Why is Ribavirin prescribed with S+O?

[LurkAndLearn]

I am Genotype 1a, no cirrhosis and was prescribed Sovaldi, Olysio and Ribavirin.  Curious what the Ribavirin addresses since I see some folks only have to take the Sovaldi and Olysio.

[hepcandme]

I'm cheering you on Heart. This time, you're going to be cured!

[heart_in_the_keyes]

there are different combos/mixes of these three drugs......it all depends on the state of your liver and several other tests they take.

Interferon is a beast...it affected all my muscles, caused me rashes, and hair loss, and aged me 20 years in 2 years.

I am now on sovaldi/riba...so far have done well on it...1st mo. lots of energy...2nd month did too much...wasn't hydrating enough or resting,,..,platelets dropped,,.,  almost needed a transfusion...but doctor changed the dosage on the riba,,,, dizziness & nausea have gone......platelets normal now,,, resting more and not overdoing my activities.  Everyone is different....my age is also a factor.... but got my fingers crossed as I want this HCV gone before I have my transplant.

Have had HCV since mid 90's....null responder to every single other drug protocol they put me on.....was on 5....but interferon or pegainferon was included in them and they just didn't work.  

[flyinlynn]

Hi Marty

I am now wondering why you and I are doing different treatments I am only taking Sovaldi and Olysio no riba and only 12 weeks. Although I am happy about the non riba and 12 weeks now I am worried about the possibility of relapse post treatment.

Ok read a little further I see you did Victrelis I never did that one because I already had cirrhosis by then that is my guess why the 24 weeks for you vs 12 weeks for me.

I have known I have hep c since 1990 and been a 3 time null responder. I also slowly progressed over the years and was diagnosed with cirrhosis in 2008. I did not have the Q80K check. I am holding I have treated enough I guess I will know in 12 weeks

Lynn

[zarmar]

I am 3 weeks in with Sov/Olysio, 1a with cirrhosis, tx naive. I was not prescribed Rib as I already have low WBC, RBC, and platelets.  My hepatologist wanted to reduce risk for me. This is a legitimate case I have learned that has been accepted by a number of insurers in approving the off-label combination that excludes Rib.

[goater]

Have you treated before?  If treatment naïve be thankful you're not taking interferon.   I'm also GT1a and on Sovaldi / Olysio + Riba.  This is day 25 and approved for 24 weeks.  However, I'm cirrhotic and treated twice before.  Was a null responder with 48 weeks of SOC and relapsed two months post 48 weeks of SOC+Victrelis.

Did you test for Q80K?  We didn't test as some of the later studies indicated that polymorphism associated with 1a's, if present, should not preclude the prescribing of Olysio.  Not knowing if I had Polymorphism is the main reason for adding Ribavirin.  My GI doc felt I'd remain healthy enough to wait for sol/led next year and was not as excited as I was to begin this course.  I thought that with a 9 year history of cirrhosis, why wait.

The three drugs all interrupt the ability of the virus to replicate itself but in distinct ways.  Sovaldi is a polymerase inhibitor, Olysio a protease inhibitor (somewhat similar to the last class of PI's) and Riba is thought to deplete nucleotides thus blocking replication and maturation of viral cells.

If you've never taken Ribavirin before keep an eye on your Hemoglobin (hgb) as hemolytic anemia is a common side effect.  So far at 25 days my hgb has fallen off rather slowly and a little higher than at the same point of previous attempts.  Expecting it to stabilize  in the 11's which is doable.

Been watching your awesome progress Lynn as we have similar stats.

Best wishes LandL,
Marty

[heart_in_the_keyes]

When I talked one on one with the sovaldi rep she said a simple explanation is:

HCV blood cells are in a strand....kind of like a strand of twisted pearls.
They are connected.  The sovaldi comes in and "snips" the connection.

This makes the HCV cells start to separate from the cell strand.  Now think of the Riba as fighter pilots.  They come in...target the HCV cell...and destroy it.  

In the process they can also destroy good blood cells because they really can't differ between good and bad.  That is why you have to get weekly blood tests to check your blood platelets.

You will go UND (undetectable) during treatment hopefully leading to a status of SVR.  

So I vision the sovaldi and O as the seperator and the riba as the destroyer.
Have to separate the HCV cells to make them vulnerable.