Genotype 1A or 1B - does it matter anymore?

[hepcandme]

My doc says that the new treatment regimens do not differentiate for those with Genotype 1A or 1B. This seems to substantiate that assertion:

http://www.medscape.com/viewarticle/823549#1

I am also wondering why anyone would add Riba to the  ledipasvir and sofosbuvir combination since it doesn't seem to improve outcomes?

And, thoughts on 12 weeks vs 24 weeks?

Looking to begin a new treatment just as soon as the FDA approves this combo

[Willy50]

I have been worrying that I have only had negative things to say.

The answer is that I do not know, and I frankly think that many doctors would argue the point. I have no doubt of it.  But..... it is your body and your life.

Do not just take what I say as fact; run it by a doctor or 3, and ask a few pharmacists and always read up on drugs you take.
To the best of my knowledge one does not take drugs life cipro prophylactically, especially when one has liver disease.
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My friend, whose life a floroquinalone basically destroyed only took 2 doses, but (in her case) it is especially counter indicated with steroids. Yes, it was prescribed by a doctor prophylactically.
Somewhere on medhelp there are also a few threads on this very topic.

http://www.medhelp.org/user_journals/show/16135/Fluoroquinolones-increase-risk-of-tendon-rupture-in-elderly--transplant-recipient--steroid-users

If you have neuropathy you might see a neurologist. My neuropathy ramped up with treatment, I felt due to anemia.  My world class doctor argued with me, but the neurologist allowed that I may have been right. Such as it was....one could not prove anything.

Point is..... why risk it?

I know very very little of your case, so don't trust me, just follow up on a few things I'm asking and see where it takes you.

If you have neuropathy you might also look at my old threads; there is one called something like Vitamins and Micronutrient Testing. There are some you tube links which demonstrate some of what I am referring to; drug interactions and the gut.

http://www.medhelp.org/posts/Hepatitis-Social/Vitamin-and-Micronutrient--Testing/show/2027720#post_9603214

This should keep you busy for a while.

Take care and I hope this has been of some benefit to your situation.

willy

[hepcandme]

Wow

The Cipro I take is intended as a prophylactic antibiotic but it is really frightening to think that taking it once a week could actually be Causing my neuropathy to worsen

Geesh, why don't the docs consider these factors?

I do know that others in this group have been prescribed Cipro and in much higher doses so I think it is part of the standard of care for cirrhotics

My Vitamin B level is fine. It was on the low side before but never out of the normal range and now it is in the high normal range

Magnesium - I will ask for them to throw that test on in the next labs in a few weeks

thanks Willy for all the great input

[Willy50]

Here is another idea for your next TX;
Sovaldi and Daclatasvir (also currently in trials; they may be looking for TX failures to PI's)

This treatment might not need ribavirin

http://www.natap.org/2013/EASL/EASL_106.htm
(scoll down to figure 23 and read)

"Apparently the combination of DCV + SOF is so potent that it even works without additional ribavirin. These findings are very helpful as they help to envision that there will be potent salvage regimens even in patients failing previous DAA therapy and resistance development. "

~W

[Willy50]

http://www.fda.gov/Drugs/DrugSafety/ucm365050.htm

Safety Announcement

[8-15-2013]  The U.S. Food and Drug Administration (FDA) has required the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs be updated to better describe the serious side effect of peripheral neuropathy. This serious nerve damage potentially caused by fluoroquinolones (see Table for a list) may occur soon after these drugs are taken and may be permanent.

The risk of peripheral neuropathy occurs only with fluoroquinolones that are taken by mouth or by injection.  Approved fluoroquinolone drugs include levofloxacin (Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), and gemifloxacin (Factive).  The topical formulations of fluoroquinolones, applied to the ears or eyes, are not known to be associated with this risk.

If a patient develops symptoms of peripheral neuropathy, the fluoroquinolone should be stopped, and the patient should be switched to another, non-fluoroquinolone antibacterial drug, unless the benefit of continued treatment with a fluoroquinolone outweighs the risk. Peripheral neuropathy is a nerve disorder occurring in the arms or legs. Symptoms include pain, burning, tingling, numbness, weakness, or a change in sensation to light touch, pain or temperature, or the sense of body position.  It can occur at any time during treatment with fluoroquinolones and can last for months to years after the drug is stopped or be permanent.  Patients using fluoroquinolones who develop any symptoms of peripheral neuropathy should tell their health care professionals right away.

[Willy50]

Yes, it is good news and it bodes well for your future treatment.

If you want to treat as soon as possible it looks to me like the gilead (sov/ledi) treatment will be what you need, but I would consider adding RBV.

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"I am not taking many meds now - Spiro 25 mg (diuretic), Vitamin B 500 mg and a once a week antibiotic - Cipro "
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It seems to me that you are on meds if you are taking cipro. I also don't understand; there is a once per week antibiotic? Is that according to recommended dosing? Or is it being used prophylactically?

Cipro is a pretty serious antibiotic. Read up on it; the floroquinalone group is getting a lot of scrutiny lately. I have a friend who took only two doses whose life has been destroyed. I'm in no position to question suitability, but I wonder if you might review your usage of this drug with your doctor and perhaps moreso your pharmacist. Please also read up on it.

I am afraid that some of these hi powered antibiotics have been prescribed improperly.

Far be it from me to diagnose, but this blog contains some concepts, that you may want to run down;
http://www.survivingcipro.com/articles-authored-by-you/gut-health/

My concern is that if drugs damage your gut flora, then the nutrients you need for your nerves get destroyed. In short- could the cipro be causing or contributing to your neuropathy?

This is also why I recommended getting your levels checked; B-vitamins and magnesium. If you are seeing a neurologist for your neuropathy you might ask them. If you are not, perhaps you should.
IF you are vitamin B deficient, you need to run that down before you start on ribavirin, sine that could contribute to the neuropathy issues you already have.

In the meanwhile..... do some reading....  : )

You have a lot to digest now, and I hope that this has helped in some ways and I hope I have not seemed too critical; the intention was to help.

willy

[hepcandme]

OK

You're right. I am not a null responder:

Null Responder: A null responder is someone who achieves little or no decrease in hepatitis C viral load during HCV treatment. Null responders are highly unlikely to respond to re-treatment with an interferon-based regimen.

Non-responder: Often referred to as a "treatment failure," a non-responder is someone who does not have an EVR or, if they stay on treatment for 24 weeks, does not ever have a 2-log (99%) drop in hepatitis C viral load or undetectable HCV RNA during hepatitis C treatment.

Partial Responder: A partial responder is someone who experiences at least a 2-log decrease in hepatitis C viral load during HCV treatment. Partial responders are more likely to respond to re-treatment than non-responders or null responders.

Relapser: The term relapser refers to someone who has had an EVR or ETR, but whose virus rebounded after they completed HCV treatment. People who had a relapse after completing HCV treatment are more likely to achieve SVR after re-treatment than partial responders, non-responders, or null responders.

but, this is good news that I am a relapser since it improves my chances of achieving SVR, it seems