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Ariel, don’t worry and keep the resistance.
Just solve the problems one-by-one. Job? Get a new one/get yourself into something highly in-demand and interesting.
Undiagnosed disease? Get blood tests done, make a list of appointments to different doctors and undergo diagnostic procedures. If it were hep b, get treated against it. If it is something else, get treated against it. You probably should start with the job, then doctors. I don’t have a house and recently got my very first job. It all starts somewhere.
Health is the most valuable thing and one should fight for it. Many people have different health problems and it is normal to withstand difficulties. You will beat this! Just work on it step-by-step.It is unlikely that you have hep b, because immunization is effective. But get tested. Most likely though, the culprit is something else, so work hard to find it.
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.15 November 2016 at 1:57 pm in reply to: Voxilaprevir (akaGS-9857) – A new Protease Inhibitor #24299Voxilaprevir works for retreatment of non-ns5a daa treatment relapsers either.
http://www.oncologynurseadvisor.com/aasld-2016/sofvelvox-effective-as-retreatment-for-non-ns5a-daa-failures/article/571437/
One way is retreating with sof/vel/riba@24, another one – sof/vel@12, yet another one – sof/vel/vox@12. Each has different effectiveness in different cohorts.NS3 RAVs resulting from treatment generally mostly disappear by themselves in about more than 1 year. Ns5b sof-related RAVs – in about less than 1 year.
However, acquired NS5A RAVs persist, requiring retreatment with drugs having considerably different resistance profile/mechanism of action/high bareer to resistance.
Results from 3-year follow-up study.http://www.natap.org/2016/AASLD/AASLD_61.htm
All presentations from AASLD 2016 – the long-awaited data on retreatment.
http://www.natap.org/2016/AASLD/AASLD.htm
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.15 November 2016 at 12:34 pm in reply to: Panovir (Sofosbuvir/Velpatasvir) combination from Incepta Pharma #24298I was exactly looking to start treatment this week, so I’ll try to get the prescription information from Incepta.
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.15 November 2016 at 12:36 am in reply to: Panovir (Sofosbuvir/Velpatasvir) combination from Incepta Pharma #24288Wonderful!!
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.In terms of cost/efficacy for public healthcare – yes. Not easy to justify expedited approvals.
But resistance to it is lower and it’s believed to have less side effects. Moreover, it sometimes allows retreatment.
However, for general population – BMS’s dac was the first one to come. No doubt why there were no Phase III trials of sof/dac.
It’s good we have several great drugs available.
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.14 November 2016 at 12:31 pm in reply to: Voxilaprevir (akaGS-9857) – A new Protease Inhibitor #24277Chinese factories started selling vox API, but it’s not clear if it would be easy for a company to make working pills or capsules from it. No data on voxilaprevir solubility and permeability yet.
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.Rapid Virological Response reported in 1 case.
http://hepcfriends.activeboard.com/t62645983/epclusers-corner/
One should drink lots of lots of water with velpatasvir to avoid dehydration and take pills at one time of the day. Side effects are said to be more than manageable, mild headaches and fatigue, water helps.
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.Other companies will focus on the developing world and retreatment therapies.
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.Summary of trials data to help one compare sof/vel with other effective treatments
http://congress-ph.ru/common/htdocs/upload/fm/gepatology/2016/prez/1-3-2.pdf
http://www.natap.org/2016/AASLD/AASLD.htmIn-vivo resistance analysis (sof/vel, all phase III trials).
Enough statistics for some genotypes.
http://www.natap.org/2016/EASL/EASL_15.htm
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.8 weeks of vox is quite enough, but 12 weeks is significantly better for everyone.
We are going to get lots of data on retreatment this November.
http://www.digitaljournal.com/pr/3091534New treatments of 2016-2017 (More hope for GT3 patients!)
http://congress-ph.ru/common/htdocs/upload/fm/gepatology/2016/prez/1-3-2.pdf
(Note that the bullets denoting the drugs’ mechanisms of action are misplaced in this presentation)
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.Gilead announces SVR12 Rates From Four Phase 3 Studies of sofosbuvir + velpatasvir + voxilaprevir! (20 October 2016)
Filing FDA application very soon.
http://www.gilead.com/news/press-releases/2016/10/gilead-announces-svr12-rates-from-four-phase-3-studies-of-a-oncedaily-fixeddose-combination-of-sofosbuvir-velpatasvir-and-voxilaprevir-in-treatmentna%C3%AFve-and-treatmentexperienced-genotype-16-chronic-hcvinfected-patients
http://www.empr.com/idweek-2016–adult-infectious-diseases/high-efficacy-with-sofosbuvirvelpatasvir-voxilaprevir-for-pangenotypic-hcv/article/566893/The most common prior NS5A inhibitors were ledipasvir (55 percent) and daclatasvir (23 percent).
