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Author Topic: About to start Zepatier (Elbasvir/Grazoprevir)  (Read 1044 times)

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Offline 1bit

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  • Posts: 25
About to start Zepatier (Elbasvir/Grazoprevir)
« on: September 03, 2019, 04:24:00 pm »
Hi everyone

Long-time since I was last here, I started my second bout in 2016 (Abbvie3D + Riba) but had to terminate after just 4 days due to severe side effects. before that I was a responder/relapser on Inf+Riba in 2008/09.

Iam now starting Zepatier (Elbasvir/Grazoprevir) on Monday coming and wanted to know if any other members have had this treatment and what I should expect with regards to sides, I found the Abbvie3D+Riba regime way more nasty than Inf+Riba but thats just my personal experience.. I suffer with extreme Anxiety & Depression and my health isnt the best, Im both excited and scared at the same time (sides)

any advice is appreciated

thanks
Genotype 1a Infected 1999
- responder/relapser Inf+Rib 2008
- discont. Abbvie 3D (sides) 2016
- commencing Zepatier 2019
Biopsy 2006 = 2/6 ISHAK (Grade 7 / Stage 2)
Fibroscan 2010: 8.9 : (ALT 55)
Fibroscan 2016: 7.9 : (ALT 50)
Viral Load = 9.6 million

Offline Lynn K

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Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #1 on: September 03, 2019, 10:29:11 pm »
That ribavirin is tough stuff I took ribavirin during two of my three treatments with interferon. I was a null responder my viral load did not decrease even a tiny bit on those treatments.

I was looking at the prescribing information for Zepatier

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

Were you tested for the presence of virus with NS5A resistance-associated polymorphisms?

Several previous scenarios look like they recommend taking Zepatier along with ribavirin. You might want to look the information over.

Wondering why your doctor isn’t going with Mavyret as there is no treatment regimen with ribavirin

https://www.rxabbvie.com/pdf/mavyret_pi.pdf

Or Epclusa which only calls for ribavirin for those with advanced liver disease

https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/208341s000lbl.pdf

We have had a couple of people retreat after relapse with one of the new DAA’s they treated with either Mavyret or Epclusa and had great results. I don’t recall anyone retreating with Zepatier. I’m also wondering if with your history maybe you should be taking ribavirin along with Zepatier. I’m thinking ribavirin would be the deal breaker for me.

Anyway just my thoughts as a fellow patient maybe read up and ask your doctor if Epclusa or Mavyret might be better for you.

The PDFs also have clinical trial data and common side effect profiles

Anyway best of luck to you
Lynn
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline 1bit

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Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #2 on: September 04, 2019, 05:37:11 pm »
TBH Im not happy with my specialist because he ALWAYS puts me on cheaper regimens, always 1 or so generations behind what other GP's are giving out, I am dealing with an outreach nurse at the moment and only met her for the first time the other day and she said I would be given either Harvoni or this, I knew straight away that they would give me this because its probably cheaper, and I was right.

She told me that Genotype (1a) doesn't matter anymore?  yet I read the same as you on the basic leaflet that it should be given with Ribavirin for G1 or G4? 

last time I saw the specialist in April he had a remark "you only get 1 bite of the pie, doesnt matter if you were on treatment 4 days or 4 months".. as he was miffed because I missed an appointment in 2016, I called to cancel due to being too poorly from my 2nd bout on Abbvie3D+Riba to travel and was terminating the treatment due to severe sides, the nurse never told him i called and cancelled so he thinks I DNA'd outright (Did Not Attend), Ive had about 20 appointments with him over 10 years and never missed one but that one, this was in April.. I never heard from him again so I kept trying to call but he was always on leave or on holiday or not available, I had to get my GP to write a letter to see what was going on but I managed to see the outreach nurse, she said he already done the MDT paperwork and had me down as ready to start but failed to inform me to get it started, so she initiated it???
... I think he has an attitude problem, I would get a different specialist but if I do that I worry that the new one will be defensive for his colleague and treat me the same...or I may be refused.

and as far as I know I havent been tested for that thing you say but she did say try not too miss any as you can build up a resistance?

