Aa
geno type 4
does any body know if the new tx is working for geno type 4
Thanks Bali, Do you know if the insurance will approve Ailina for geno type4 or not. and how I make aresearch for a good hepatologist to be willing to try with me tx off label. Shoult I ask the drug company?
I just had an appt. with one of my hepatologists and he would use
Incevik for gen4. It is not doing as much as it does for gen1 but it
can deliver an additional 1 log drop he saysand it is a battle
with insurance to approve.
Just wanted to pass that on to you , make sure you have a good
hepatologist involved in research if you can.
b
Incevik for gen4. It is not doing as much as it does for gen1 but it
can deliver an additional 1 log drop he saysand it is a battle
with insurance to approve.
Just wanted to pass that on to you , make sure you have a good
hepatologist involved in research if you can.
b
Thanks again Bali for all your advice I really appreciated. I will to discuses all that test with my Dr.
" I went to the new Dr and he is willing to tray Ailina with me but he didn't care about the Il28b becauase we know already that my responce is poor"
That is true but you don`t know why your response is poor and doing the IL28b
test is easy and will give you more clues.
I don`t know how diabetic you are but I would do EVERYTHING possible to
to improve my glucose metabolism. Loose weight , diet&exercise ect.... whatever works for you it can only help.
Do you have a fatty liver ? What does your lipid panel (cholesterol) look like ?
Did you ever do an ultrasound ?
I would also predose Ribavirin for 4wks and increase dosage this
time to 1400mg (HgB permitting).
Alinia can help but I would not make the mistake and put "all eggs in one basket"
Alinia is in no way as powerful of a drug as the new geno1 meds. It only works
indirectly and not to discourage you but I know a geno 4 who was in your
situation and did retreat with Alinia and still never totally cleared the virus.
Coincedentally he is also diabetic.That does of course not mean that this
is going to happen to you but my point is to not just rely solely on Alinia
with your second tx but try to optimize everything possible such as VitD ,
Vit B12 , Vit A there is evidence that these vitamins can help and it
does not hurt to make sure you are not deficient. I also checked my iron
and ferritin.
Of course if you don`t have insurance it will be next to impossible to do all these tests , so get insurance , Alinia is very expensive as well.
You should find out what state your liver is in , so biopsie is advisable.
Eureka posted above "As a fan of FibroTest, you might appreciate this article"
This not true , I am by no means a fan of FibroTest. I did 3 of them and
two within only one week and the results were very inconsistent.
When you read up on the IL28b test and you will understand what CC means.
Do you know your Geno 4 subtype ?
Koko at the end of the day no matter how much outside help ect..you get you
are the one that needs to fight this virus inside of you by yourself and it only
helps to learn as much as possible and be proactive.
At least that`s what I did.
b
That is true but you don`t know why your response is poor and doing the IL28b
test is easy and will give you more clues.
I don`t know how diabetic you are but I would do EVERYTHING possible to
to improve my glucose metabolism. Loose weight , diet&exercise ect.... whatever works for you it can only help.
Do you have a fatty liver ? What does your lipid panel (cholesterol) look like ?
Did you ever do an ultrasound ?
I would also predose Ribavirin for 4wks and increase dosage this
time to 1400mg (HgB permitting).
Alinia can help but I would not make the mistake and put "all eggs in one basket"
Alinia is in no way as powerful of a drug as the new geno1 meds. It only works
indirectly and not to discourage you but I know a geno 4 who was in your
situation and did retreat with Alinia and still never totally cleared the virus.
Coincedentally he is also diabetic.That does of course not mean that this
is going to happen to you but my point is to not just rely solely on Alinia
with your second tx but try to optimize everything possible such as VitD ,
Vit B12 , Vit A there is evidence that these vitamins can help and it
does not hurt to make sure you are not deficient. I also checked my iron
and ferritin.
Of course if you don`t have insurance it will be next to impossible to do all these tests , so get insurance , Alinia is very expensive as well.
You should find out what state your liver is in , so biopsie is advisable.
