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You need to register for free with this site to get the slides.
While this set of slides does not exactly answer your question, it does provide a lot of detail on the treatment of cirrhotics. All the slides I looked at showed that if ribavirin was used at all then it was used for 24 weeks. Maybe there is no good clinical reason for that, just the way the trials were designed that produced the data. I don’t know.
dt
Hi Mike, very interesting. Did the insurance company pay for the meds or the guy?
I ask because if US insurance companies were to sign on to the concept of personal importation of the meds, thus circumventing the patent laws, then it’s game over for Big Pharma. So I’d find an event like this of seismic importance.
dtThe AASLD updated their guidelines recently:
http://www.hcvguidelines.org/full-report/retreatment-persons-whom-prior-therapy-has-failed
dt
“26 subjects with GT 1b (the easiest to treat)”
Hi Doc Freeman,
Do you have any links that show that GT 1b is the easiest to treat?
I am 1b. In the Gilead ION2 trial the subtype 1b came out significantly worse than the 1a.
There were only 23 people who were 1b so maybe this is just an example of the sample size being too small. However I asked my doc and he also seemed to think that 1a had a better chance with Harvoni than 1b.On the subject of subtypes, the UK NHS don’t even test for subtype these days, so people don’t know. I only know mine because it was tested when I did a trial.
Thanks,
dtOMG!
I can’t help myself from wanting to know the details even if they just make the picture more gruesome.I was kinda theorising that maybe virions don’t always snag a hepatocyte the first time around.
The reality will no doubt turn out to be stranger than anything I can imagine.
dtI am puzzled about this:-
The DAAs target the virus inside the hepatocyte and stop it replicating. So when all the hepatocytes are saturated with DAAs then replication of the virus should be stopped dead in its tracks. As most of the virus is in the blood, that should be the time it takes for all the blood to circulate through the liver. That would be <24 hours. So why does it actually take weeks to get to UND? What am I missing?
dt
Hi LG, there’s no nice way to say this. Your consultant sounds like a right C***. How unfortunate that you drew the short straw with him. However, even a more helpful NHS consultant has their hands tied when it comes to supplying the drugs we need, courtesy of Big Pharma’s pricing and NHS collusion with it.
Now, you have got me started on UK dentists, which are another UK professional body straight out of the dark ages. I could rant on about them for hours but will try to restrain myself. Their greed is every bit as invidious as Gilead’s. They insist you have to be registered with them even if you only want one little filling. My (private) dentist thinks that taking the time to match the colour of my front tooth with a filling is beneath him. He only likes the £500 root canal jobs – which then fail. Even the hygienist was salivating on my first visit hoping that she’d got another old fart with gum disease who’d need expensive periodontal treatment. When she found my gums perfectly healthy her face changed like she’d just sucked a lemon. I’d go someplace better but I’ve already been all over town and not found better and got myself a reputation for switching dentists (a bad thing, must be my fault). I really feel trapped in a system which is not serving my interests. To their credit, opticians don’t do this. I can walk in to any optician and get service. Which makes it even more irritating that with dentists I can’t.
My point is that the UK is riddled with closed shops. We are just the cash cows for their convenience and they tie us up in knots with this enforced registration and transfer of records. The only viable action we can take is the one you are proposing. Go overseas to another country for treatment. If the UK population did this in droves then these dentisits would all go out of business, which they so richly deserve to do. Same for generic meds. India, China, Bangladesh & elsewhere will do business on our terms so take our business there.
dt
There are different kinds of anemia:-
Iron deficiency anemia is treated by taking iron supplements.
Hemolytic anemia is the kind induced by ribavirin. Iron supplements should be avoided for this kind of anemia.The subject has been a source of confusion for heppers, like forever.
dt
Bloot
I’ll be enjoying a few glasses of red wine myself when I get free of this virus. You bet.Chrisp
There have been studies done to find the effects of alcohol on HCV progression. So while you may be right that for some the not drinking message is a moral one, there is also scientific data on it.
For example:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842525/“There are numerous clinical studies that suggest a strong epidemiological link between the consumption of alcohol and accelerated liver disease in HCV infected individuals”
” there is clinical evidence to suggest that alcohol metabolism increases HCV replication”
The way it was explained to me is that when I consume alcohol the virus has an orgy and makes much more progeny than usual. Whether it is true or not, I found that image so disturbing that I literally couldn’t touch another drop. I have found recently though that people with hepC who have been on the wagon for years have started drinking moderately again because they know they are near the finish line and will be getting rid of the virus soon. Before there was a cure nobody knew how long their livers would have to hold out, and that stopped them drinking. So the whole landscape has changed.
dt
Hi LG,
The UK NHS is not doing any monitoring anyway for people on Harvoni who have no other complications. They’ll only do a few blood tests if you are on riba as well. No PCRs during tx. You get the baseline bloods and then you get the pills and you get on with it. So you are not missing much.
dt
What if your fibroscan is not so bad? Does that mean your decision will be to wait until it is?
Are you bipolar?dt
It’s not really a strange symptom but I think almost everybody is scared when they are diagnosed with hepC. I learned via a phone call from my GP, and remember feeling like a Hiroshima bomb had gone off in the room. I was gripped by terror for weeks afterwards, sitting up late into the night studying the disease and possible cures. Virtually my only solace was a blog written by somebody who had gone down the road already and had actually been able to write about it on the way. Then I found the forums and other people in various stages of dealing. Coming to terms with my possible future was a slow and angst-filled process, not helped by the hospital dragging their feet about the tests and not knowing for weeks whether I was good to go for a while or near to death’s door.
But those days were before we had a CURE. There’s no need now for fear. There’s no need for stigma. It’s just an infection, like any other infection that we’ve learned to get on top of. It is going the way of all the other feared infections – TB, pneumonia, etc. that used to routinely carry people off. All that remains is to get our heads round that, get tested, get cured. Easy as ….
dt
“I’m not too afraid of death
Maybe I’ll change my tune if it is staring me in the face. I’ll know when it happens I guess”You’ll know before that. Death is not the problem actually. Trust me. It’s what happens to your body on the way there. I won’t list the symptoms of advanced liver disease because I think you are afraid enough already to be in denial about your hepc. You can look them up for yourself. I sincerely hope that you spare yourself that journey, stop drinking, do the tx and thank your lucky stars that now we have the meds to let us escape this nightmare disease.
dt
There was a paper written some time ago when the DAAs were a concept but not yet a reality. Sorry I can’t find the link to it but the gist was as follows:
Mathematicians got together with medical specialists studying the hepc virus and how it mutates to escape threat. They calculated that if the virus was disabled in 3 different places at the same time then there was no possibility for it to escape via mutation. ie. 3 drugs with different actions would be a guaranteed success in eradicating any virus that was exposed. To date I don’t know if their theory has been disproved but the concept made sense to me. I don’t know if ribavirin was counted as one of the 3 DAAs.
dt
Hi LG,
This is interesting because you are in the UK also. If your hospital was routinely checking it implies that they were prepared to give you another vaccination if they found you had no resistance to Hepb. Otherwise why check? Are you immunocompromised?
The guidelines posted by the doc say not to worry about it. Get the primary course and you are good to go. No need to check.
So I don’t know, but good luck with this Vicki. If you learn any more at your next clinic visit I’d be interested to hear about it.
dt -
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