Liver biopsy results

[cbw36]

Just found out last month. Lft's slightly elevated, were slightly elevated 5 years ago too. 36 years old, 1b, vl 4.8 mil. No symptoms, other than a little fatigue which I thought was related to being overweight. BMI 31. Ultrasound mildly enlarged liver with mild fatty infiltration. Starting tx asap.
Liver biopsy next week. Not scared of procedure,  rather what liver damage they may find. Anyone here with similiar scenario recieve unexpected biopsy results?

[eureka254]

Out-of-pocket costs for treatment medications can be prohibitive; having good insurance has made treatment affordable for my husband, making for only a reasonable co-payment with prescription coverage.  However, without insurance, it would easily have been several thousand per month.

With active hep c, alcohol consumption should be a thing of the past :)!  I believe the facial flush with alcohol is due to metabolic differences rather than an indication of liver damage, but either way, the only flush alcohol should get from you these days is down the loo!  Maybe the flush you're getting is mother nature's way of making you look embarrassed when you drink ;).

Glad that your biopsy went smoothly.  Waiting for the results is probably harder than the procedure itself... good luck! ~eureka

[cbw36]

just had by liver biopsy today....piece of cake! I asked the nurse to go easy on the sedation, and I was pretty awake for the whole thing.  I think I got maybe 1 mg versed. didn't evel know I got it.  The skin local wasn't bad at all.  Worst part was the local to liver capsule.  That lasted maybe a second.  That's it.  painless otherwise.  So I can stop obsessing about that now, just hope the results are not god aweful, as I'd like to hang around for a little while.

[Bill1954]

The retail, cash-out-of-hand cost for interferon/riba therapy in the U.S. is usually around $USD 2000-2200 /month; it appears you’re looking at ~ $1440/month or so- is that correct? It’s hard to tell how much insurance is contributing to that cost; can you call their Rx plan and ask them what, if anything they’re contribution to this is, and if they’re quoting their contract supplier or is that FOB at the local pharmacy?

Again, there can be a HUGE difference in cost sometimes between buying through insurance via their contract mail order pharmacy compared to a local, out of contract supplier. And if all that checks out correctly and the drugs really do cost that much, I’d contact the mfgrs patient assistance anyway, and ask what they can do to help. They used to provide assistance to underinsured as well as uninsured; however, this policy might have changed more recently.

Additionally, don’t be afraid to involve the assistants at the doc’s office too; they often know some tricks of the trade to get you going.

Good luck-

Bill

[cbw36]

The numbers I got was $250 per injection of pegasys and $110/month for generic ribavirin. Does that sound right? or discounted at all?

[Bill1954]

Hi there—

Are you *sure* your insurance won’t cover these drugs? Are they simply not on the formulary, or could you be trying to obtain them locally, rather than from their contract specialty pharmacy? Most Rx plans cover IFN/ribavirin at least to some degree, although some of us end up with significant copays.

Typically, insurance contracts with pharmacies like Curascript that ship meds via FedEx in insulated cold packs to the patient’s home. It’d be a good idea to double or triple check to make sure; and get your doctor’s office to help if you continue to stumble around with it.

Additionally, the patient assistance programs might be worth contacting anyway; if you have a letter of denial to pay from insurance, they might not be particular as to your income, although I really don’t know for sure:

Pegassist (Genentech Pegasys system): 888-941-3331

Commitment to Care (Merck PEG-Intron system): 866-363-6379, opt 1

I’ve heard anecdotal stories in here that the DAA drug mfgrs have assistance plans in the works for the new stuff too, but nothing authoritative that I can cite here. This is *all* pricey; interferon/riba alone can cost >$ USD 20,000/year; out of reach for nearly everyone without adequate coverage…

Kick it around, and let us know it anything changes via perseverance—

Bill

[cbw36]

Thank you in advance for any/all input

[cbw36]

By the way, how do those of you in the USA afford these medications?
I fortunately/unfortunately have a great career and health insurance. Howeve, health insurance does not cover pegasys/copegasys. Unlikely it will cover tela or boc. And because I make a little over 100k a year, I don't think manufacturers will assist me. If I have to pay out of pocket, I won't be able to afford mortgage/car payments/day care, etc. So...how did some of you afford to treat?

[Bill1954]

Yes, new DAA (STAT-C) drugs have increased treatment success considerably in clinical trials. Hopefully, this increased efficacy will translate into higher SVR rates in the field too. I think the results vary between product, as well as arm-t0-arm in trials, but the %’s are somewhat similar to that.

Good luck with the pathology results; take care-

--Bill

[cbw36]

The funny thing about it is that I'm not Asian, not even remotely.
I understand that genotype 1 b is worse than 2 or 3, but I think the new drugs show 70-80% for G1, no?

[Bill1954]

No, no facial flush here. I recall reading about a genetic deficiency(?) in some Asian populations that negatively affects alcohol metabolism. On a positive note, some studies have shown that Asians responded somewhat more positively to interferon/ribavirin therapy for HCV. These were older studies; I’m not sure if recent data bears that out or not.

I’m not sure how much advanced fibrosis affects treatment outcome when combined with DAA (Direct Acting Antiviral) drugs; although there should be at least preliminary data available. Good question for the doctor, indeed.

As far as I know, genotype trumps all other predictive factors for treatment response; unfortunately, as you probably realize, GT-1 can indeed be problematic.

You might ask your doctor about the ‘IL28B’ test; this is a relatively new test that can help predict IFN treatment response from a genetic standpoint:

http://people.genome.duke.edu/~dg48/L8464-0710-Service-Announcement-FINAL.pdf

This might be a helpful tool in the ‘treat/no treat’ decision process; how this test integrates with treatment involving adjunctive DAA drugs is a good question for the doctor as well. Good luck, and let us know how things go—

--Bill

[cbw36]

By the way, thank you for the info. It's great to be able to get input from those who've been there already

[cbw36]

I was never a heavy frequent drinker. Nowhere near alcoholic, but perhaps a bit more than social, but only on occasion. What's odd is that about 2 or 3 years ago, I would often get a patchy facial flush after consuming alcohol. I googles it and it's called Asian Flush. Anyone else here have such a thing?
Anyway, what's scary is that I'm not sure how long I've had this, and what degree of fibrosis I have if any. I hear that increased stage of fibrosis reduces the chances of SVR, even with the new drugs?

[Bill1954]

It’s nearly impossible to predict in advance how the pathology report will stage and grade the results. On an optimistic note, it’s unlikely you’d have progressed into frank cirrhosis at this point; simple blood tests (which you’ve likely already had) can generally discern cirrhosis from less serious fibrosis.

Additionally, lifestyle can often influence disease progression; previous alcohol consumption generally has a negative influence on the degree of fibrosis.

Fortunately there are newer, more efficacious drugs on the verge of approval that should make treatment outcome more predictable; at least they’ve done so in clinical trials.

Good luck, and welcome to the discussion group-

--Bill