Type2

[Doofus_jones]

Hi People

I have just been diagnosed with HepC type 2b today. I have stage 3 fribrosis and a viral load of 1.3 mill. Problem is I'm 63 years old. I think this has been hanging around from a very brief period of fooling with drugs in the early 70s. Anyone here know anyone my age who has come through a 24 week interferon and ribavirin course OK.? I thought I read somewhere Drs wouldn't give interferon to anyone over 60?

Best wishes to you all

Doofus

[Idyllic]

Greetings and Welcome to the Forum.
Your treatment options may be broader than it seems. It depends on a few other factors however there are many trials in progress for Geno 2 & 3 for the all oral HCV meds. Considerable efficacy with a less harsh side effect profile & possibly shorter treatment times have given to promise to many of us who for various reasons are reluctant to treat with Interferon.

I would not rule out treatment with Interferon & Riba however. There are many of us 60 and older who have treated with these meds. As I said it depends on a variety of factors but you may have more treatment options than you think,.

You posted at a rather slow time on the forum so be sure to check back later ♫

[coraggio]

There are lots of people in their 50's and 60's who are currently treating or have treated successfully.  Many are genotype 1 and undergo triple therapy with a protease inhibitor, interferon and ribavirin. Triple therapy is a response guided therapy and those who do not clear the virus according to the prescribing guidelines end up having to do 48 wks total.  
Being 63 does not disqualify you from treating unless there is some other medical condition that the doctor feels would endanger your health while treating with interferon and ribavirin.  Genotype 2 has a high cure rate (around 80%) with interferon and ribavirin and given the fact that you have stage 3 fibrosis treating now is advisable.  I think there are trials currently in progress for geno 2 & 3 that do not use interferon and the success rate has been phenomenal so if your opposed to using interferon that might be an option.   However, those drugs won't be approved by the FDA and released to the public for another several years, maybe 2014/15, therefore, I would not wait that long due to your degree of fibrosis.

Good Luck

[desrt]

At stage 3 I would go ahead and give interferon and ribavirin a try now. You can do a genetic test (IL28B) that will help you and your doctor do a response guided course of treatment.

http://www.gastrojournal.org/article/S0016-5085(10)00841-3/abstract

If your side effects aren't too bad, you test CT or CC on the IL28B, and you test undetected at 4 weeks into treatment, do the 24 weeks. If the side effects are bad, you test TT, and are still detectible at 4 weeks, you may have the option of stopping and waiting for something better to come along.
Good luck.

[willbb]

I would agree with corragio ,in that being 63 in and of itself does not mean that treating your HCV is not an option.
Doctors are somewhat cautious treating someone advancing in age ,however this is predicated on one's overall health (especially any possible heart issues).

The treatment drugs can sometimes cause side effects that would need to be closely monitored and given again as corragio mentions that you have St 3 liver damage treating sooner rather than later would be advisable before the liver becomes chirrotic .

Below is a recent article that will give you info. about the treatment of Genotype 2 including possible "future therapies"

Good luck and welcome to the group...

Will

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02710.x/full

HCV genotype 2 treatment: PEG-IFN and ribavirin combination

The combination of PEG-IFN and RBV has been shown to be very successful in patients with genotype 2. The AASLD guidelines [5] advise treating HCV-2 and -3 patients for 24 weeks with combination treatment, including PEG-IFN alpha-2a or alpha-2b and a fixed dose of 800 mg of RBV [6]. With this treatment, more than 80% achieve SVR. However, because experimental and clinical data suggest possible differences between HCV-2 and -3 [7-9], it may be worthwhile to focus on response rates by genotype for the future scenario of the treatment of hepatitis C.

[coraggio]

Are they still prescribing a fixed dose of 800 mg of ribavirin for geno 2 & 3?
Personally, I feel ribavirin dosage for geno 2 & 3 should be weight based for optimal results even with the high success rate for those genotypes.  iIn particular genotype 3 which has a lower response rate than geno 2 and can be a tough nut to crack.

[willbb]

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02715.x/full


Present treatment for hepatitis C genotype 3

According to the recent AASLD guidelines [15], PEG-IFN α-2b (1.5 μg/kg/week) plus RBV (800–1400 mg/day) or PEG-IFN α-2a (180 μg/week) plus RBV (800 mg/day) for 24 weeks are the established SOC regimens for patients with chronic hepatitis C genotype 2 or 3. However, optimal administration of PEG-IFN/RBV, in particular, the duration and the dosage have still not been clearly established in relation to outcome in rapid and slow responders. Based on the concept of ‘response guided treatment,’a recent meta-analysis evaluated the issue of decreasing the duration of treatment to improve tolerance and cost effectiveness, and most importantly to decrease viral resistance to the standard bitherapy [16]. Treatment with PEG-IFN and weight-based RBV for 16 weeks in patients a with rapid virological response (RVR) resulted in an SVR of 76.3% and 86.4% with 24 weeks of treatment, unlike genotype 2 which was 83.8% and 89.3% respectively

[Doofus_jones]

thank you for this reply. You are very kind. I'm an ex-pat living in HK and there is no free medicine here and no free trials. My doctor has ONLY talked of interferon and ribavirin. I will ask about other treatment.