Complete results from all four studies will be presented at the AASLD Liver Meeting® 2016 in Boston. Nov 11 – 15, 2016.
http://www.pr-medicalevents.com/congress/aasld-2016/
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.Yes, you may not need voxilaprevir. Sofosbuvir (an ns5b inhibitor) creates temporary resistance s282t that gets cleared by itself in 6-12 months. http://onlinelibrary.wiley.com/doi/10.1111/jvh.12405/summary There are also L159F and V321A, but those were found to be weak and to not influence treatment outcomes greatly.
http://jid.oxfordjournals.org/content/early/2015/11/24/infdis.jiv564
In contrast, Ns5a inhibitors create permanent resistance.
Yes, you should wait for lab tests for resistance to see if you have any baseline RAVs, except possible ribavirin resistance.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961994/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786064/
http://www.nejm.org/doi/full/10.1056/NEJMoa1512612#t=article
Resistance profile of velpatasvir looks slightly better then the one of daclatasvir for gen 2 viruses. (According to the articles above).
The choice between vel and dac, of treatment duration and whether to include ribavirin for the third time is a really important one and depends on your fibrosis state and baseline RAVs. The addition of vox vs using ribavirin for the third time, if needed, also depends. You should research it very carefully. Vox may be not necessary and would possibly bring in NS3 resistance, if failed.
The outlook for you is very good though, if treated properly (and timely).
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.Another good option for you could be to enroll into a phase 3 US trial of some other company. Abbvie for example has some meds that are effective for retreatment, but has not tested them on gen 3 people yet. A trial of some other company could get you cured earlier.
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.Splitdog,
you should consider data from this small Phase 2 trial (sof/vel/riba @ 24 weeks for retreatment)
http://www.hcv-trials.com/showStudy.asp?Study=112
http://www.catie.ca/en/treatmentupdate/treatmentupdate-216/anti-hcv-drugs/sofosbuvir-velpatasvir-epclusa-ribavirin-retreatm
http://www.natap.org/2016/EASL/EASL_11.htm
http://www.natap.org/2016/EASL/EASL_56.htm
Another news is Velpatasvir may get available in India ~ March 2017 (or earlier) as the local Indian trials of generic sof/vel end, unless the approval is expedited.
The sof/vel/vox trial for NS5A-experienced people is going to end in Jan 2017 (https://www.smartpatients.com/trials/NCT02607735) => sof/vel/vox may get to be FDA-approved in July 2017. Generic availability – 6+ months from that moment in India, unless local Indian trials requirement is waived there (it might happen because nothing else is better for retreatment) or 0+ months elsewhere (Bangladesh for example).
The main question in your case would be – how effective sof/vel/vox would be for retreatment of a sof/vel/riba & sof/dac combined failure for a fibrosis state. It may get answered in Jan 2017.
However, you should consider sof/vel/riba @ 24wks if your liver got worse. No more trial results for now.EDIT: Please, note that people on this trial had been treated with suboptimal doses of velpatasvir before relapsing (25 and 50mg vs 100 mg). The natap publication includes more details, but there is a typo there – it is 50 mg that the dose of velpatasvir that 59% of prior relapsers had been treated with was, not 100 mg. The results may differ for those previously treated with the optimal 100 mg dose of velpatasvir or patients with an advanced liver disease.
Also, the problem is dac gives y93h resistance in 90% of variants after a relapse. http://aac.asm.org/content/58/9/5155.full
Velpatasvir is generally weak against Y93H in gen 3 viruses. However, 14 of 15 people with Y93H mutation were cured with sof+vel+vox, 9 of 11 (13 people with NS5A RAVs in total) people with gen 3 and y93h were cured with sof+vel+riba @ 24wks.
Both were phase 2 trials, so they do not provide statistically significant information. You may or may not get cured with sof + vel + ribavirin (for 6 months) now, if treated. More reliable statistical data on retreatment comes in 2017.
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.20 September 2016 at 1:11 am in reply to: Velpatasvir is not suitable for home compounding from API #23131Hello!
Could someone possibly share information regarding the India launch and what’s the state of affairs?
Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60. -
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