I am relapsed after taking sovaldi , Rvabirin and Interferon for 12 weeks

[elsharony]

i took sovaldi , Rvabirin and Interferon for 12 weeks and relapsed after the treatment! I am genotype 4 with liver cirrhosis F4. I am very frustrated and don't know what to do.My doctor recomended taking another round of Sovaldi and Olysio for 12 weeks. Will this combo work?

[Mmorgan856]

Thanks, thanks!!!  I'm optimistic I'll achieve SVR.  I'm taking this attempt to clear this HCV VERY SERIOUSLY.  taking care of myself as best I can.  I cannot begin to imagine why that ( excuse the description ) Bozo would have even treated me at that time.  Biopsy at that time showed minimal, an now I'm finding out that I probably went through that horror an the chances of going SVR were practically nil.  Doesn't change anything now an I'm so grateful I have a better chance of SVR now.  That experience kept me away from even thinking about treatment an I did an ostrich-in-the-sand attitude all these years.  So far, this is a piece of cake, so to speak.  I beginning to feel empowered with everything I'm learning, an I want to thank ALL out there for educating me.  I'm tired of this crappy hep C diagnosis keeping me scared all these years.  I feel like fighting back for the first time!!

[Pamelajean1]

Well you'd certainly qualify for being 'intolerant'. Interferon has shown to be inferior though for GT 2's.

Per HCVguidelines.org for GT 2....

Sofosbuvir (400 mg daily) was combined with weight-based RBV (1000 mg to 1200 mg) to treat HCV genotype 2 treatment-naive patients across 3 clinical trials: FISSION, POSITRON, and VALENCE. (Lawitz, 2013b); (Jacobson, 2013c); (Zeuzem, 2013b) The FISSION study randomized patients to daily PEG/RBV (800 mg) for 24 weeks or sofosbuvir plus daily weight-based RBV (1000 mg to 1200 mg). (Lawitz, 2013b) The SVR was higher (94%) in patients who received sofosbuvir plus RBV compared with those who received PEG/RBV (78%) (52/67). Across all 3 trials, 201 of 214 (94%) patients with HCV genotype 2 achieved SVR with sofosbuvir plus RBV. Among patients who did not achieve SVR, sofosbuvir resistance- associated amino acid variants were not detected. (US FDA, 2013a)

[hepc4Sandi]

Thanks Mary, I just went in for the blood draw for the Viral Load Test, I should know the result on August 7th or 8th, as they have to send it out for the test. I would think you would not be classified as a non-responder since that is not why you stopped treatment before. (ComicCon is going on here in San Diego, so you know… May the force be with you.)

[Mmorgan856]

ALMOST THERE!!! Wishing you the best.  I can imagine how nervous every single person was at your point of treatment.   1. DAY ,  hoping you the best news   THOSE 3 LETTERS...  SVR.  take a deep breath, stay strong an positive, just knowing you can change your name to hepcNO MORE 4Sandi, soon.  Keep us up to date.  Take good care of yourself.  Mary

[Mmorgan856]

Wow, thanks for all the info.. Although I'm GT 2 ,  all information concerning this virus is good information to know..  That brings me to another question that maybe someone out there can answer.  Would I be considered a non-responder if I treated with interferon but opted out of treatment after 4 mths of a 6 mth. Due to severe side affects .i wasn't taken off treatment for labs or anything that I can remember.  This was back in the mid 90s.  Thanks everyone.  Mary

[hepc4Sandi]

Thank you for the reply. I was UND during and at 4 weeks post treatment, the enzymes were not high before treatment, and were even lower after at 4 weeks. I took the same Tx as you. I am just hoping that it is still UND, will know in 2 weeks or so. I am new to all this as I didn't know I had HCV until last fall, though I have had it since the 70s. This is my first Tx, and hopefully my last. Thank you for the info, us G4s have to be a support to each other. Please let the Forum know what happens next for you.

