title: Meta-analysis of patients with hepatitis C virus genotype 6: 48 weeks with pegylated interferon and ribavirin is superior to 24 weeks.
abstract: BACKGROUND
  Hepatitis C virus genotype 6 (HCV-6) is common in patients from Southeast Asia and the surrounding regions. Optimal treatment duration for HCV-6 is unknown given the inconclusive evidence from studies with varying methodologies and small sample sizes.
  
  
  METHODS
  A literature search for 'genotype 6' in MEDLINE and EMBASE in October 2013 produced 161 and 251 articles, respectively. Additional abstracts were identified from four major international GI/liver conferences in 2012/2013. Inclusion criteria were original studies with ≥10 HCV-6 treatment-naïve patients treated with pegylated interferon + ribavirin (PEG IFN+RBV). Exclusion criteria were coinfections with HBV, HIV, other HCV genotypes, and/or other liver diseases. Primary outcome was pooled sustained virologic response (SVR). Heterogeneity was defined by Cochrane Q test (p value of 0.10) and I (2) statistic (≥50 %).
  
  
  RESULTS
  A total of 13 studies with 641 patients were included. The pooled SVR estimate was 77 % (CI 70-83 %) (Q value = 38.4, p value <0.001, I (2) = 68.7 %) overall, 79 % (CI 73-84 %) for the 48-week group and 59 % (CI 46-70 %) for 24-week group, respectively. In studies with direct comparison of the two groups, SVR was superior in patients treated for 48 versus 24 weeks, OR 1.9 (CI 1.08-3.2, p = 0.026). In studies with direct comparison of patients with rapid virologic response (RVR), there was no difference in SVR between 48 versus 24 weeks, OR 1.74 (CI 0.65-4.64, p = 0.27).
  
  
  CONCLUSIONS
  Hepatitis C virus genotype 6 patients should be treated for 48 weeks, and those who achieve RVR may receive the shorter 24-week treatment duration. The high SVR (~80 %) with 48 weeks of PEG IFN+RBV therapy may be a cost-effective option for HCV-6 patients from resource-poor regions.
authors.affiliation: School of Medicine, University of California, San Diego, CA, USA.
authors.forename: Nghia H
authors.initials: NH
authors.lastname: Nguyen
authors.affiliation: School of Medicine, University of California, San Diego, CA, USA.
authors.forename: Shelley A
authors.initials: SA
authors.lastname: McCormack
authors.affiliation: School of Medicine, University of California, San Diego, CA, USA.
authors.forename: Brittany E
authors.initials: BE
authors.lastname: Yee
authors.affiliation: Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
authors.forename: Pardha
authors.initials: P
authors.lastname: Devaki
authors.affiliation: Department of Internal Medicine, Stanford University, Palo Alto, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Jencks
authors.affiliation: Department of Internal Medicine, University of Pittsburg Medical Center, Pittsburg, PA, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Chao
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA. mindiehn@stanford.edu.
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
keywords: Chronic hepatitis C; Chronic liver disease; Sustained virologic response; Treatment response; Viral hepatitis