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TOPIC: Geno 4 and something

Geno 4 and something 3 years 4 months ago #6423

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Feeling this will be a lonely subforum, so let's try to make it living.
Maybe I'm not the right person for discussing G4, cos I also have 1b, but will present all I found about G4, and co/superinfections.
G4 seams to be most common genotype in the world but is concentrated to Egypt and Middle East countries, recently spreading to Europe.
Lucky for me treatment for G4 is compatible with G1, but in practice no one can tell how it will work on me. I'm planning to start generic Harvoni tx soon, and will post all my findings and results.
There are very few info about multiple genotype infections, and these are two I found most informative:
www.cdc.gov/hepatitis/resources/mtgsconf...pdfs/20_blackard.pdf
jid.oxfordjournals.org/content/195/4/519.full
Genotype 1b & 4, F0/A1, failed Peg&Riba TX 2015,
22 Jan. 2016 - Back from Delhi with 12 week Ledifos supply :) Thx to Parag
Started TX on 27.Jan.2016 - AST 41, ALT 59, GGT 39, ALP 74, VL 500.000, Fibroscan 6.8
19. Feb 2016 - ALT 14, AST 14, GGT 19, ALP 107
19. Apr 2016 EOT - Undetected :)
26. Apr 2016 (1 week after EOT) - ALT 14, AST 17, GGT 12, ALP 77
28. Aug 2016 (17 weeks after EOT) - UND, ALT 15, AST 12, GGT 5, ALP 39 :)
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Geno 4 and something 3 years 4 months ago #6851

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It's interesting to see that the incidence of co-infection seems to be 5-10% when people look, but out of several hundred patients I have only seen 1 reported.

I suspect what's happening is that they test for all 6 genotypes and pick the biggest one an call patients GTX even though 5-10% of the time the lab also saw some GTY
YMMV
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Geno 4 and something 3 years 4 months ago #6853

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Is the other possibility that the patient profile through here (from what I can see) tends to be baby boomers who were effectively riding the crest of the initial wave of the epidemic within their region so less opportunity for co-infection. But if a more representative sampling by infection date was taken then the incidence would indeed be higher given the now greater spread of GTs between continents?
G3a since '78 - Dx '12 - F4 (2xHCC)
24wk Tx - PEG/Riba/Dac 2013 relapsed
24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 - 22/06/17 UND
SRV12 - 27/07/17 UND
SVR24 - 26/10/17 UND
:cheer: :cheer: :cheer:
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Geno 4 and something 3 years 4 months ago #6921

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James-Freeman-facebook wrote:
It's interesting to see that the incidence of co-infection seems to be 5-10% when people look, but out of several hundred patients I have only seen 1 reported.

I suspect what's happening is that they test for all 6 genotypes and pick the biggest one an call patients GTX even though 5-10% of the time the lab also saw some GTY

I find that quite possible. When I was due to run test for genotyping, public lab did not have appropriate tests, and I was told to wait until they got supply. I'm not a patient person, so I did test in private lab which got latest genotyping tehcnology, and that's probably reason why I got precise result.
Genotype 1b & 4, F0/A1, failed Peg&Riba TX 2015,
22 Jan. 2016 - Back from Delhi with 12 week Ledifos supply :) Thx to Parag
Started TX on 27.Jan.2016 - AST 41, ALT 59, GGT 39, ALP 74, VL 500.000, Fibroscan 6.8
19. Feb 2016 - ALT 14, AST 14, GGT 19, ALP 107
19. Apr 2016 EOT - Undetected :)
26. Apr 2016 (1 week after EOT) - ALT 14, AST 17, GGT 12, ALP 77
28. Aug 2016 (17 weeks after EOT) - UND, ALT 15, AST 12, GGT 5, ALP 39 :)
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Geno 4 and something 3 years 4 months ago #6922

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That's interesting. I was wondering about this overnight and whether it may explain some non-responders and supposed re infections where the patient swears they haven't put themselves at further risk.

Whichever way you look at it though, it does seem to indicate that the way forward for new HCV drugs development should be pangenotypic where possible.
G3a since '78 - Dx '12 - F4 (2xHCC)
24wk Tx - PEG/Riba/Dac 2013 relapsed
24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 - 22/06/17 UND
SRV12 - 27/07/17 UND
SVR24 - 26/10/17 UND
:cheer: :cheer: :cheer:
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Geno 4 and something 3 years 3 months ago #9608

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Just found out this on topic of changing genotypes.
www.bccdc.ca/resource-gallery/Documents/...oad_Rec_20150609.pdf

Last paragraph is very interesting:
For all treatment experienced patients, whether they are considered a non-responder or they relapsed post-therapy, or, if re-infection is a consideration, the HCV genotyping should be repeated prior to retreatment.
Genotype 1b & 4, F0/A1, failed Peg&Riba TX 2015,
22 Jan. 2016 - Back from Delhi with 12 week Ledifos supply :) Thx to Parag
Started TX on 27.Jan.2016 - AST 41, ALT 59, GGT 39, ALP 74, VL 500.000, Fibroscan 6.8
19. Feb 2016 - ALT 14, AST 14, GGT 19, ALP 107
19. Apr 2016 EOT - Undetected :)
26. Apr 2016 (1 week after EOT) - ALT 14, AST 17, GGT 12, ALP 77
28. Aug 2016 (17 weeks after EOT) - UND, ALT 15, AST 12, GGT 5, ALP 39 :)
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Geno 4 and something 3 years 3 months ago #9621

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Thanks. As you say, very interesting.

