Possible resistant gene to Harvoni?

[strongtower]

Hi Everyone,

Well, I got my 2nd blood test done and my viral load is still not 0. It's 76. My doctor called me and wants me to do this separate test to see if I have a resistant gene to Harvoni. She said that in some people with the genotype 1a there is a resistant gene. Has anyone heard of that? This is what I read:

Depending on the patient’s HCV genotype (1a versus 1b) and the presence of cirrhosis, concomitant administration with weight-based ribavirin may be necessary. Although Viekira Pak has similar efficacy, the advantage of ledipasvir/sofosbuvir lies in its once-daily fixed-dose regimen that does not require the coadministration of ribavirin.

Also here:

LDV inhibits HCV replication by targeting the NS5A protein, which is an essential viral protein that plays roles in both viral RNA replication and the assembly of HCV virions (10, 11). Recently, LDV was shown to inhibit NS5A through direct binding to the NS5A protein, and resistance to LDV was shown to be the result of lower binding affinity to NS5A mutants (12). Targeting NS5A has been validated clinically, as treatment with NS5A inhibitors elicits a rapid decline of HCV viral load (13, 14) and enhanced SVR rates when combined with Peg-IFN and RBV (15) or other DAAs, including SOF (7, 8, 16).

Not sure if that is the case.. I was just searching for "resistance" in these articles.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378517/

[dragonslayer]

I wouldnt be too concerned!  I had a viral load on the last day of treatment, and even 8 wks later, I was still detected..  But on the only test that counts for most people, the one that is used to measure SVR, the 12 wk post treatment test, I was no longer detected.. There are others like me... On-treatment testing with the DAAs can scare people, but the results are hardly ever probative.  I dont think your on-treatment result means a whole hellofa lot..

[strongtower]

Thanks! That made me feel better. I was wondering tho, what are DAA's? It wasn't on the acronym post..

~Maddy

[dragonslayer]

Basically, that term stands for Direct Acting Antivirals, and refers to those treatments since Interferon which target HCV's ability to replicate.

[gnatcatcher]

Maddy, I don't see any harm in getting the resistance testing. If it turns out that you are resistant, then your doctor will have the proof she needs to get your insurance to okay a different pill for you. If you're not resistant, then there is an excellent chance you, like dragonslayer/Paul, will still become undetected, just not as quickly as some people do.

Gnatty

[strongtower]

Thanks. I am *definitely* getting it done. Might as well, right? I tried to get my labs done today but the doctor hadn't ordered them yet! Ugh. I will let you know how it goes. Apparently this test takes about 5-6 weeks for it to come back.

[treatfailure]

Hi

I have just had that resistance testing done and I test "resistance likely" to Ledipasvir (harvoni componant) and many of the other NS5A drugs. Wish this test had been done before Harvoni treatment as i had a treatment failure and it will be at least one year until medical insurers and Government "may" fund another option.

I am seeking third world options for purchasing another treatment option myself

[strongtower]

I have just had that resistance testing done and I test "resistance likely" to Ledipasvir (harvoni componant) and many of the other NS5A drugs.

So can you be more specific? Did they find that you have that resistance gene? What was their answer? Any improvement at all as far as viral load, etc.?

[gnatcatcher]

treatfailure, my sympathy. I see from your other post that you're in Canada. If the free Patient Advocate Foundation's Hepatitis C Careline covers Canada, it might be able to help you get treated faster:
https://hepatitisc.pafcareline.org

Maddy, I'm glad your doctor is being proactive by having your resistance checked now. If someone experiences a treatment failure, the hep C typically comes roaring back, so the viral load gets high quickly.

[treatfailure]

I had blood tests done to see why I failed and what other options may be for future treatment. I was only tested for drugs approved in Canada I am "likely resistant" to Daclatavir- Daklinza
Ledipasvir - Harvoni
Velpatasvir - Epclusa
Elbasvir - Zepatier
Ombitasvir- Holkira Pak + Technivie
Simeprevir-Galexos
They have no answers  I have a list of drugs I am "likely susceptible" to (should work)as well and if and when I can find them my Doctor will give me a prescription so I can import them to Canada
My viral loads were 3 M to start and went down to 350 before starting to climb

Your numbers are very promising/impressive be positive!

[strongtower]

Wow, treatfailure, I am so sorry. I wish you the best and hope things will look up for you soon. They are finding out so many things, something is out there, yet to be discovered. Take care!!!! LMK if you do find something else....