Zepatier and Sovaldi

[kelleyp2000]

Hi Everyone, i have started Zepatier and Sovaldi for hep C genotype 3 treatment with HIV. Does anyone have experience with Zepatier? Please help !

[andrew j]

Hi Kelley,

This must be a combination prescribed for you because you have HIV -
(It's not a combination that would normally be prescribed for HCV infection on it's own).

For what it's worth - they're top-quality meds.

I don't know much about HIV / HCV co-infection.
Hopefully someone who does will chime in soon.

I just wanted to reach out to you.

[Lynn K]

OK so I found the ZEPATIER aka elbasvir and grazoprevir per the AALSD can be used for patients who are HIV/HCV co-infected but I did not see a mention of the use with sovaldi:

http://www.hcvguidelines.org/full-report/unique-patient-populations-hivhcv-coinfection-box-summary-recommendations-hivhcv

 Daily fixed-dose combination of elbasvir/grazoprevir:
Elbasvir/grazoprevir should be used with antiretroviral drugs with which it does not have clinically significant interactions: abacavir, emtricitabine, enfuvirtide, lamivudine, raltegravir, dolutegravir, rilpivirine, and tenofovir.

Also this information

 HIV/HCV-coinfected persons should be treated and retreated the same as persons without HIV infection, after recognizing and managing interactions with antiretroviral medications (see Initial Treatment of HCV Infection and Retreatment of Persons in Whom Prior Therapy Has Failed).

and in Red:

Elbasvir/grazoprevir should NOT be used with cobicistat, efavirenz, etravirine, nevirapine, or any HIV protease inhibitor.
Rating: Class III, Level B

Going to standard treatments for genotype 3 per the AASLD

http://www.hcvguidelines.org/full-report/initial-treatment-box-summary-recommendations-patients-who-are-initiating-therapy-hcv

Genotype 3 Treatment-Naïve Patients Without Cirrhosis - Recommended
Recommended regimens are listed in groups by level of evidence, then alphabetically.
 

    Daily daclatasvir (60 mg*) plus sofosbuvir (400 mg) for 12 weeks is a Recommended regimen for treatment-naïve patients with HCV genotype 3 infection who do not have cirrhosis.
    Rating: Class I, Level A
     
    Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg) for 12 weeks is a Recommended regimen for treatment-naïve patients with HCV genotype 3 infection who do not have cirrhosis.
    Rating: Class I, Level A

So I am not seeing so far anything that says you should be prescribed zepatier for genotype 3 per the AASLD but I do see in Canada that treatment is approved. per the Zepatier prescribing information sheet it is only approved for genotypes 1a, 1B & 4 which doesn't mean it could not be effective for GT3 just not on label usage yet.

looks like a good web page for you

http://www.catie.ca/en/catienews/2016-01-29/zepatier-hepatitis-c-approved-canada


In the interim here is a link to the prescribing information sheet for Zepatier. It lists common side effects and the frequency they were experienced in clinical trials as well as clinical trial results and any important known drug interactions but with a quick read it looks similar to the other new meds mild headaches, nausea and fatigue experienced by about 11% in the trials.

https://www.merck.com/product/usa/pi_circulars/z/zepatier/zepatier_pi.pdf

Hope that helps

[kelleyp2000]

Thanks so much Andrew and Lynn for the great information. I am so confused as my doctor says that they do not prescribe Daklinza+sovaldi for genotype 3 HIV coinefection, and has asked me to use Zepatier. Yes Lynn as per your article, i did not see anywhere that zepatier is used for genotype 3, but i see with sovalidi has been used for coinfection with no results.

Any feedback would be greatly apprecaited, i have started the medication but was thinking of discontinuing it. My liver is at F2 and not sure if i should wait for Epclusa which is used for all genotypes and available.

[andrew j]

I get the impression from looking at the AASLD Guidelines for special populations (incl. those with HIV), that there is less drug-to-drug interaction when using Zepatier with HIV meds., than with some of the other normally-prescribed HCV meds.

i.e. Your regimen has probably been well (and carefully) thought out.

i.e. I would definitely stay with it for now - at least until you can talk about it with yr. specialist.

Best regards,
A.

[andrew j]

... The thing is Kelley - if you discontinue what is in fact a carefully-crafted treatment package, tailor-made for you - you might have a devil's-own job finding something else that will work for you.

Again - given that you are co-infected, your doctor(s) will have had to take a complex array of factors into account when formulating a treatment plan for you -
esp. in reln. to potential drug-to-drug interactions.

[Lynn K]

And it is a recommended combo in Canada so very likely your doctors a very much up to speed on what to treat you with

[Gaj]

Hi Kelley,

As Lynn states, Zepatier + Sovaldi has been used in Canada and is apparently an effective and safe combination for GT3. As with HIV medications, three way drug combos are likely to be more effective than two way such as Sof/Dac. Ones that target NS3/4a, NS5a and NS5b sites at the same time seem to be the way of the future for HCV medications with a number of pharmacuetical manufacturers working towards them currently so this cross brand one makes sense as being available now.
I actually had a meeting with my specialist on Thursday where we discussed this as an off label combination for my next treatment because I relapsed after 24 weeks Sof/Dac/Riba. His view was that this was the best option given my history puts me in the 'hard to treat' category. It will be a couple of months before I can commence so I will be keen to hear of any feedback you can provide.

[kelleyp2000]

Thanks andrew, Lynn and Gaj for all your input and comments.

Gaj- will let you know how things progress!