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Hepatitis C Main Forums => Considering Hepatitis C Treatment => Topic started by: justrichard on December 08, 2015, 01:12:30 pm

Title: Geno 1a and 2b, any information
Post by: justrichard on December 08, 2015, 01:12:30 pm

New to your forum, thank you for being here!
Apparently I have (Geno 1a and 2b) and Stage 4 Cirrhosis.  Any information of this combo?

Dr. is starting me on Harvoni and Ribavirin, i guess that I am waiting on the Ins. company to ok...

Any thoughts to the Geno types

Thank you in advance

Title: Re: Geno 1a and 2b, any information
Post by: HEPful Guy on December 13, 2015, 03:13:10 am

Having a mixed genotype is somewhat rare and can make treatment tricky. Fortunately Genotype 1 and 2 both have similar treatment regimens and Harvoni with Riba should have no problem covering both genotypes. Ideally the regimen should be 16 weeks of Harvoni + Riba, but that could be difficult to get covered depending on how logical your insurance is. The reason I say 16 weeks of Harvoni Riba is because Harvoni 90/400mg (Ledipasvir/Sofosbuvir) x 12 weeks is recommended for 1a cirrhosis patients and for 2b cirrhosis patients Sovaldi (Sofosbuvir) + Ribavirin is recommended for 16 weeks. So realistically Harvoni + Riba for 16 weeks should cover both genotypes since Harvoni contains the Sofosbuvir component in it.

Having cirrhosis almost always guarantees that the insurance company will approve you for therapy. The potentially hard part is going to be convincing the insurance company to do the Harvoni for 16 weeks (assuming that is what your physician is doing), since there are no real clinical guidelines for mixed genotype infections. Your insurance may initially deny therapy saying the Harvoni is being used off-label even though logically it is being used appropriately.

Title: Re: Geno 1a and 2b, any information
Post by: Lynn K on December 13, 2015, 05:11:01 pm

I look at it as treating 2 different infections at the same time. The  gt1 with cirrhosis is recommended Harvoni for 24 weeks or Harvoni / Ribavirin for 12 weeks. The gt2 infection treatment is 12 weeks Sovaldi / Ribavirin per the Sovaldi prescribing information sheet

http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/sovaldi/sovaldi_pi.pdf


As noted above Harvoni contained Sovaldi in the same amount 400mg so my thinking is a 12 week treatment of Harvoni /Ribavirin should be all that is needed it can do the job for both.

With having cirrhosis that does greatly help with insurance approval.

Good luck with treatment
Lynn

Title: Re: Geno 1a and 2b, any information
Post by: HEPful Guy on December 13, 2015, 05:52:39 pm

The package insert is a great way to find out the general information about the drug, but is no way used to help guide therapy by physicians. Harvoni x 24 weeks or Harvoni + riba x 12 weeks is only recommended in patients that are cirrhotic and treatment experienced. If you are genotype 1, new to treatment(naive) and have cirrhosis, Harvoni x 12 weeks by itself is recommended.  In genotype 2, per AASLD guidelines patients are recommended to receive Sovaldi + Riba x 16 weeks if they are naive to treatment, or 24 weeks if they are treatment experienced.

http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection

Title: Re: Geno 1a and 2b, any information
Post by: Lynn K on December 13, 2015, 06:05:28 pm

Ok thanks I had obviously looked at the Sovaldi prescribing info and had forgotten the 24 weeks or 12 weeks plus Ribavirin was only for treatment experienced. Guess I was projecting my situation and forgot about the gt1 with cirrhosis tx naive.

I now see the 16 week recommendation for the gt2 with cirrhosis per the AASLD guidelines but that is not per the prescribing information and would make it off label so that "could" have his insurance thinking about a bit longer but likely he will be approved as he has cirrhosis and up to his treating physician as to the number of weeks although that is a convincing argument for 16 weeks of treatment basically they are treating the more difficult to cure situation.

Thanks for the correction HEPful and welcome to the forum
Lynn

Title: Re: Geno 1a and 2b, any information
Post by: justrichard on December 15, 2015, 04:03:01 am

Thank you for your responses  HEPful and Lynn, 
Very informative.  It has been almost three weeks and still have not heard anything from doctors off or insurance company/pharmacy...?  Dr. said that I would be starting at the end of the week....  11/30
I will drop dr. a note and inquire about the prescription for 12wk Vs. 16-24..?

Again Thank you both and hope you have a great Christmas and New Years

Richard

Title: Re: Geno 1a and 2b, any information
Post by: Lynn K on December 15, 2015, 04:08:01 am

Most of us have had to be proactive to avoid falling through the cracks. There are lots of patients trying to get treated and it is easy to get lost in the shuffle.

Call everybody get the ball rolling especially if it has rolled under a table somewhere and been forgotten.

Good luck and have a great holiday season!
Lynn

Title: Re: Geno 1a and 2b, any information
Post by: justrichard on December 15, 2015, 04:28:46 am

Thanks Lynn   :)

Title: Re: Geno 1a and 2b, any information
Post by: justrichard on December 22, 2015, 08:25:17 am

Hey Lynn and HEPful Guy;

Update:
Insurance company approved both (Reba and Harvoni) for 16 weeks....
** Started Saturday 12-19-15    None to soon   My body is wore out!  All's well so far

Had Rheumatologist appointment yesterday (Psoriatic Arthritis)  asked about starting back on the Enbrel and anti inflammatory....   nope!   not till i finish the 16 weeks.... 

     Thanks for reading

Yall have a Great Christmas and New Years

Richarxd

Title: Re: Geno 1a and 2b, any information
Post by: jakas on December 22, 2015, 08:55:17 am

Great !!! Get well soon and Happy Holidays :)

Title: Re: Geno 1a and 2b, any information
Post by: Lynn K on December 23, 2015, 12:47:30 am

Great news Richard!

Congrats and Happy Holidays!
Lynn

Title: Re: Geno 1a and 2b, any information
Post by: HEPful Guy on December 24, 2015, 10:37:49 pm

Congrats Richard!