Aa
Genotype 4
Hello. Anyone have any experience with Hep C, Genotype 4?
Like I wrote on your other post I am on day 34 of 12 weeks on Sovaldi, Pegasus, Ribavirin, and found out yesterday my virus level is undetectable! Please let me know how it goes for you. Very high cure rate right now! 96%!
I have been diagnosed also with HCV-4. My doctor and I have agreed to start therapy. I am now waiting for my insurance to authorize the medication.
Here is a I thought nicely put together presentation for HCV-4 including treatment outcomes ect....
http://www.colloquium.eu/congres/11PHC/presentation/Monday_Amphi_bleu/S_KAMAL.pdf
b
http://www.colloquium.eu/congres/11PHC/presentation/Monday_Amphi_bleu/S_KAMAL.pdf
b
You are of to a good start.
Hope you don`t mind but I will mention it one more time and than I will never mention it again :-) please check your HOMA2-IR before tx (fasting glucose + insulin from same blood draw).
Good luck with your appointment and we are here if you have any questions.
b
wk45
Hope you don`t mind but I will mention it one more time and than I will never mention it again :-) please check your HOMA2-IR before tx (fasting glucose + insulin from same blood draw).
Good luck with your appointment and we are here if you have any questions.
b
wk45
Again, I'd like to thank everyone for your response and your support! I've set up my appointment for April 13th at the U of M and until that day comes around, I'll be searching and researching everyones suggestions. I am forever grateful! I will keep you posted after my appointment.
Thanks
Thanks
You are welcome !
I am convinced Dr. Ana Lok will be supporting Alinia for GT4.
To check for Vit D and Vit B12 is harmless. All it involves is a bloodtest
to check if you have adequate amounts. A small effort for possible benefit.
Please also check your HOMA-IR ! This is very important and very easy !
http://gut.bmj.com/content/58/12/1662.abstract
I have seen too many people by now not responding well because they were insulin
resistant.
Again it is as simple as running a few extra vials at your next bloodtest.
Just because your glucose might be in range does NOT garantee that you are not IR.
Let me know if you have any questions
I am convinced Dr. Ana Lok will be supporting Alinia for GT4.
To check for Vit D and Vit B12 is harmless. All it involves is a bloodtest
to check if you have adequate amounts. A small effort for possible benefit.
Please also check your HOMA-IR ! This is very important and very easy !
http://gut.bmj.com/content/58/12/1662.abstract
I have seen too many people by now not responding well because they were insulin
resistant.
Again it is as simple as running a few extra vials at your next bloodtest.
Just because your glucose might be in range does NOT garantee that you are not IR.
Let me know if you have any questions
Thank you Bali. I'll be sure and look up the links. The Hepatologist I'm going to see is the head of the hepatitis research department at U of M. I made the decision to go see her because of the G4. This whole hep thing is way above my head and felt that seeing this Dr who at least knows about the G4 gives me a better chance for success. Not sure how I feel about the experimental/research factor, but it feels like no matter what or who is treating, it's all experimental for G4. Trying to muddle through all of the responses and I'm very grateful for all who contribute. I am learning. Slowly, but I do believe I am learning.
Hi Zeke,
Here are a few links to what I suggested earlier. Maybe something to talk to your hepatologist about.
Alinia (Nitazoxanide) and genotype 4
http://www.ncbi.nlm.nih.gov/pubmed/19135998
Predosing Ribavirin
http://www.hivandhepatitis.com/2010_conference/aasld/docs/1214_2010_a.html
Vitamin D
http://www.hivandhepatitis.com/2010_conference/easl/docs/0518_2010_b.html
Vitamin B12
http://www.hivandhepatitis.com/2009icr/ddw/docs/060509_b.html
b
wk45
Here are a few links to what I suggested earlier. Maybe something to talk to your hepatologist about.
Alinia (Nitazoxanide) and genotype 4
http://www.ncbi.nlm.nih.gov/pubmed/19135998
Predosing Ribavirin
http://www.hivandhepatitis.com/2010_conference/aasld/docs/1214_2010_a.html
Vitamin D
http://www.hivandhepatitis.com/2010_conference/easl/docs/0518_2010_b.html
Vitamin B12
http://www.hivandhepatitis.com/2009icr/ddw/docs/060509_b.html
b
wk45
Thanks for the link, Mike - not the detail I'm looking for in what you've posted so will look forward to reading the article.
Trish
Trish
Thanks for the direction to CCO for this. I'll look there.
I've heard that data on rhesus monkeys however heard other data that puts that in perspective. At this point, I have a different opinion than you of R7128.
This is the very beginning of the journey for zeke. Lots to sort out and a step at a time.