[elsharony]

The relapse occurred after the 12 weeks of treatment. I mean after I finished the 12 weeks, my doctor asked me to do the blood work two weeks after I stopped and the virus was there while it was undetected during the the 12 weeks. my liver enzymes were elevated before the treatment , but it was normal during the treatment. After the virus came back, my liver enzymes are elevated again. I took Ribavirin plus Sovaldi and Interferon for the 12 weeks.

[hepc4Sandi]

I am so sorry that this happened to you. The numbers for the response rates on these new meds are just coming in.

A couple more questions: Sorry, just trying to figure out your timing. You did your treatment 1 week behind me. So did the relapse occur just now? Before your 12 week Viral Load Test? Or did it show at your 4 week test? This week would be week 11 EOT for you right? Were your liver enzymes elevated before, during, after treatment too? Was your Ribavirin adjusted at all during your treatment?

[elsharony]

Thank you, guys for your nice words! I started the treatment in Feb, 12 and finished on May 8. I have liver cirrhosis F4, grade A3 , and I have no symptoms at all of the cirrhosis. I was undetected during the treatment, but the virus came back after I finished. I wish I did not take that como. I will waite untill the new med. But help me guys and explain to me how much is the response rate with new treatment for those who relapsed and have cirrhosis F4.
Thanks

[Healingangel]

I too had Genotype 4 and treated for 12 weeks with Sovaldi and Olysio.  My 4 week EOT blood test came back undetected.  I feel so blessed that this combo seems to have worked for my body and genotype.  I go in for my 12 week EOT test the beginning of September and just keep thinking positive thoughts that I will achieve SVR.  

So please listen to your doctor, it does work for Genotype 4.  Give it a try and hopefully will work for you as well.  We all deserve to achieve SVR!!!

[hepc4Sandi]

At what point did you find out that you relapsed? When did you finish treatment? I am/was G4, did the same Tx, ended May 1, was UND at 1 month EOT, am going in tomorrow for my 3 month viral load test. Just wondering. Am very nervous, but am feeling really great physically. Was this your first treatment?

[Boobert]

Sorry to hear about yor relapse. I WAS a genotype 4 also and got into a BMS trial with 3 drugs for 12 weeks.Daclatasvir,Asunaprevir and BMS-791325. I was UD at day 9 and stayed UD that was 2/14/13.Daclatasvir is suppossed to be released at this years end. If you can wait you'll be able to treat with Daclatasvir and Solvaldi combined with a very high 90% rate of clearing for good. Take some time before jumping into the Olysio combo. Talk with your Hep Doc about Daclatasvir's release later this year. There are many new drugs very close to being released much better then Olysio. Good luck and Take care.
Bob

[Pamelajean1]

http://hepatitiscnewdrugs.blogspot.com/2014/06/my-treatment-approach-to-chronic_4.html

"Genotype 1 is the most common form of HCV worldwide. Genotype 4 is the dominant genotype in Egypt and the Middle East, genotype 5 is frequent in South Africa, and genotype 6 is common in Vietnam and Cambodia.4040 In the United States, genotypes 4 through 6 are uncommon and rarely seen except in immigrants from the aforementioned regions of the world.

In patients with genotypes 1, 4, 5, or 6 without cirrhosis, our treatment approach is PEGINF, SOF, and RBV for 12 weeks. The SVR rate is 92% or greater, and less than 2% of these patients will be unable to tolerate this regimen. For patients who have not achieved an SVR during previous treatment with PEGINF and RBV or PEGINF, RBV, and either TPV or BOC, our approach is the same. Patients without cirrhosis who prefer not to be treated with PEGINF or have intolerance or contraindications to PEGINF can defer treatment and wait for an FDA-approved all-oral antiviral combination. Two such regimens are expected to be available before 2015. We do not promote either SOF and RBV for 24 weeks or SOF and SMV for 12 weeks in patients without cirrhosis.
In patients with cirrhosis and genotypes 1, 4, 5, or 6, our approach is still PEGINF, SOF, and RBV for 12 weeks as long as the platelet count and serum albumin level are normal and there is no history of hepatic decompensation or evidence of esophageal varices or subclinical hepatic encephalopathy. In contrast, we would not treat patients with cirrhosis and any of these laboratory or clinical abnormalities with a PEGINF-containing regimen. In a previous study in which patients with these characteristics were treated with PEGINF, RBV, and either TPV or BOC, more than half experienced severe anemia, 25% discontinued treatment, and 1% to 2% died as a result of hepatic decompensation.4141 In our opinion, the risk that this poor outcome could also occur with a 12-week PEGINF and RBV–containing regimen is considerable. In addition, the SVR that could be achieved with PEGINF, SOF, and RBV is reduced to 80% or less in such patients.