Im not having Ribavirin with this...sorry your post confuses me a little.
« Last Edit: September 04, 2019, 05:44:04 pm by 1bit »
Genotype 1a Infected 1999
- responder/relapser Inf+Rib 2008
- discont. Abbvie 3D (sides) 2016
- commencing Zepatier 2019
Biopsy 2006 = 2/6 ISHAK (Grade 7 / Stage 2)
Fibroscan 2010: 8.9 : (ALT 55)
Fibroscan 2016: 7.9 : (ALT 50)
Viral Load = 9.6 million

Offline 1bit

  • Member
  • Posts: 25
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #3 on: September 04, 2019, 05:45:57 pm »
....(continued)

ive just read this on the zepatier PDF:

Hepatitis B virus (HBV) reactivation has been reported, in some cases resulting in fulminant hepatitis, hepatic failure, and death.


I dont have Hep-B but I used to have it?  is this a concern?  re-activation whats that...causes death??
Genotype 1a Infected 1999
- responder/relapser Inf+Rib 2008
- discont. Abbvie 3D (sides) 2016
- commencing Zepatier 2019
Biopsy 2006 = 2/6 ISHAK (Grade 7 / Stage 2)
Fibroscan 2010: 8.9 : (ALT 55)
Fibroscan 2016: 7.9 : (ALT 50)
Viral Load = 9.6 million

Offline Lynn K

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  • Get tested, get treated, get cured, fight Hep c!
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #4 on: September 05, 2019, 12:51:05 am »
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Lynn K

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  • Member
  • Posts: 4,309
  • Get tested, get treated, get cured, fight Hep c!
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #5 on: September 05, 2019, 12:54:36 am »
Per the treatment table for Zepatier several scenarios recommend taking ribavirin depending on the patient’s history and if there is liver damage.

They also recommend checking for that specific type of resistance before treating with Zepatier if you have been previously treated with some classes of DAA meds
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,309
  • Get tested, get treated, get cured, fight Hep c!
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #6 on: September 05, 2019, 01:05:30 am »
What is your genotype of hep c?

Per the prescribing information for Zepatier

Patient history:
Genotype 1a: Treatment-naïve or PegIFN/RBV- experienced* without baseline NS5A polymorphisms†

Treatment:
ZEPATIER 12 weeks

Patient history:
Genotype 1a: Treatment-naïve or PegIFN/RBV- experienced* with baseline NS5A polymorphisms†

Treatment:
ZEPATIER + ribavirin 16 weeks

Patient history:
Genotype 1b: Treatment-naïve or PegIFN/RBV- experienced*

Treatment:
ZEPATIER 12 weeks

Patient history:
Genotype 1a or 1b: PegIFN/RBV/PI-experienced‡

Treatment:
ZEPATIER + ribavirin 12 weeks
 
Patient history:
Genotype 4: Treatment-naïve

Treatment:
ZEPATIER 12 weeks


Patient history:
Genotype 4: PegIFN/RBV-experienced*

Treatment
ZEPATIER + ribavirin 16 weeks
*Peginterferon alfa + ribavirin.

Also recommended testing prior to initiating treatment

“Testing Prior to Initiation of Therapy:

Test all patients for HBV infection by measuring HBsAg and anti-
HBc. (2.1)

Genotype 1a: Testing for the presence of virus with NS5A
resistance-associated polymorphisms is recommended. (2.1)”
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Lynn K

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Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #7 on: September 05, 2019, 01:11:14 am »
Ok I just saw in your signature you are genotype 1a so if you have the NS5A polymorphism you would need to have Zepatier and ribavirin for 16 weeks to improve your odds of cure. You need to have the test for NS5A polymorphism to ensure you are being treated properly.
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Lynn K

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  • Member
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  • Get tested, get treated, get cured, fight Hep c!
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #8 on: September 05, 2019, 01:30:37 am »
Per the AASLD (American Association for the study of liver diseases) the treatment recommendation for a patient previously treated with an NS5A Inhibitor DAA Genotype 1

https://www.hcvguidelines.org/treatment-experienced/gt1/ns5a

Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/voxilaprevir (100mg)

the trade name of this drug is Vosevi

The 3D combo you previously treated with is several classes of meds including the classification of NS5A so per the AASLD the recommendation is Vosevi.