I don't think mine was rechecked so just glad I'm on Dac which is pangenotypic. :)
G3a since '78 - Dx '12 - F4 (2xHCC)
24wk Tx - PEG/Riba/Dac 2013 relapsed
24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 - 22/06/17 UND
SRV12 - 27/07/17 UND
SVR24 - 26/10/17 UND
:cheer: :cheer: :cheer:
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Geno 4 and something 3 years 3 months ago #9622

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Geno1b4 wrote:
Just found out this on topic of changing genotypes.
www.bccdc.ca/resource-gallery/Documents/...oad_Rec_20150609.pdf

Last paragraph is very interesting:
For all treatment experienced patients, whether they are considered a non-responder or they relapsed post-therapy, or, if re-infection is a consideration, the HCV genotyping should be repeated prior to retreatment.

thanks geno1b4, thats quite helpful information. I have also heard of some new drugs being launched by Gilead for those who have relapsed on Harvoni.? how true is that. surprised there are people even relapsing.
Geno 1a since 2003,
Generic Harvoni purchased from Mumbai Ledifos
started treatment on 1st january 2016,
VL after 4 weeks of treatment - ONLY 508 :)
Hopefully UND within one week.
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Geno 4 and something 2 years 11 months ago #17219

Indeed, it is very interesting that so few dual or multiple genotypic infections occur. If you think of the primary cause of HCV infection and the multiple opportunities that arise for transmission, in the course of active addiction, it's quite astonishing really that the vast majority of people only have one genotype.

I hear the analysis bias argument, but there must be more to it. If one thinks of the incidence of co-infection with HIV then wouldn't it be logical that rates of multiple HCV genotypic infection would be higher than they (apparently) are, especially so given that it's much easier to contract HCV than HIV through IVDU.

Anyway, it's a bit academic.

There are now 2 people on this forum with G4. It's a real drag that so few data exist around G4 and that treatment decisions need to be extrapolated from G1 studies. That said, there seems to be more and more G4s included in studies these days.
45 yo male; UK; HCV since 1996; G4; F2-3 (fibroscan score 9.1);
Null responder interferon/ribavirin 2008;
4/16 Harvoni 8 weeks; Pre-tx VL 2.1 million; week 4 VL 269; EOT UND; but...
6/16 Tx extended w/ generic sof/dac x 12 weeks due to concerns around my slow response to Harvoni. UND at end of 2nd round of treatment and EOT+4.
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Geno 4 and something 2 years 11 months ago #17296

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Hi remember december.

I have wondered if I have more than one GT - I have even wondered if they gave me the wrong genotype on my initial report as a typo - They have made many typos regarding other things, including Alt 71 typed as 21 eg so it's not 'that' far-fetched, you know. I was told over the phone if I remember correctly, must check my paperwork I can't actually remember everything any more there is so much of it ! Anyway, admin errors have been many in my personal experience.

I also find these things interesting, the thing is unless there have been lengthly trials etc, most NHS staff will not venture outside the box in way of conversation or exchange of ideas it seems, especially with patients. Genetics are becoming very interesting indeed. I was told there is no such thing as genetic testing for HCV unless it's part of a trial. Hmm.
GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 'In the slow lane'
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
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Geno 4 and something 2 years 11 months ago #17310

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Dr Freeman was onto it back in October last year … SOF + DCV as the pangenotypic cure for HCV … you wouldn’t even need a genotype test done… if you had GT1 – GT6, or any combination, the Darvoni would be the cure all. See:

fixhepc.com/forum/media-news/1053-darvoni-story.html#17255

From my understanding, the only reason a patented version has not been developed is Gilead refused BMS’s offer to work together on this … and has been developing its own pangenotypic NS5A inhibitor called Velpatasvir (VEL). SOF + VEL has been reported as having very high cure rates for all genotypes, but seems to have more side effects than SOF + DCV.

It’s all about money. Gilead simply wants to corner the market with a one pill cure all. However, there’s already a generic one pill cure all called Darvoni.
1983: Hospitalised with Acute non-A, non-B Hepatitis after ICU blood transfusion 3mths earlier => HCV GT2
22/02/16: (pre-tmt) ALT 61, VL 2.48 IU/ml Hepascore 0.32 (F1/2), fatigue, brain fog, bloating (Treatment Naïve)
10/04/16: (Start tmt) Sofovir +DaclaHep (SOF + DCV) by Hetero Labs in India
09/05/16: ALT 34, VL: NOT Detected :cheer: :) , FBG 11.9 :huh:
17/6/16 FBG 5.7; PPBG (@14.22) 6.9 (@ 20.45) 7.1; BP 124/72
:) (Accu-Chek Mobile & Omron Auto BP Monitor) :)
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