Eureka posted above "As a fan of FibroTest, you might appreciate this article"
This not true , I am by no means a fan of FibroTest. I did 3 of them and
two within only one week and the results were very inconsistent.
When you read up on the IL28b test and you will understand what CC means.
Do you know your Geno 4 subtype ?
Koko at the end of the day no matter how much outside help ect..you get you
are the one that needs to fight this virus inside of you by yourself and it only
helps to learn as much as possible and be proactive.
At least that`s what I did.
b
HI Bali05 thanks for your advice, but i don't undersatand what is CC and how i know if Iam insulin resestance is any lab work could confirm that or I should be insuline resestance because I am diabetic. I read befor that geno type 4 usualy cause diabetise is this true.I will do the biobsy as soon as i get insurance do you think that will help to know the resone for the falier.
Hi every one thanks for all your responce I went to the new Dr and he is willing to tray Ailina with me but he didn't care about the Il28b becauase we know already that my responce is poor,by the way Iam from middle east not african american.
I can't find any information about the condition of your liver but it would be important to me to know that if I was making a decision about treatment. Perhaps Bali and you have had some discussion behind the scenes or I am missing something obvious about your health, I apologize if I am.
Since you are only 31 I am hoping that you have not had HCV for a very long time and you do not have any or much damage to your liver yet and you are not suffering from the disease in other ways yet. When I was 31 having been infected approximately 8-11 years of disease unknown to me I felt no adverse effect. Everyone is different of course.
One thing that I am learning everyday concerning the treatment of HCV and how quickly treatment is changing and drugs are being developed is that what I know today is not necessarily what will be true tomorrow, and tomorrow seems to be arriving much more quickly then expected. It's difficult to keep up.
Bali did a wonderful job of being thorough with the tools available when he decided to treat which from what I understand did not happen overnight and accompanied a lot of apprehension and a lot of research as it does for many of us.
New drugs are approved or being developed (depending on genotype) that depend less or not at all on interferon response, BMI, insulin resistance, degree of liver damage, genetics and so many other factors that aren't even understood about why people succeed or fail. Obviously if the answers to failure were so simple everyone would be able to SVR the second time if not the first.
There is a risk in treating with the current drugs and there is a risk in waiting for new ones. I posted some info about your genotype and trials because you may have time to wait for something better.
Good luck to you,
Dave
Since you are only 31 I am hoping that you have not had HCV for a very long time and you do not have any or much damage to your liver yet and you are not suffering from the disease in other ways yet. When I was 31 having been infected approximately 8-11 years of disease unknown to me I felt no adverse effect. Everyone is different of course.
One thing that I am learning everyday concerning the treatment of HCV and how quickly treatment is changing and drugs are being developed is that what I know today is not necessarily what will be true tomorrow, and tomorrow seems to be arriving much more quickly then expected. It's difficult to keep up.
Bali did a wonderful job of being thorough with the tools available when he decided to treat which from what I understand did not happen overnight and accompanied a lot of apprehension and a lot of research as it does for many of us.
New drugs are approved or being developed (depending on genotype) that depend less or not at all on interferon response, BMI, insulin resistance, degree of liver damage, genetics and so many other factors that aren't even understood about why people succeed or fail. Obviously if the answers to failure were so simple everyone would be able to SVR the second time if not the first.
There is a risk in treating with the current drugs and there is a risk in waiting for new ones. I posted some info about your genotype and trials because you may have time to wait for something better.
Good luck to you,
Dave
"Confirmation" and "contributing factor" is a clear distinction, and it's good that you make that second distinction in your subsequent post. I don't deny being single minded; better that than simple-minded.
Advanced fibrosis is contributory to both relapse and lack of early response, and has long been recognized as such, much more so than with insulin resistance, though certainly that is a factor as well. As a fan of FibroTest, you might appreciate this article:
TITLE: " FibroTest is an independent predictor of virologic response in chronic hepatitis C patients retreated with pegylated interferon alfa-2b and ribavirin in the EPIC3 program."
