iam new here 48 yrs had hep c 20 yr are more I am stage 1 grade 0 - 1 should I treat now are find a trail drug all my blood work has ben normal range for years doc ask if I ever ben test for hep c because I have lots of tattoos let check and here I am talk to me
It would help to know what your genotype is. With your low liver damage you have time to wait. Newer treatments that look to be here around the first of the year for type one is a lot shorter but still have Interferon and Ribavirin in the mix. Someone that is type 2 should jump at the newer treatments as there is no interferon, as for type 3 while the treatment is the same as type 2 the success rates were not as great.
Time is on your side, just keep in mind Hep C can cause other problems besides the liver. Find a good doctor that is very much up to date with these newer drugs and also the drugs that are in current trials... Best to you.
So far as I know, for genotype 1, interferon and ribavirin will still be part of the treatment with the new drugs that hopefully will be available in a few months. Unfortunately, interferon free treatments for genotype 1 are still a way out in the future. No one knows how long. So, as can-do says, with your low liver damage, time is on your side. You could 1) treat now with triple therapy (Incivek or Victrellis, Interferon, and Ribavirin), 2) wait until the new treatments are approved and available, probably around Jan. 2014, and treat then (the treatment will be a new drug, Interferon, and Ribavirin), 3) look for a clinical trial for genotype 1's that is interferon free (trials have their own risks and you should study the pros and cons carefully), or 4) monitor the health of your liver regularly (every 6 mo to a year?) and have another liver biopsy in 3 years, hope for little or no progression of damage, and wait (which has it's own risks too as liver damage doesn't progress in a predictable fashion all the time).
Keep us posted and let us know what you and your doctor decide.
When was your liver biopsy, by the way?
The current standard of care to treat Hepatitis C Genotype 1 is the triple medication regimen (Interfero, Ribavirin, and a Protease Inhibitor, either Telaprevir or Boceprevir). This regimen is for 24 weeks, 28 weeks, or 48 weeks depending on various factors and if a person clears the virus by week 4 (Telaprevir) or week 8 (Boceprevir) of treatment. The cure rate for the triple medication regimen is about 75% for treatment naive individuals (those who have never treated before).
The FDA is currently reviewing a new treatment regimen for Genotype 1. This regimen includes Interferon, Ribavirin, and Sofosbuvir for 12 weeks of treatment. This new treatment may be approved in early 2014. This new treatment has a 90% cure rate for treatment naive individuals.
I understand that you want to treat right away. I also wanted to treat right away and I did so, 2 years ago. I am not usually a fan of waiting because Hepatitis C can cause a lot of medical problems in addition to liver related problems. However, in your case, since you have very little liver damage, a few months probably will not make any difference. Keep in mind that the new treatment, if approved, is only 12 weeks long (as opposed to 24 weeks or sometimes 48 weeks long) and the new treatment has a 90% cure rate (as opposed to a 75% cure rate). It is also hopefully going to be approved by the FDA in just a matter of a very few months, perhaps as soon as the first part of the year.
Here is a recent article about the new treatment with Sofosbuvir, Interferon, and Ribavirin:
EASL 2013: Sofosbuvir + Interferon/Ribavirin Cures 90% of People with Hard-to-Treat HCV Genotypes
Published on Friday, 03 May 2013 00:00
Written by Liz Highleyman
Adding the second-generation HCV polymerase inhibitor sofosbuvir (formerly GS-7977) to pegylated interferon plus ribavirin led to a sustained response rate of 89% for treatment-naive patients with HCV genotype 1 in the NEUTRINO study, researchers reported at the EASL International Liver Congress(EASL 2013) last week in Amsterdam. High rates were also seen for the less common genotypes 4, 5 and 6.
While all-oral direct-acting antiviral (DAA) regimens for chronic hepatitis C are eagerly anticipated, many patients with progressive liver disease cannot afford to wait. Adding the approved HCV protease inhibitors boceprevir (Victrelis) or telaprevir (Incivek or Incivo) to interferon-based therapy can shorten treatment and increase response, but these drugs have difficult dosing regimens and come with side effects of their own. Several next generation DAAs are easier to take and better tolerated.
Eric Lawitz from the University of Texas Health Science Center and colleagues conducted an open-label, non-randomized phase 3 clinical trial to evaluated the safety and effectiveness of 400 mg once-daily sofosbuvir plus 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 1,000-1,200 mg/day weight-based ribavirin.
All participants were treated for 12 weeks, with no response-guided therapy. The standard duration of pegylated interferon/ribavirin alone is 48 weeks for people with genotype 1 and 24 weeks for those with genotypes 2 or 3.
NEUTRINO enrolled 327 previously untreated chronic hepatitis C patients with HCV genotypes 1, 4, 5, and 6. These genotypes have traditionally been considered "hard to treat," but as several studies at the congress showed, all may not be equally difficult, just as genotypes 2 and 3 are not equally "easy to treat".
Just over 60% of participants were men and the mean age was 52 years. The study had broad inclusion criteria and enrolled "a good representation" of the U.S. hepatitis C patient population, Lawitz said.
Looking at predictors of poorer treatment response, 17% were black and 70% had unfavorable (non-CC) IL28B gene variants. The mean body mass index was 29 (with 30 being the cut-off for obesity) and 17% had liver cirrhosis. People using opiate substitution therapy were included.