(Good luck with all this, zeke. :)
Trish
I've heard that data on rhesus monkeys however heard other data that puts that in perspective. At this point, I have a different opinion than you of R7128.
This is the very beginning of the journey for zeke. Lots to sort out and a step at a time.
(Good luck with all this, zeke. :)
Trish
http://www.clinicaladvances.com/cmexpress_pdfs/gh-article-201101-sup1.pdf
"...Telaprevir alone demonstrated modest antiviral
activity in these patients, with a median decline in HCV
RNA levels of 0.77 log10 IU/mL between baseline and
Day 15. In comparison, treatment with peginterferon
and ribavirin was associated with a decline in HCV RNA
levels of 1.58 log10 IU/mL, and treatment with telaprevir
plus peginterferon and ribavirin was associated with a
median decline of 4.32 log10 IU/mL. This finding suggests
that the 3 agents may achieve a synergistic effect when
used together. The investigators noted that IL-28B genotypes
were not investigated in this study; thus, imbalances
in the frequency of these genotypes cannot be excluded
as a potential explanation for the differences among the
3 groups.
No significant differences in outcomes among the 3
groups were noted at the end of the peginterferon and
ribavirin treatment period. In an intent-to-treat analysis,
the proportion of patients with undetectable HCV RNA
levels was 75% in the group treated with telaprevir plus
peginterferon and ribavirin, 75% in the group treated with
peginterferon and ribavirin alone, and 88% in the group
treated with telaprevir alone followed by peginterferon
and ribavirin for 46 weeks. SVR rates were 50%, 63%,
and 63%, respectively...."
"...Telaprevir alone demonstrated modest antiviral
activity in these patients, with a median decline in HCV
RNA levels of 0.77 log10 IU/mL between baseline and
Day 15. In comparison, treatment with peginterferon
and ribavirin was associated with a decline in HCV RNA
levels of 1.58 log10 IU/mL, and treatment with telaprevir
plus peginterferon and ribavirin was associated with a
median decline of 4.32 log10 IU/mL. This finding suggests
that the 3 agents may achieve a synergistic effect when
used together. The investigators noted that IL-28B genotypes
were not investigated in this study; thus, imbalances
in the frequency of these genotypes cannot be excluded
as a potential explanation for the differences among the
3 groups.
No significant differences in outcomes among the 3
groups were noted at the end of the peginterferon and
ribavirin treatment period. In an intent-to-treat analysis,
the proportion of patients with undetectable HCV RNA
levels was 75% in the group treated with telaprevir plus
peginterferon and ribavirin, 75% in the group treated with
peginterferon and ribavirin alone, and 88% in the group
treated with telaprevir alone followed by peginterferon
and ribavirin for 46 weeks. SVR rates were 50%, 63%,
and 63%, respectively...."
I don`t have the link at hand for Tela and GT4 however you find it under Clinical Care Options study C210. Again, I also posted it above.
What you are suggesting is a pretty big gamble in my view.
We simply don`t know which drug is going to be available for GT4 and worth
its risks any time soon.
BTW , R7128 has shown kidney problems in resus monkeys and I personally
know someone that was part of the phase 2 trial and developed horrible kidney
problems.The fact is R7128 is still in trial and part of that is to find out if
there are side effects, not something I would want to be part of if I have better options.
.
What you are suggesting is a pretty big gamble in my view.
We simply don`t know which drug is going to be available for GT4 and worth
its risks any time soon.
BTW , R7128 has shown kidney problems in resus monkeys and I personally
know someone that was part of the phase 2 trial and developed horrible kidney
problems.The fact is R7128 is still in trial and part of that is to find out if
there are side effects, not something I would want to be part of if I have better options.
.
Can you post the actual link to that? It seems similar to the link that's posted when people suggest Telaprevir is of no use to G3's - and only goes so far as Day 15. Actual SVR rates showed an increase however despite not achieving an RVR. I'd like to read the whole study to see how far they went in their use of Telaprevir on G4's. Thanks.
There are a number of new drugs that have shown no side effects - R7128 among them. I'm not nearly as turned off by R7128 as you are. More data to be known. I was in the ill-fated R1626 trial so I know full well it ain't over til it's over. I just personally don't think there is enough data on Tela and Boce as yet to be able to put it in such black and white statements that it has no benefit for a G4.
Waiting increases the chance for more fibrosis but we also know that doesn't happen overnight and progression is slow in most people, however that's unpredictable from person to person so it requires ongoing monitoring. However, again, it's not something that generally happens in a short time frame and signs of potential for advancing fibrosis are usually quite evident. Watchful waiting when new and more effective treatment drugs are on the way is not a bad option either when used intelligently.
