I am a 57-year-old white American male infected with Hepatitis C. I am involved in a controlled medical research study by Roche Pharmaceuticals of an experimental Polymerase Inhibitor (RO5024048 also known as RG7128) drug therapy for the virus. This document is the story of my illness and the experience of treatment. My lovely and pretty damn wonderful wife will be contributing her take on the experience as well.
Tuesday, June 2, 2015
My viral load at the beginning of treatment was 3,550,000 IU (international units) per milliliter of blood. This is considered a high viral load. Not as high as the first time I went through treatment when it was 15,000,000, but still high. High viral load (anything over 800,0000) was considered to be somewhat more difficult to treat under the old regimen.
After one month of treatment, the test came back at 25 IU per milliliter. That is more than a LOG 5 drop in viral load which is an excellent response to treatment. Here is a post about what Log numbers mean regarding viral load.
In Hep C treatment, any number under 50 IU per ML is considered to be a Sustain Viral Response or SVR which means you are cleared of the virus. In the case of Harvoni treatment, this level of response has to be repeated at the two month test and the 3 month test to be considered successful.
Finally, in order to be considered to be cleared (or in remission) this same low level must be repeated in a test 6 months after treatment is finished. If you are below 50 IU per ML six months later you are considered to be, according to the doctors, in remission. The drug manufacturers, of course, say you are cured.
So, the viral load is currently below the threshold for an SVR which is great news. If this continues for the next two months it will be even better. It certainly makes the headaches and gas easier to deal with.
Thursday, May 21, 2015
I have noticed a persistent low-grade headache; some abdominal effects notably diarrhea and bouts of truly astonishing amounts of gas production; a bit of nausea occasionally and finally, quite contrary to the advertised fatigue, a bit of a speedy effect, especially if any caffeinated beverages are consumed. The headache is manageable through over the counter meds, the gas is manageable by removing myself from the company of others and enduring the effects alone and the energy boost can be useful though it is accompanied by enough loss of focus that it is best avoided.
It will be interesting to keep track of how the side effects evolve over time. So far, the nausea has decreased a lot, the headache has slowly been increasing and the speed effects are something I am trying to keep away from. My primary hope in the long term, is that killing off the virus will help with the brain fog and other long term memory and cognitive deficits of Hep C. Until then I can just keep on wearing the wrist band with my name on it...
Friday, May 8, 2015
Aside from the sheer cost of the drug to health care providers, the hammer really falls on the people actually infected with Hep C. If you don't have insurance, you are basically screwed. If you have one of the bronze level plans of the Affordable Care Act with a 40% effective co-payment you would have to pay $33,600 for treatment. A silver level plan would leave you with a $25,200 cost and even a gold level plan would still run you a bit over $16,000 out of pocket to be cured of Hep C. For those of us in the fast disappearing middle class in the USA, these are fairly staggering amounts. Sure there are various subsidies and cost breaks available, but given the way they are structured, if you make an amount of money that puts you in the middle class, you are often ineligible for help. I could get into a long rant here about how the Affordable Care Act is really only an affordable insurance act and the cost of any serious health care is just as out of reach under Obama's sellout to the insurance industry as it was in the days before the law was passed, but I will spare you that diatribe. Suffice it to say that the combination of Gilead's predatory pricing and Obamacare's mostly high patient payments means that a large number of Hep C sufferer's are shut out of access to the latest and best treatments available.
Earlier this year, Gilead announced that it will be cutting the cost of Harvoni by 46% sometime this year. This is because AbbVie has introduced their own interferon-free treatment Viekira Pak (which is priced similarly to Harvoni). While this competition is a good thing, the fact that the AbbVie product requires 4-6 pills a day and has more side effects than the single pill Harvoni might mean that it does not provide an effective competitor. If the competition is effective and does induce a lower cost for Harvoni, it means that treatment under a bronze plan would cost about $18,000; a silver would be $13,000 and a gold plan would drop to just over $8,000. While much better for patients, these are still large numbers. Numbers that would have put the treatment out of reach for someone like me.
I got lucky. I have health insurance through my employer and the roll-out for Obamacare has been complex enough that many employers have been granted waivers the past few years allowing them to keep their former plans in place until the regulations for employer-paid Obamacare plans have been worked out. My employer was granted that kind of waiver. I am insured by Kaiser Permanente in San Francisco and my plan is one that has a $30 co-pay for prescription drugs. I have been closely watching the Kaiser drug formulary (the list of which drugs Kaiser provides through their plan) to see when and if Harvoni was added. As soon as it was, I contacted my gastroenterologist to try to initiate treatment. Luckily for me, Kaiser has an extremely proactive view toward Hep C treatment. They believe that everyone who wants to receive treatment should have access. They seem to understand that, regardless of the high cost of the medication, it is cheaper to treat than to deny treatment and then have to pay the higher costs of late stage Hep C and/or cirrhosis treatment. Many insurers are not as forward thinking. Kaiser did initially prioritize the Harvoni treatment to the sickest patients but as that cohort moved through treatment, they rapidly expanded care to their other Hep C patients.
When I saw my gastro guy, I explained that I currently had a health plan that made treatment affordable, but that our current plan would be most likely transitioning to the less affordable Obamacare varieties by the end of the year and thus I would like to be treated as soon as possible. He told me stories of a number of his patients on the lesser insurance plans who indeed were currently shut out of treatment. This factor meant that while my liver is not in a particularly bad state, he agreed that the issue of affordability was one that qualified me for moving up the queue for treatment. He set up the necessary tests and within a month, I began treatment.
I feel extremely lucky that the new drugs came out when they did, that Kaiser moved relatively quickly to include them in their formulary and that they have a very proactive institutional policy toward treatment. If any of these factors had taken another 6 months to work out, most likely I would be like many other Hep C sufferers on the outside of treatment looking in.
Thursday, May 7, 2015
The cure rates for genotype 1 Hep C (most common and vicious form) are in the 94%-99% range for treatment naive patients (those who have never undergone any sort of treatment) and in the 90% range for those of us who underwent treatment in the past and failed (thus leaving behind tougher versions of the virus). The side effects are also MUCH less difficult than those of the old standard of care of interferon and Ribavirin. The most common are headache, fatigue, diarrhea, nausea and insomnia. While these sound bad, and they are no fun, most reports have them present at levels significantly lower than the same side effects on the old standard treatment.
All of this sounds pretty good. High cure rates and moderate side effects are a strong combination. This is no doubt why you are seeing numbers of soft-sell, perhaps it's time to do something about your Hepatitis C, sorts of ads on television and in print media. Now that there is a treatment without injections, taking only one pill per day, with moderate side effects and with a treatment length of only 12 weeks (and in some instances 8 weeks) it is time for the drug companies to pile on the advertising. That and the fact that Gilead is charging $84,000 ($1000 per pill) for a 12 week course of treatment. (AbbVie has a 4 pill treatment on the market as well: Viekira Pak). The fact that the price is $1000 per pill for the Harvoni may account for the fact that the pill is in the shape of a diamond.
It's a bit too early to have much to say about the side effects, but taking a pill that cost $1,000 is definitely a new experience for me. I'll have more news about how it feels in the next few days.
Tuesday, September 11, 2012
Saturday, September 8, 2012
I've joined the Liver Life Walk in San Francisco as part of Team HepRat, in honor of my husband, the author of this HepRat blog, who has recently struggled with liver issues and the side effects of current treatments. Visit this link to read more or support our cause: GO TEAM HEPRAT!