  1/1/2002

MOST RECENT REVIEW DATE:  9/14/2017

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