There are a number of new drugs that have shown no side effects - R7128 among them. I'm not nearly as turned off by R7128 as you are. More data to be known. I was in the ill-fated R1626 trial so I know full well it ain't over til it's over. I just personally don't think there is enough data on Tela and Boce as yet to be able to put it in such black and white statements that it has no benefit for a G4.
Waiting increases the chance for more fibrosis but we also know that doesn't happen overnight and progression is slow in most people, however that's unpredictable from person to person so it requires ongoing monitoring. However, again, it's not something that generally happens in a short time frame and signs of potential for advancing fibrosis are usually quite evident. Watchful waiting when new and more effective treatment drugs are on the way is not a bad option either when used intelligently.
I posted the Telaprevir GT4 study above , it did not improve SVR.
Funny you mention R7128 , I was up for that one ! Today I am glad I did NOT go for it.
My hepatologist is one of the investigators.
Why wait for wishful new drugs that can bring additional health risks if it might not
be nessecary in the first place?
As we all know waiting increases the chance for more fibrosis which leads
to higher relapse rates even in well responding patients.
Funny you mention R7128 , I was up for that one ! Today I am glad I did NOT go for it.
My hepatologist is one of the investigators.
Why wait for wishful new drugs that can bring additional health risks if it might not
be nessecary in the first place?
As we all know waiting increases the chance for more fibrosis which leads
to higher relapse rates even in well responding patients.
At this point, it's not known if zeke needs to treat in the immediate future and there are the options of clinical drug trials if they fit. The nucleoside polymerase inhibitor R7128 shows great promise across all genotypes. It's in Phase IIb testing I believe but could be pushed ahead just as well if it continues to show the results it has been. I think Roche is a little skittish after it's experience with R1626 and moving along perhaps a little more carefully. Just a guess on my part though.
Not sure if Telaprevir or Boceprevir have been tested on Genotype 4 however many folks are fond of saying there is no merit to them for Geno 3 yet they show an increase in SVR rate of 23% - no small shakes. I'm not all that fond of saying these PI's won't work at all for this or that Genotype when the testing has not been all that extensive as yet.
Personally I'd opt for doing the IL28B test ahead of time than doing 12 weeks of treatment in lieu of an IL28B test. More knowledge up front. That's simply my own take on it.
Trish
Not sure if Telaprevir or Boceprevir have been tested on Genotype 4 however many folks are fond of saying there is no merit to them for Geno 3 yet they show an increase in SVR rate of 23% - no small shakes. I'm not all that fond of saying these PI's won't work at all for this or that Genotype when the testing has not been all that extensive as yet.
Personally I'd opt for doing the IL28B test ahead of time than doing 12 weeks of treatment in lieu of an IL28B test. More knowledge up front. That's simply my own take on it.
Trish
"The current treatment might work just fine for you without adding in anything else. It does for just under 50% of the folks."
Zeke is GT4 with an average response rate of 50-60% to SOC. That can be increased
by adding Alinia to a response rate of 79%.If in addition he makes sure not to be insulin
resistant and by optimizing a few other things like Vit D ect... he can achieve a very good
response. The IL28b would be interesting and I would do it however post facto response
pattern trumps the IL28b.
Even a CT or TT can achieve SVR and the best way to find out
is to go for 12weeks and see response pattern. If response is not satisfactory and he
is a T-patient than waiting for a third drug to become available would be advisable
unless he has advanced disease.
At current there is NO PI in the immediate future for GT4 !
Zeke is GT4 with an average response rate of 50-60% to SOC. That can be increased
by adding Alinia to a response rate of 79%.If in addition he makes sure not to be insulin
resistant and by optimizing a few other things like Vit D ect... he can achieve a very good
response. The IL28b would be interesting and I would do it however post facto response
pattern trumps the IL28b.
Even a CT or TT can achieve SVR and the best way to find out
is to go for 12weeks and see response pattern. If response is not satisfactory and he
is a T-patient than waiting for a third drug to become available would be advisable
unless he has advanced disease.
At current there is NO PI in the immediate future for GT4 !
Hi Zeke - welcome to the forum.
I think you're on the right track to get a biopsy done to determine whether you have time to wait for treatments and time to gather your information and thoughts together. Two schools of thought on biopsy for those who are treating right away (if indeed you decide to do that once you've gathered various pieces of information together). Some think there is no need. For myself, I think it adds perspective to every decision you make for yourself going forward - even if you do treatment right away. If treatment goes unexpectedly, what decisions you make can be done in light of how little or how much liver damage you have. I know lots of times people have asked for input and to provide it without knowing level of liver damage means an either-or type of answer. Clearly, I'm firmly in the camp that a biopsy is a good thing to have. :)
The current treatment might work just fine for you without adding in anything else. It does for just under 50% of the folks. If you want to increase those odds, there are other drugs coming along that might be more suitable for you. Depends on the answers to a variety of other factors.