Pete

[Doofus_jones]

thanks so much for your very good advice. I will let you know what i do. Right now I'm thinking I will start treatment on Friday.

Pete

[Kristina538]

I did the interferon/riba combo with Stage 3/4 (3A) and was told initially, a 50/50 chance because of the early cirrhosis; with RVR on the 4 weeks 75-80% chance.  My Dr used aggressive treatment with 1000 riba and I managed SVR.  I was 55 and had carried the virus for 26 years.

[Asuncion]

I was 55 when I tried Interferon Ribavirin therapy. I relapse, but I am 60 now and will give it another try.

You should do a genetic test (IL28B) as desrt tells you. You could end up doing more than 24 weeks. Be prepared, it is a hard blow when doctors don´t tell you to.

Best regards,

[rambleon40]

I respectfully assert that the cure rate goes down the further advanced the damage to the liver.  

[rambleon40]

I would take a few months and do some more research and think very, very carefully about what you should do.  The cost-benefit analysis is not as rosy as most liver docs and BigPharma present.  You may still come down in favor of treatment, but right now I am almost certain you have little idea of the real risks you run w/ INF combo treatment vs. the high odds of dying from causes entirely unrelated to Hep C.

For instance there is, in my opinion, a growing amount of evidence that INF treatment too often accelerates liver damage.

Jumping into treatment on Friday is rash.  I believe even those in this forum more inclined to support INF treatment than myself might agree.  

[coraggio]

Opinion, opinions, always nice to have varying opinions but I totally disagree with your assessment.  Stage 3 is serious business and dj should educate himself a little more about the side effects associated with interferon before treating but under his circumstances I see no other choice but to treat as soon as possible.  He has a greater chance in the next few years of crossing over to cirrhosis which lowers the odds of successful treatment in the future than he has suffering from accelerated liver disease due to interferon use.

Also, he lives in Hong Kong and SOC is the only available method of treatment.  Right now he has a very good chance of eradicating the virus and avoiding cirrhosis and a low probability of suffering long term side effects and further liver damage because of interferon use.

[willbb]

The OP has advanced liver damage To embark on treatment currently with an 80 % chance of cure ,given the data  to avoid possible  pending cirrhosis.would seem anything but "rash"

Will

[BoceprevirGal]

  Hi Pete:  I go to a support group for Hep C, and most of us are in our 50's and 60's.  I know of a few people who have cleared the virus, at your age, from my group.
   The side effects for genotype 2 treatment can usually be tolerated quite well,
depending on the person, etc, of course. If you are feeling up to it, I would say Go For It on Friday, and start your cure.
   Wishing you much hope and luck~  Katy

[pooh55811]

There are many, many people on the forum who are over 60 years old. The oldest couple I saw were 70 and 71 respectively. I am 66 years old. I have had Hep C for 30-37 years depending on how I got it. I am Genotype 1, Grade 2 Stage 2 fibrosis. I just finished 48 weeks of triple medication treatment with Interferon 180 weekly, Riba 600 mg twice daily, and Incivek 750 mg 3 times a day. It was no picnic, but it was very doable. The Incivek was the worst. Once I finished the Incivek I felt a lot better. I had to do the longer treatment because I was still detectable at 4 weeks, but I have been undetectable since 8 weeks (weeks 8, 12, 16, 20, 24, 28, 32, 36, and 48 were all undetectable). I did okay on treatment even though I am 66. I feel much better than I did before treatment. Hep C was causing a multitude of problems for me and now, after treatment, most of them are gone.

If you are already at Stage 3 fibrosis, your clock is ticking. It is much easier and more successful to do treatment before you reach Stage 4 (cirrhosis). Plus, you want to do treatment before you get cirrhosis and before you develop any other diseases that may prohibit you from treating. You may not have time to wait for new drugs and you sure would not want to be in the placebo arm of a trial/study.

Treatment does have side effects, but most of them are doable and will not cause a person to quit treatment. Some  (like nausea or rash) can be controlled with other medications. Many people have very few side effects. Others have more. Some have mild side effects, some have more troublesome side effects. Many people continue to work through treatment, some cannot, especially on triple med treatment (which you are not on). Cirrhotics, are at risk for more health problems when doing treatment and they can risk liver failure or other problems. The drugs do not work as well on cirrhotics so the treatment success rate is lower. That is why it is best to treat before cirrhosis sets in.

In addition, the Hep C virus is not just taking a nap in the body. It is very busy doing all sorts of damage, not only to the liver, but to many other organs as well.

I have been extensively educating myself about Hep C. The studies, articles and presentations I have seen, all conclude that the benefit of treatment outweighs the cost. Treatment is cost effective. Treatment is a whole lot cheaper than a liver transplant.

It is true that a few people can have long term side effects from treatment so people need to be aware of that.  However, they can also have major health problems if they do not treat, including End Stage Liver Disease (something you really do not want to get). I will include some links at the bottom.