“VIEKIRA PAK with or without ribavirin is indicated for the treatment of patients with genotype 1 chronic hepatitis C virus (HCV) infection including those with compensated cirrhosis. VIEKIRA PAK includes ombitasvir, a hepatitis C virus NS5A inhibitor, paritaprevir, a hepatitis C virus NS3/4A protease inhibitor, ritonavir, a CYP3A inhibitor and dasabuvir, a hepatitis C virus non-nucleoside NS5B palm polymerase inhibitor. (1)”

Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,309
  • Get tested, get treated, get cured, fight Hep c!
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #9 on: September 05, 2019, 01:31:32 am »
Here is general information from the AASLD about treatment recommendations for those who failed prior treatment

https://www.hcvguidelines.org/treatment-experienced/gt1
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,309
  • Get tested, get treated, get cured, fight Hep c!
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #10 on: September 05, 2019, 01:38:48 am »
Although hepatitis B virus (HBV) reactivation has been reported in hepatitis C patients who received interferon therapy, rare cases of HBV reactivation occur in the context of direct-acting antiviral (DAA) agent therapy for treatment of hepatitis C virus (HCV) infection. Recent studies observed that the reactivations were predominantly in hepatitis B surface antigen (HBsAg) positive patients, but reactivation can rarely occur in patients who are HBsAg negative and hepatitis B core antibody (HBcAb) positive. The severity of an HBV flare varies. In some cases, severe liver injury or fulminant hepatic failure may occur. HBV reactivation may occur regardless of HCV genotype and type of DAA regimens. The onset of HBV reactivation can range from 4 to 48 weeks after initiating DAA therapy.

https://www.sciencedirect.com/science/article/pii/S2542568418300382
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline 1bit

  • Member
  • Posts: 25
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #11 on: September 06, 2019, 07:52:06 am »
phwoarr! I wished I never asked now lol... I do appreciate the deep research you have done but i think sometimes the less you know the better, I was already scared and now im having palpitations and i haven't even started yet...

it seems to me that HBV reactivation is possible in all or most treatments including the two I had before..

on the Abbvie3D (3 drugs in 2 tablets) + Ribavirin I only managed 4 days before my face turned grey, eyeballs yellow and felt like I was dying, I woke at 2am on the 4th day with 180BPM heart-beat which lasted 7 hours straight.. thus I stopped the treatment, it was 10x worse than Peg-Inf+Rib in my opinion.

Iam in the UK too (just so your aware)
Genotype 1a Infected 1999
- responder/relapser Inf+Rib 2008
- discont. Abbvie 3D (sides) 2016
- commencing Zepatier 2019
Biopsy 2006 = 2/6 ISHAK (Grade 7 / Stage 2)
Fibroscan 2010: 8.9 : (ALT 55)
Fibroscan 2016: 7.9 : (ALT 50)
Viral Load = 9.6 million

Offline Mugwump

  • Member
  • Posts: 759
  • My number of posts means nothing, piscor ergo sum!
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #12 on: September 06, 2019, 04:01:55 pm »
Most importantly IMO if you have extreme fears associated with a DAA treatment is to try to follow a regime that makes some sense during treatment. What I mean by this is if the treatment needs to have a meal consumed to absorb the drug then make certain that you follow the recommendation. For me the opposite was the case with Harvoni treatment. However; carefully staying well hydrated and active during treatment is crucial regardless of which DAA you are taking.


The reason for this is that clearing large amounts of the byproducts of inert HCV, dead liver cells and all the associated substances that are associated with the rapid removal and recreation of liver cells will put stress on your renal system. And this is why you can experience side effects like increased blood pressure, the anxiety that it causes if you stress your system too much during treatment with a DAA. I am also somewhat prone to anxiety and overthinking things at times. What helped me the most during treatment was staying active mentally and physically during treatment and not reading things into every little ache and pain that occurred during treatment.


All DAA treatments will effect your renal and waste systems to an extent so you can expect increased blood pressure for this very reason.


I did experience some rapid heart beat at first with Harvoni treatment and found that getting out and doing relaxed exercises while staying adequately hydrated and properly nourished was the only solution to the side effect of having the sudden renal stress that a DAA treatment creates. All my best and I am certain everyone here is pulling for your success and future free from this God forsaken disease! Eric
Caution shameless self promotion below :-)
https://www.hepmag.com/article/eric-reesor-27742-782589663
DING DONG MY DRAGON (HCV) IS FINALLY DEAD!

Offline Lynn K

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  • Member
  • Posts: 4,309
  • Get tested, get treated, get cured, fight Hep c!
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #13 on: September 06, 2019, 05:37:19 pm »
Yeah sorry about all that less than happy information. I’m just a lay person fellow patient but your I would suggest you get information from your doctor about the hep b reactivation “black boxed” warning
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline 1bit

  • Member
  • Posts: 25
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #14 on: September 11, 2019, 09:49:47 am »
I started this treatment 3 days ago... the only symptoms so far are extra sensitivity to cold, sound and smell/taste but only a small amount its not serious, in fact, the smell is welcome, being a smoker I usually struggle to smell anything, today I just had to move the ash-tray because of the smell and could smell downstairs cooking!! hehe.

