Hepatitis C Genotype 3 with Cirrhosis

[hamid]

Hi
It's great opportunity for me to have your opinion about our Hepatitis C case. My Grandma (75 Yrs) has just recently been diagnosed with Hepatitis C, GT3 with compensated Cirrhosis . Doctors here (in Iran) are prescribing Harvoni and I know it is more effective for GT1. They reason that she can't stand the side effects of Ribavirin and etc. My question is that considering her age conditions (she also suffers from heart problem), what should we use to cure her Hepatitis?

Hamid

[KimInTheForest]

Hi
It's great opportunity for me to have your opinion about our Hepatitis C case. My Grandma (75 Yrs) has just recently been diagnosed with Hepatitis C, GT3 with compensated Cirrhosis . Doctors here (in Iran) are prescribing Harvoni and I know it is more effective for GT1. They reason that she can't stand the side effects of Ribavirin and etc. My question is that considering her age conditions (she also suffers from heart problem), what should we use to cure her Hepatitis?

Hamid

Hi Hamid. Welcome to the forums!

I too am/was Genotype 3. (I believe I am cured now but will find out in a couple of weeks). It is my understanding that Harvoni alone has a low success rate for Genotype 3. I did 12 weeks of Harvoni+ribavirin, which has a very high success rate for Geno 3 people.

I understand the concern about ribavirin with your 75-year-old grandmother with cirrhosis. However, there are other forum members here with compensated cirrhosis whose treatment involved ribavirin, and they are now cured. I think sometimes a reduced dose of ribavirin is given - maybe 600 mg instead of 1,000-1,200.

Another possibility (if you can get it) is 24 weeks of Sovaldi+Daklinza. That is one of the recommended treatments for genotype 3 with cirrhosis, according to this chart:

http://www.hepmag.com/articles/2512_18756.shtml

Good luck, and keep us posted!

kim

[Joe NM]

the highest cure rates currently would be Daclatasvir (brand name in the US is Daklinza) plus Sofosbuvir (brand name Sovaldi) for 24 weeks, either with or without ribavirin depending on what the doctor thinks. Harvoni is NOT as effective for genotype 3.

I don't know if Daclatasvir (Daklinza) is available where you are, though. Before it came out, the recommended treatment was Sovaldi plus ribavirin for 24 weeks. That would certainly have a higher cure rate than Harvoni, but not as high as Daklinza/Sovaldi.

A great source for the most current treatment recommendations is the AASLD/IDSA guidelines, here's the link:
http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection

[hamid]

Hi guys,

Many thanks for the reply, I really appreciate it.

Daclatasvir is not available in Iran and I guess will be too expensive upon arrival. Our preference is Sovaldi + Ribavirin, since Sovaldi has an affordable indian counterpart (though I'm not sure about its quality). Due to business cases, doctors here insist on Harvoni (and we have to buy from them ...). How should we know that she can take Ribavirin consistently for 24 Weeks? Is there any guidelines for it?

[Joe NM]

I did finally find one article talking about Harvoni with genotype 3...said that 82% of people were cured with genotype three with twelve weeks of Harvoni and ribavirin...I haven't found any studies of Harvoni without ribavirin for 24 weeks (but there are studies, for genotype 1 at least, that show that 24 weeks of Harvoni are just as effective as 12 weeks of Harvoni + ribavirin, but again that doesn't give much of a picture of what would happen in genotype 3)...so it's really unpredictable whether or not she'd be cured, can't really give a good figure. Seem like the chance for cure would be higher if she could combine it with some ribavirin (Harvoni is just Sovaldi plus a second medication, ledipasvir, so 24 weeks of it and ribavirin is no different from 24 weeks of Sovaldi and ribavirin, just more expensive) but I understand if that's not an option due to ribavirin side effects. I assume your doctor might know something about this??? That is to say, I'm not a doctor!