I have not read anything about interferon treatment "too often" accelerating liver damage. In people with cirrhosis who are doing treatment, there is a higher risk of health problems developing than if a person is not cirrhotic. But that is because the liver is already compromised and affecting other parts of the body and other functions of the body.

One of the most resent presentations I watched stated that it is becoming more clear that the percentage of Hep C infected people who go on to develop cirrhosis is much, much higher than previously thought. So is the percent of Hep C infected people who have cirrhosis/liver related deaths.

Of course, more people die from other causes, or so the death certificates state. However, how many of those deaths are Hep C related but just not attributed to Hep C. It has been found that people who have Hep C are much more likely to develop major chronic health problems which are "seemingly" unrelated to Hep C (and those problems are more severe), than do people who are not Hep C positive. These include diabetes, lung disease, cardiovascular diseases,  kidney disease, and many more. So if the cause of death is a renal failure and the cause of the renal failure was Hep C, that death is Hep C related even if the cause of death states renal failure.

Of course a person needs to be well informed about the disease, its treatment, and the treatment side effects. But a person also needs to be well informed of the consequences of not treating while they still have the chance to treat.  

I hope some of the people with cirrhosis will chime in here. Many of the people on the forum have cirrhosis so they know first hand the consequences of not treating in a timely manner.


Link to articles on extrahepatic manifestations of Hep C:

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Extrahepatic.pdf

http://www.hcvadvocate.org/hcsp/articles/Bonkovsky-2.html


A 2005 article:

http://www.ccjm.org/content/72/11/1005.full.pdf

[Doofus_jones]

Dear desrt

I hope you do not mind me writing but you seem to be very well informed on HEPC and treatments

I am searching for a Dr to give me the IL28B test. In Hong Kong this does not appear to be easy. I have emailed a hospital in Bangkok and will fly there if I cannot find here.

Am I right in saying that the test is looking whether you a re CC CT or TT? (whatever that means.)  If so which category is the one that will be most receptive to Interferon and ribavirin treatment?

The Dr tells me I've probably been carrying this for 30 odd years. I am totally asymptomatic. I work a 12 hour day all week and feel fine on it. In fact people tell me how well I look. This HepC has fallen out like a joker in the pack.  I have seen the reports and read them so I KNOW they are true.  But it is almost in the realms of fantasy that I'm going to risk all the side-effects to these drugs when I feel so well. This must be common - right?

How long have you been dealing with this disease?

best wishes


Pete
_____

[Doofus_jones]

Dear Idyllic

Where did you find info about the trials in progress for Geno 2 & 3 for the all oral HCV meds?  I'm wondering when we can expect these drugs to come onto the market.

best wishes

Pete

[orphanedhawk]

I'm genotype 2. Right now interferon treatment is all that is available to you.
The new orals in trial could be available to the public anytime from as early as 2014 in the U.S. It could be longer and who knows how long, until it is available elsewhere.

Because you are genotype 2, I'd suggest you begin tx sooner rather than waiting.
I saw a good GI in Bangkok at British Nursing Hospital.
Bumrungrad is fancier but I liked my GI at BNH better.
Bumrungrad is more likely to have you do more than is necessary to simply get more money out of you.

[Doofus_jones]

Your comments are very much appreciated. I have found a lab to get the IL28B done and I'm going tomorrow to get the test. I need to wait three days for the results to come through. I guess I will start the treatment the following Friday.

Thanks again


Pete

[desrt]

Glad you found a lab.

The gene combo which seems to be the best to carry on this particular test is CC. CT is next most receptive and TT the least. There are other spots on the IL28B gene that seem to have some bearing on response, but this is the only test commercially available at the time.
But the most important thing in response guided therapy is getting those early viral load tests, especially the one at 4 weeks. Even someone with the TT gene combo has a better than 70% chance of a sustained response if they show undetected at 4 weeks - RVR (rapid virological response).
You are very kind to say that I "seem to be very well informed". I'm just a little obsessive on this particular topic ;-).
For years, one of HCV patients primary complaints was that doctors were giving us 'one-size-fits-all', 'cookie cutter' style treatments. Now that we are starting to get the tools to do response guided tx, I think we should use them.

Best,
d

[Doofus_jones]

Thanks so much for this explanation. I'm off this morning for my IL28B.

Pete

[mykids247]

I am 60 years old and finished 24 weeks of peg and riba in march.....6 months end of treatment CURED. I am g 2. It wasnt easy but worth every bit............  

[Doofus_jones]

Did you have symptoms before you embarked on treatment - that is to say were you feeling ill?  I'm not, in fact people keep telling me how well I look!

The only way I can liken this is sort of hairline fractures on an airplane that superficially looks fine. I can't imagine myself saying I feel much better after 24 weeks of treatment coz I feel fine anyway. I suppose if I hit myself on the head with a hammer it will feel nice when I stop.

Anyway will start treatment next friday.

best wishes to you. I glad you are well and I hope this works for me too.

Pete