Author: Poynard, Thierry; Munteanu, Mona; Colombo, Massimo; Bruix, Jordi; Schiff, Eugene; Terg, Ruben; Flamm, Steven; Moreno-Otero, Ricardo; Carrilho, Flair; Schmidt, Warren; Berg, Thomas; Mcgarrity, Thomas; Heathcote, E. Jenny; Goncales, Fernando; Diago, Moises; Craxi, Antonio; Silva, Marcelo;Boparai, Navdeep; Griffel, Louis; Burroughs, Margaret Add.Author / Editor: Poynard, Thierry; et al.
Citation: Journal of Hepatology Feb 2011, Vol. 54 Issue 2, p227-235
Year: 2011
Abstract: Background & Aims: EPIC-3 is a prospective, international study that has demonstrated the efficacy of PEG-IFN alfa-2b plus weight-based ribavirin in patients with chronic hepatitis C and significant fibrosis who previously failed any interferon-alfa/ribavirin therapy. The aim of the present study was to assess FibroTest (FT), a validated non-invasive marker of fibrosis in treatment-naive patients, as a possible alternative to biopsy as the baseline predictor of subsequent early virologic (EVR) and sustained virologic response (SVR) in previously treated patients. Methods: Of 2312 patients enrolled, 1459 had an available baseline FT, biopsy, and complete data. Uni- (UV) and multi-variable (MV) analyses were performed using FT and biopsy. Results: Baseline characteristics were similar as in the overall population; METAVIR stage: 28% F2, 29% F3, and 43% F4, previous relapsers 29%, previous PEG-IFN regimen 41%, high baseline viral load (BVL) 64%. 506 patients (35%) had undetectable HCV
RNA at TW12 (TW12neg), with 58% achieving SVR. The accuracy of FT was similar to that in naive patients: AUROC curve for the diagnosis of F4 vs F2=0.80 (p <0.00001). Five baseline factors were associated (p <0.001) with SVR in UV and MV analyses (odds ratio: UV/MV): fibrosis stage estimated using FT (4.5/5.9) or biopsy (1.5/1.6), genotype 2/3 (4.5/5.1), BVL (1.5/1.3), prior relapse (1.6/1.6), previous treatment with non-PEG-IFN (2.6/2.0). These same factors were associated (p ⩽0.001) with EVR. Among patients TW12neg, two independent factors remained highly predictive of SVR by MV analysis (p ⩽0.001): genotype 2/3 (odds ratio=2.9), fibrosis estimated with FT (4.3) or by biopsy (1.5). Conclusions: FibroTest at baseline is a possible non-invasive alternative to biopsy for the prediction of EVR at 12weeks and SVR, in patients with previous failures and advanced fibrosis, retreated with PEG-IFN alfa-2b and ribavirin.
Advanced fibrosis is contributory to both relapse and lack of early response, and has long been recognized as such, much more so than with insulin resistance, though certainly that is a factor as well. As a fan of FibroTest, you might appreciate this article:
TITLE: " FibroTest is an independent predictor of virologic response in chronic hepatitis C patients retreated with pegylated interferon alfa-2b and ribavirin in the EPIC3 program."
Author: Poynard, Thierry; Munteanu, Mona; Colombo, Massimo; Bruix, Jordi; Schiff, Eugene; Terg, Ruben; Flamm, Steven; Moreno-Otero, Ricardo; Carrilho, Flair; Schmidt, Warren; Berg, Thomas; Mcgarrity, Thomas; Heathcote, E. Jenny; Goncales, Fernando; Diago, Moises; Craxi, Antonio; Silva, Marcelo;Boparai, Navdeep; Griffel, Louis; Burroughs, Margaret Add.Author / Editor: Poynard, Thierry; et al.