There is the IL28B test that will tell you what your response rate is likely to be to current treatment. Info on this:
http://www.natap.org/2009/AASLD/AASLD_30.htm
Always good to have an experienced and knowledgeable hepatologist treating you. Hopefully your Dr. Lok has stayed current - you'll find out rather quickly. Doesn't hurt to have a second opinion and you'll figure out where you're most comfortable. I personally liked the hepatologist I had, he was current and open to dialoguing with me and would not only allow me to ask questions but would hear me and answer. That relationship is really important for a long haul treatment of 48 weeks.
Good support and shared experiences and information here. Good luck to you as you work your way through all the bits to figure out what is best for yourself. :)
Trish
I think you're on the right track to get a biopsy done to determine whether you have time to wait for treatments and time to gather your information and thoughts together. Two schools of thought on biopsy for those who are treating right away (if indeed you decide to do that once you've gathered various pieces of information together). Some think there is no need. For myself, I think it adds perspective to every decision you make for yourself going forward - even if you do treatment right away. If treatment goes unexpectedly, what decisions you make can be done in light of how little or how much liver damage you have. I know lots of times people have asked for input and to provide it without knowing level of liver damage means an either-or type of answer. Clearly, I'm firmly in the camp that a biopsy is a good thing to have. :)
The current treatment might work just fine for you without adding in anything else. It does for just under 50% of the folks. If you want to increase those odds, there are other drugs coming along that might be more suitable for you. Depends on the answers to a variety of other factors.
There is the IL28B test that will tell you what your response rate is likely to be to current treatment. Info on this:
http://www.natap.org/2009/AASLD/AASLD_30.htm
Always good to have an experienced and knowledgeable hepatologist treating you. Hopefully your Dr. Lok has stayed current - you'll find out rather quickly. Doesn't hurt to have a second opinion and you'll figure out where you're most comfortable. I personally liked the hepatologist I had, he was current and open to dialoguing with me and would not only allow me to ask questions but would hear me and answer. That relationship is really important for a long haul treatment of 48 weeks.
Good support and shared experiences and information here. Good luck to you as you work your way through all the bits to figure out what is best for yourself. :)
Trish
It will be a lot more helpful for Zeke if everyone will remember that all of this is new to him. You must put everything in Laymen’s Terms or it is just going to go over his head. This will make your comments futile because you are only confusing him more.
Zeke, if you don’t get many responses in the next few days, don’t get discouraged. It is the weekend and the forum seems to slow down over the weekend.
Welcome and Glad you found us, R Glass.
Zeke, if you don’t get many responses in the next few days, don’t get discouraged. It is the weekend and the forum seems to slow down over the weekend.
Welcome and Glad you found us, R Glass.
do these bloodtests now
Vit D , B12 ,
Insulin serum and glucose (same blood draw) and
calculate your HOMA-IR
talk to your hepatologist about to a drug called Alinia
also asked her about predosing Ribavirin for a couple of weeks
those are my thoughts....
Vit D , B12 ,
Insulin serum and glucose (same blood draw) and
calculate your HOMA-IR
talk to your hepatologist about to a drug called Alinia
also asked her about predosing Ribavirin for a couple of weeks
those are my thoughts....
I've decided to head over to the U of M to a Hepatologist, Dr. Ana Lok, who has over 30 years of experience in treating hepatitis. Any thoughts anyone?
Zeke
Since adding the third drug does nothing to give you better odds but does also give you a chance at additional side effects I can't see why your doctor would add it, except that most possibly he doesn't realize that it's not for geno4. Unfortunately, many of the GPs and GIs dont really know very much about hepC and what they do know is not exactly correct.
I found that I learned more in here (and the guys were SO patient and didn't mind my 4,000 questions either) than my doctor knew. LITERALLY. In the beginning it's all overwhelming but hang out in here and ask questions and I guarantee you in a short time you'll be answering questions for people who are newer than you are.
Since adding the third drug does nothing to give you better odds but does also give you a chance at additional side effects I can't see why your doctor would add it, except that most possibly he doesn't realize that it's not for geno4. Unfortunately, many of the GPs and GIs dont really know very much about hepC and what they do know is not exactly correct.
I found that I learned more in here (and the guys were SO patient and didn't mind my 4,000 questions either) than my doctor knew. LITERALLY. In the beginning it's all overwhelming but hang out in here and ask questions and I guarantee you in a short time you'll be answering questions for people who are newer than you are.
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