Most patients (89%) had HCV genotype 1, though the proportions with subtypes 1a and 1b were not reported. 28 people, or about 9%, had genotype 4 (most commonly found in the middle-east and Africa, especially Egypt), while 7 people, or about 2%, had genotypes 5 (found mostly in South Africa) or 6 (found mostly in Asia).
By week 4 of treatment, 99% of participants overall had rapid virological response.
The same proportion still had undetectable HCV RNA at the end of the 12-week course of treatment.
At 12 weeks post-treatment, 90% overall achieved sustained virological response (SVR12), exceeding an estimated historical control rate of 60% for similar patients using pegylated interferon/ribavirin alone.
By genotype, 89% of people with genotype 1 achieved SVR12, as did all but 1 patient with genotype 4 (96%) and all 7 patients with genotypes 5 or 6 (100%).
A sub-group analysis showed that HCV subtype 1b had a lower response rate -- contrary to most DAA studies, which find 1a harder to treat; Lawitz explained that in this study people with subtype 1b were disproportionately likely to have unfavorable IL28B variants.
Genotypes 4, 5, and 6 were associated with better treatment response.
People with cirrhosis had similar response rates as non-cirrhotics at weeks 4 and 12 on treatment (96% and 100%, respectively), but this fell to 80% at post-treatment week 12.
Black patients, people with IL28B non-CC variants, and people with higher baseline viral load were somewhat less likely to achieve sustained response, but all achieved SVR12 rates of at least 80%.
All virological failures were attributable to relapse, with no viral breakthroughs during treatment.
Genetic sequencing revealed no S282T resistance mutations and no other NS5B substitutions causing reduced susceptibility to sofosbuvir or ribavirin.
Treatment with triple therapy was generally safe and well tolerated.
Almost all participants (98%) completed the study, with 7 total early discontinuations, 5 (2%) of which were due to adverse events.
About one-third of participants experienced side effects -- the most common being fatigue (59%), headache (36%), and nausea (34%) -- but serious adverse events were rare (1%).
Looking at side effects associated with other DAAs, 18% of patients experienced rash, 23% developed moderate anemia, and 2% had severe anemia.
Sofosbuvir + pegylated interferon + ribavirin for 12 weeks "resulted in 90% SVR12 rate," which was "statistically superior to historical control SVR rate of 60%," the investigators concluded. "Sofosbuvir was well tolerated without any additive effects of sofosbuvir to the expected safety profile of [pegylated interferon + ribavirin]."
Lawitz added that the sustained response rate of more than 80% for cirrhotic patients "is the highest reported in cirrhosis yet."
Since the overall response rate with 12 weeks of therapy was so good, an audience member asked if treatment could potentially be shortened even further. Lawitz replied that a shorter regimen is "worth studying" in a clinical trial. However, he noted, the study did not identify any on-treatment predictors (such as early viral kinetics) to indicate which patients are likely to relapse.
Even though this regimen still includes interferon and ribavirin, "from the patients' point of view, 12 weeks is a major breakthrough," said EASL Secretary-General Mark Thursz at a press conference highlight hepatitis C findings.
You've gotten excellent advice from Pooh, Advocate and Candyman. To summarize: if you want to nip it in the bud right away, your best bet is probably the soon-to-be-approved drugs that include interferon but only require 12 weeks of tx. If you want to avoid interferon at any cost, then you'll have to persuade yourself to settle down and wait for new drugs. The only possible way to get an interferon-free tx sooner is if you can watch for new clinical trials and jump to get in them, but this is a mixed bag. Some clinical trials fail, and some could conceivably put you on interferon or something with equally bad side effects, as most of them are blind, so patients don't know exactly what they are getting until well after the trial has ended. You have to be careful about the decision to participate in a trial.
Hi, I was reading your post and I wondered if you are in the US or Canada. I am genotype 1a with normal enzymes and 0-1 fibrosis for 17 years now but I'm on an interferon free regimen and I am now undetectable after 4weeks. I have another 4 weeks to go and they will test me again to see if I test for SVR by that time or continue for another 4 weeks which in total would be 12 weeks altogether. I'm on the Merck trial with the new drugs called mk-5172 and mk-8742 and I'm treatment naive which means I have never treated before this. People that have treated before get ribavirin with the other 2 protease inhibitors. The side effects are tolerable and my clinical nurse said that because I had so many symptoms to start with, I wouldn't be able to do the triple therapy treatment which is grueling for some and not others.
What I did was have all my lab reports and info faxed off to a clinic in Vancouver and I know a lot of people are going this route. Are you seeing a Hep C specialist? My specialist didn't even offer that option and I had to do my research and found out I should get my name on their list. I been having to travel back and forth to Vancouver which takes 6 hours on the bus but I have been very determined to get better!!! The study nurse would call me and ask me if I wanted to go on a certain trial that was coming up. I also asked her for an interferon free study and I got my call for the new Merck trial in phase II. This clinic take very good care of you and they also follow up for 3 years as well. If I didn't respond to this one, they would put me on another trial as soon as they could.
Also, the good this is that I didn't have to pay for the drugs because its a trial. I have so very ill with this disease and fed up with being sick every single day. There are people out there that are symptomatic as well.
Let me know how this goes with you. I'm interested. Take care and good luck!!
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