Citation: Journal of Hepatology Feb 2011, Vol. 54 Issue 2, p227-235
Year: 2011
Abstract: Background & Aims: EPIC-3 is a prospective, international study that has demonstrated the efficacy of PEG-IFN alfa-2b plus weight-based ribavirin in patients with chronic hepatitis C and significant fibrosis who previously failed any interferon-alfa/ribavirin therapy. The aim of the present study was to assess FibroTest (FT), a validated non-invasive marker of fibrosis in treatment-naive patients, as a possible alternative to biopsy as the baseline predictor of subsequent early virologic (EVR) and sustained virologic response (SVR) in previously treated patients. Methods: Of 2312 patients enrolled, 1459 had an available baseline FT, biopsy, and complete data. Uni- (UV) and multi-variable (MV) analyses were performed using FT and biopsy. Results: Baseline characteristics were similar as in the overall population; METAVIR stage: 28% F2, 29% F3, and 43% F4, previous relapsers 29%, previous PEG-IFN regimen 41%, high baseline viral load (BVL) 64%. 506 patients (35%) had undetectable HCV
RNA at TW12 (TW12neg), with 58% achieving SVR. The accuracy of FT was similar to that in naive patients: AUROC curve for the diagnosis of F4 vs F2=0.80 (p <0.00001). Five baseline factors were associated (p <0.001) with SVR in UV and MV analyses (odds ratio: UV/MV): fibrosis stage estimated using FT (4.5/5.9) or biopsy (1.5/1.6), genotype 2/3 (4.5/5.1), BVL (1.5/1.3), prior relapse (1.6/1.6), previous treatment with non-PEG-IFN (2.6/2.0). These same factors were associated (p ⩽0.001) with EVR. Among patients TW12neg, two independent factors remained highly predictive of SVR by MV analysis (p ⩽0.001): genotype 2/3 (odds ratio=2.9), fibrosis estimated with FT (4.3) or by biopsy (1.5). Conclusions: FibroTest at baseline is a possible non-invasive alternative to biopsy for the prediction of EVR at 12weeks and SVR, in patients with previous failures and advanced fibrosis, retreated with PEG-IFN alfa-2b and ribavirin.
I find your interpretation of what I posted single minded.
Koko`s being diabetic could have been a contributing factor to slow response.If I were Koko I would do the IL28b.
Also having advanced stage fibrosis has little to do with early response
but more with increased relapse risk.
Koko`s being diabetic could have been a contributing factor to slow response.If I were Koko I would do the IL28b.
Also having advanced stage fibrosis has little to do with early response
but more with increased relapse risk.
"Again , it is imperative in my mind to exhaust every reason or possibility
of previous INF failure first before deciding where to go from here."
------------------
Optimizing individual treatment is definitely key, Bali; eliminating negative predictive factors whenever possible is important, but I think in most cases we can only guess at why someone does or does not respond to tx.
We have seen time and time again that early response and host factors can trump IL28B genotype results. Just because a diabetic is CC and fails treatment doesn't mean that insulin resistance was the source of failure. Being stage 3/4 is often a poorer predictor of response -- attributing a single factor to treatment failure is both a long shot and short-sighted, imho.
of previous INF failure first before deciding where to go from here."
------------------
Optimizing individual treatment is definitely key, Bali; eliminating negative predictive factors whenever possible is important, but I think in most cases we can only guess at why someone does or does not respond to tx.
We have seen time and time again that early response and host factors can trump IL28B genotype results. Just because a diabetic is CC and fails treatment doesn't mean that insulin resistance was the source of failure. Being stage 3/4 is often a poorer predictor of response -- attributing a single factor to treatment failure is both a long shot and short-sighted, imho.
"Don`t really see the point in posting trials that are offered to tx naives when Koko80 is not naive.I would get a hepatologist that is involved in the latest
research so that if something becomes available they will let Koko know"
I agree that with you he should find the right hepatologist. The point of posting the trials was some encouragement about drugs being developed for geno 4 and drugs and eventual results that might be worth keeping an eye on. I followed the research for geno 1 for many many years before I treated, it gave me hope.
You are the medhelp genotype 4 expert and Koko80 is lucky to have your advice and experience to help him.
Best of luck Koko,
Dave
research so that if something becomes available they will let Koko know"
I agree that with you he should find the right hepatologist. The point of posting the trials was some encouragement about drugs being developed for geno 4 and drugs and eventual results that might be worth keeping an eye on. I followed the research for geno 1 for many many years before I treated, it gave me hope.