I've never taken Harvoni so can't speak to the side-effects, I just know they're mild in general and very few people choose to stop taking it due to side effects.
 
here's the article I found, it's actually from the hepmag site, coincidentally: http://www.hepmag.com/articles/Harvoni_3_6_2501_26447.shtml

[Joe NM]

If she does take ribavirin, first they should dose according to weight (1200mg/day is usually the maximum, and they go down from there, the dose can be reduced further if the side effects are becoming dangerous). The big issue with ribavirin is that it causes anemia in some people (reduction in the number of red blood cells/ability for blood to carry enough oxygen to parts of the body). Guidelines say she should have blood drawn periodically throughout treatment (my clinic does at least once a month) to check if this is happening, to watch the hemoglobin levels. If hemoglobin levels are going down dangerously that's when doctors can reduce the dose of ribavirin, or occasionally have to take someone off of it for a brief period to let the hemoglobin go back up (and that's 'hemoglobin,' not 'hemoglobin A1C,' the diabetes test!)

[Lynn K]

With taking Ribavirin she would need to have frequent blood testing.

I was tested weekly which I believe is the recommended protocol after my anemia stabilized it went to monthly.

I was GT 1a and due to multiple treatment failures and having cirrhosis I treated with Harvoni for 24 weeks and we later added 1200 mg Ribavirin for 15 of those 24 weeks.

I did dose reduce after 4 weeks of Ribavirin to 1000 mg a day because I became anemic. After dose reduction it was tough going but my anemia was holding steady at 10.1 which they wanted to see no lower than 10.0

Best of luck to you and your mom
Lynn

[KimInTheForest]

Hello Hamid. The ELECTRON-2 study in New Zealand had a 100% cure rate for treatment-naive genotype 3 patients on 12 weeks of Harvoni+ribavirin - and that included the patients with cirrhosis.

Here is a 6-page PDF on the study:
https://depts.washington.edu/hepstudy/presentations/uploads/129/electron2__ledipasvir_sofosbuvir.pdf

If you look on pages 4 and 5 you will see that 5 of the patients in the trial had cirrhosis (page 4), and that all patients receiving the Harvoni+ribavirin were cured (page 5).

By comparison only 64% of the patients on Harvoni alone were cured (page 5). So Geno 3's really need the ribavirin with Harvoni for it to work.

Best of luck!
kim

[hamid]

Hi all,

Thanks for all your answer. Based on the Doctor suggestion, we chose to go for:
Daclatasvir 60 mg for 12 weeks
Sofosbuvir 400 mg for 12 weeks
+-Ribavirin 1000 mg for 12 weeks

However I have still two questions:

   1-How and where can I buy Daclatasvir?
   2-Are the Indian counterpart reliable?

Thanks in advance for the help. I hope to see a day where this diseases is cured with reasonable price for every body in every country.

Hamid

[BillT]

Hi Hamid,
             I found this site and hope it helps.The other things you may try are contacting Bristol-Myers Squibb and I know there are Canadian pharmacies that ship international.A lot of people here in the States order their meds from there because they're cheaper.I'll try to find some for you and will post when I do.Cheers

http://www.bocsci.com/Daclatasvir-cas-1009119-64-5-item-84-408940.html

I'm not sure about the Indian counterparts.I personally wouldn't want to try them.

[Joe NM]

Sorry if someone has already posted this to you, but the expert on getting HCV medications from other countries is this guy: http://blogs.hepmag.com/gregjefferys/

He tends to respond to e-mail very quickly, and is legitimate by all accounts. I think at the moment some people are able to import Daclatasvir ("Daklinza") from China, but only in powder form, which can then be taken to a compounding pharmacy to be tested and put into capsules. It can be a lengthy process. Don't think India is producing daclatasvir at the moment, just sovaldi.

In response to your question, the Indian-made medications are absolutely as reliable as any of them! They're licensed by the drug companies and are totally trustworthy. Last I checked the powder coming from China has consistently tested as good. But they may not be importing to individuals, not sure how exactly it's working at the moment.

Importing can be tricky, it's best to let Greg help guide you to prevent any scams (no one else has worked out this system as well as he has, or if anyone has they're not telling the world about it), also you'll have to check on the laws about importing medicine in your country to make sure you don't get in trouble and the medication actually gets there (usually it's total legal to import medicine for personal use, just not if you're selling the medicine)

Best of luck, this should all be so much easier!