Hep C Discussion Forum

Hey Mr. Tamb,

That's great you are in good shape, a runner, in good health (other than your virus), with no other probs. All of that is good, helps you of course, and is in your favour. You start with advantages!

The reason I asked how your kidneys were is only because Zep happen to be one of the regimes that taxes the kidneys less, compared to most of the regimes, as far as excretion, so Zep is especially useful for pts. who also happen to have varying degrees of kidney disease. Sometimes this regime is chosen expressly for that purpose. But with no kidney issues in your case,  Zep also just happens to be a very effective regime (with or without kidney issues)!

I am hoping you are a GT1b, as that may somewhat lessen the chances that they will have to add a third drug to your regime (the riba), or to make the treatment longer. 

A "double" treatment, two drugs only, (such as Zep), as are most of the other new anti-viral treatments (being "doubles" as well), are generally easier to take, than if you have to have a third drug (like riba) added to the regime to make it a "triple" therapy.

If it turns out you are a GT1a, and they see reason to/wish to add riba to your Zep (because of having certain 5A Ravs) then perhaps you could always ask if there is not a "riba-free" regime you could have, that might be just as effective, as an alternate choice.

There are few others here at this site who are from your neck of the woods, "Jaggles" in the UK, and "Jane-n-phil" in Wales. Jaggles is awaiting her imminent start of Epclusa, and Jane-n-phil have already stared their Epclusa.

I am glad you are young and fit. How has the HCV been making you feel, as of late, or in the last years?

If you are able to find out your sub-type (a or b), earlier than Apr 14/15, or, if you find out or know any of your other blood test results, current or past (such as ALT, AST or billirubin) please do pass them along.

Have they checked your Hep A and B immunity levels? Did they ask you about being up to date on other immunizations such as flu shots? I expect they did.

Be assurred, the new regimes are very effective, with such less sides than the old regimes. It is a good time to get cured!  C.

Hi Mr. Tamb,

Glad to meet you here, and glad to here you are getting well lined up for your imminent treatment.

Good your fibroscan was done. 6.8 kPa's puts you roughly at about F0 to F1, so that is not too bad at all, assuming you have had HCV for at least? the last 10 years or more, as you mentioned trying to avoid doing interferon for the last 10 years. Based on that "avoiding" interferon for 10 years, I then also just assume that you are indeed "treatment naive" (have never been treated) - these are all good things for us to know for background info.

I also wish we knew whether you were a GT1a or GT1b.

As you can see in the link Tig provided, and as he pointed out, these things (prior treatment experience, and, 5A RAV testing) have a bearing on whether riba is added, or not, and how long the treatment may last.

You mentioned you are waiting for further testing results (your thought for your viral load?) perhaps this is so, but perhaps as well it might be your "sub-type" that is being confirmed, either 1a or 1b (odd tho that they would not have your a or b subtype as of yet), but, as well, quite possibly it could be 5A RAV's they are checking you for.

How are all other areas of your health - is your kidney function normal as far as you know?

Is there any particular reason they wished you to have ZEP over any other drug regime? Did they discuss any other drug regime choices with you other than Zep?

How are you feeling and holding up during this waiting period?  Glad you came here.  C.

There generally isn't any regard given to the viral load quantity with Zepatier. If your doctors are utilizing an off label consideration, that should be clarified. Here's a screen grab from the link I'm providing HERE. The use of Ribavirin was limited to those that had a history of Interferon based treatment or test for NS5a polymorphisms (resistant to the planned drug therapy). These are simply my opinions, ask your doctor and nurse for more information next time in.

Have you had your fibrosis level determined? If you have any test results, share them if you can.

----------------------- DOSAGE AND ADMINISTRATION -----------------------

 TestingPriortoInitiationofTherapy:

•   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)

•   Obtainhepaticlaboratorytesting.(2.1)

 Recommended dosage: One tablet taken orally once daily with or without food. (2.2)

Dosage Regimens and Durations for ZEPATIER in Patients with Genotype 1 or 4 HCV with or without Cirrhosis

Patient Population	Treatment	Duration
Genotype 1a: Treatment-naïve or PegIFN/RBV- experienced* without baseline NS5A polymorphisms†	ZEPATIER	12 weeks
Genotype 1a: Treatment-naïve or PegIFN/RBV- experienced* with baseline NS5A polymorphisms†	ZEPATIER + ribavirin	16 weeks
Genotype 1b: Treatment-naïve or PegIFN/RBV- experienced*	ZEPATIER	12 weeks
Genotype 1a or 1b: PegIFN/RBV/PI-experienced‡	ZEPATIER + ribavirin	12 weeks
Genotype 4: Treatment-naïve	ZEPATIER	12 weeks
Genotype 4: PegIFN/RBV-experienced*	ZEPATIER + ribavirin	16 weeks

*Peginterferon alfa + ribavirin.
†Polymorphisms at amino acid positions 28, 30, 31, or 93. ‡Peginterferon alfa + ribavirin + HCV NS3/4A protease inhibitor. 

Hey Paul,

Welcome to the forum! Glad to hear you're going to get treatment started soon. Zepatier is a very effective protocol.

You shouldn't experience much in the way of negative side effects from this combination. Like most of these new drugs, you may feel some fatigue and headaches, but they are generally kept at bay by simply drinking 3-4 liters of water everyday. Without fail! The patients required to take Ribavirin will experience additional issues, like anemia, among a few others. Will you be taking that?

Tell me a little more about the tests you've had completed thus far and I'll understand things a little clearer. Have they tested you for any resistance to NS5a drugs? That can determine whether Ribavirin or an extended (16 weeks) of care are warranted.

Zepatier eConsult