You are the medhelp genotype 4 expert and Koko80 is lucky to have your advice and experience to help him.
Best of luck Koko,
Dave
Doing great Dave , thanks.
Don`t really see the point in posting trials that are offered to tx naives when Koko80 is not naive.I would get a hepatologist that is involved in the latest
research so that if something becomes available they will let Koko know.
In the meantime Koko80 should try and learn as much as possible from the previous tx failure and take it from there such as IL28b.
Are you by any chance african american Koko80 ?
Don`t really see the point in posting trials that are offered to tx naives when Koko80 is not naive.I would get a hepatologist that is involved in the latest
research so that if something becomes available they will let Koko know.
In the meantime Koko80 should try and learn as much as possible from the previous tx failure and take it from there such as IL28b.
Are you by any chance african american Koko80 ?
Hi Bali-
I hope you are doing well these days?
koko80
Here are couple of trials that are including genotype 4, hopefully something will be available in the near future that will work for you.
This trial will be for naives, perhaps they will also be conducting something soon for previously treated.
http://clinicaltrials.gov/ct2/show/NCT01448044
Phase III BMS-790052 Add-On to Peg-Interferon Alfa-2a and Ribavirin in Naive Hepatitis C
not recruiting but in process:
PSI-7977 With Pegylated Interferon and Ribavirin Hepatitis C Virus (HCV) Genotypes 1,4,5,6 (ATOMIC)
http://www.clinicaltrials.gov/ct2/show/NCT01329978?term=Pharmasset+ATOMIC+Trial+of+PSI-7977&rank=1
I hope you are doing well these days?
koko80
Here are couple of trials that are including genotype 4, hopefully something will be available in the near future that will work for you.
This trial will be for naives, perhaps they will also be conducting something soon for previously treated.
http://clinicaltrials.gov/ct2/show/NCT01448044
Phase III BMS-790052 Add-On to Peg-Interferon Alfa-2a and Ribavirin in Naive Hepatitis C
not recruiting but in process:
PSI-7977 With Pegylated Interferon and Ribavirin Hepatitis C Virus (HCV) Genotypes 1,4,5,6 (ATOMIC)
http://www.clinicaltrials.gov/ct2/show/NCT01329978?term=Pharmasset+ATOMIC+Trial+of+PSI-7977&rank=1
Koko80 had a poor INF response on previous SOC tx and aborted tx after
little over 12wks because of it if I remember correctly.
Koko is also diabetic which could be one reason for poor INF response.
I would do IL28b to see if genetics possibly played a role.
little over 12wks because of it if I remember correctly.
Koko is also diabetic which could be one reason for poor INF response.
I would do IL28b to see if genetics possibly played a role.
Do you have advanced liver disease? Have you had HCV for a long time? Why is there an urgency to use something not proven for your genotype at this point?
-Dave
-Dave
Incevic/Victrelis are only FDA approved for geno 1.
There is one geno4 on this forum who was prescribed Vic by his Dr and I know of one other case where a Dr. mentioned to be willing
to try Incevic for geno 4 but that does not classify as "working" in my book
more of an experiment for difficult to tx cases.BTW even if you have a Dr
willing to experiment "off label" it is highly questionable if insurance will pay.
Did you do the IL28b test ?
There is one geno4 on this forum who was prescribed Vic by his Dr and I know of one other case where a Dr. mentioned to be willing
to try Incevic for geno 4 but that does not classify as "working" in my book
more of an experiment for difficult to tx cases.BTW even if you have a Dr
willing to experiment "off label" it is highly questionable if insurance will pay.
Did you do the IL28b test ?
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for non-naive geno4s.
Again , it is imperative in my mind to exhaust every reason or possibility
of previous INF failure first before deciding where to go from here.
If Koko80 is a CC maybe all that is needed is getting the glucose metabolism in order and try SOC again for 12wks with different INF+
Alinia and maybe 1400mg of Riba HgB permitting...
Remember MerryBe (geno1) , she had a very poor INF response with
very late UND and relapse even after long extention of tx.
When IL28b became available she tested CC and it confirmed her
suspicion that insulin resistance caused her problem.