I have been feeling a bit...well..sort of "better" since about 2 hours in, I dunno what or how but I feel a bit 'clearer' and have a sense of well-being, I found others online who had similar experiences with Zepatier and Harvoni, my tinnitus is much less pronounced too (more than 50%) and I recalled that this happened during INF+RIB Tx also but didn't happen within hours like this drug, more of a few months in on INf+Rib that my tinnitus reduced...a most welcome side-effect as you can imagine.

I have been taking the meds with my tea with x1 paracetamol and x1 multivitamin around the 5pm mark as I've read of quite a few people have some acute stomach issues and its of my opinion that its possible these patients took the drugs on an empty stomach. I make sure I drink at least 1-litre of water per day (usually 2-3 x 500ml).

Seems I may be right about the hep-b reactivation in that its a concern on all DAA's, I have assumed this from research, I have not spoken to the nurse about it but I will when I see them next week for a Doppler Ultrasound..bit strange my specialist wants to do this 2 weeks AFTER starting treatment...is this normal?
Genotype 1a Infected 1999
- responder/relapser Inf+Rib 2008
- discont. Abbvie 3D (sides) 2016
- commencing Zepatier 2019
Biopsy 2006 = 2/6 ISHAK (Grade 7 / Stage 2)
Fibroscan 2010: 8.9 : (ALT 55)
Fibroscan 2016: 7.9 : (ALT 50)
Viral Load = 9.6 million

Offline 1bit

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  • Posts: 25
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #15 on: September 12, 2019, 08:33:52 am »
I woke up at 3am just like last time going into the 4th day with rapid heart rate which set my anxiety off and made it even worse, i also started shivering badly but managed to stop it with extra blankets and breathing exercises and paracetamol and water... if I didnt have anxiety it would have been nothing.

woke up feeling fine just a bad gut, I slept in much longer than normally too

fingers crossed that was just it saying "hi, im here", I feel fine now
Genotype 1a Infected 1999
- responder/relapser Inf+Rib 2008
- discont. Abbvie 3D (sides) 2016
- commencing Zepatier 2019
Biopsy 2006 = 2/6 ISHAK (Grade 7 / Stage 2)
Fibroscan 2010: 8.9 : (ALT 55)
Fibroscan 2016: 7.9 : (ALT 50)
Viral Load = 9.6 million

Offline Mugwump

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  • Posts: 759
  • My number of posts means nothing, piscor ergo sum!
Re: About to start Zepatier (Elbasvir/Grazoprevir)
« Reply #16 on: September 16, 2019, 01:08:46 am »
I woke up at 3am just like last time going into the 4th day with rapid heart rate which set my anxiety off and made it even worse, i also started shivering badly but managed to stop it with extra blankets and breathing exercises and paracetamol and water... if I didnt have anxiety it would have been nothing.

woke up feeling fine just a bad gut, I slept in much longer than normally too

fingers crossed that was just it saying "hi, im here", I feel fine now
For me I was scared to hell because my liver was on the way down and the HCV was starting to weaken me physically. In 2014-15 It was a catch 22 for me with treatment at first, too weak to get effective exercise, overweight with a distended liver and rapid heart beats, dry mouth all the time. Not so much the fear of dying but more the feeling before treatment that my life had just about run its course at the age of 62-63.
 
Curing HCV turned my life around and focusing on doing things that I put off because I never thought that I would get the chance in this lifetime gave me the strength to overcome all the terror that is having long term HCV.


I truly hope that your fears abate as have mine. It took about 2 weeks into the treatment before I started to hope that my liver would really start to turn around and heal itself. At which point all of a sudden I found a boost in my energy and spirit that comes from having normal liver enzymes and functions for the first time in a great many years.


Your liver should begin to heal very soon and when it does you will begin to feel the benefits of ridding yourself of HCV. I am pulling for you and so is everyone who has gone through this horror.


Eric 
« Last Edit: September 16, 2019, 01:10:49 am by Mugwump »
Caution shameless self promotion below :-)
https://www.hepmag.com/article/eric-reesor-27742-782589663
DING DONG MY DRAGON (HCV) IS FINALLY DEAD!

 


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