In patients with genotype 1 or 4 and cirrhosis who have intolerance or contraindications to PEGINF, our treatment approach is SOF and SMV for 12 weeks. In patients with HCV-induced extrahepatic manifestations such as symptomatic cryoglobulinemia, glomerulonephritis, or B-cell lymphoma, regardless of fibrosis stage, we also use SOF and SMV. We do not believe that testing for the Q80K sequence variation is necessary when treating patients who have genotype 1a with SOF and SMV. The SVR when this sequence variation is present is still 90%, and there is no suggestion from the data that adding RBV or extending the duration of therapy to 24 weeks enhances SVR. We do not recommend 24 weeks of SOF and RBV in these patients; the cost of this regimen is prohibitive, and the SVR rate is estimated to be only in the 70% to 75% range, approximately 20% lower than that observed with SOF and SMV. We also do not recommend deferring treatment in this population, and payers should recognize their need for treatment. These patients have cirrhosis, are at risk for development of severe and life-threatening complications of cirrhosis, and should not have to wait for an alternative all-oral regimen."

[jpfitzer]

I am six weeks post treatment on the same triple tx. So sorry to hear of your relapse. I hope that the following information is helpful...

To provide healthcare professionals with timely guidance, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) in collaboration with the International Antiviral Society–USA (IAS–USA) have developed a web-based process for the rapid formulation and dissemination of evidence-based, expert-developed recommendations for hepatitis C management. The following is excerpted from their website at http://www.hcvguidelines.org…
Below is from the section of their report that provides guidance on the retreatment of a person with chronic HCV infection in whom prior therapy has failed.

Recommended regimen for HCV genotype 4, PEG/RBV nonresponder patients:
Daily sofosbuvir (400 mg) for 12 weeks and daily weight-based RBV (1000 mg [75 kg]) plus weekly PEG for 12 weeks is recommended for retreatment of IFN-eligible persons with HCV genotype 4 infection

Alternate regimen for HCV genotype 4, PEG/RBV nonresponder patients:
Daily sofosbuvir (400 mg) and weight-based RBV (1000 mg [75 kg]) for 24 weeks is recommended for retreatment of HCV genotype 4 infection.

[hepcandme]

so sorry to hear of your relapse

We are kinda the trial rats here. Lots of tweaking to be done with the new meds - which ones? his long to treat? Riba added or not?

The good news is that the new drug combo looks to be Very promising.

I think I would go with the combo your doc is offering but, I am not a doctor and don't have any studies on Genotype 4 to back my statement

Might work and it will give your liver a break even if you relapse

[Livelife777]

So sorry about your relapse as I know it's disappointing.  Would say going another round of S and O would not be your best option.  I'm really surprised that your Doc would recommend that.  I'm not that familiar with geno 4, but have not heard going in this direction.  We have other friends on here that are geno 4, and am sure they will weigh in on that question.
Are you seeing a Hepatologist ?
Wish you only the best.
...Kim..

[Mmorgan856]

Hi,  I hate to hear about your relapse.  Although I'm not educated enough to help u out w/ suggestions, I'm sure there will be lots of people answering an setting your mind at ease as to the best way to move forward.  Take care an praying you do well.  Mary