Hepatitis C and Thai social security

[purplesage]

I have a Tha friend who was diagnosed with hepatitis C in September in Chiang Mai after a routine blood test. Normally she is covered 100% by social security, for which she pays a few hundred baht per month, but when she recently saw a liver specialist she was told that medication to treat hepatitis C is not covered. Apparently the medicine is very expensive. She is not a wealthy person. What, if any, options does a Thai person who cannot afford treatment for hepatitis C have?

 

Another doctor she saw has prescribed Lamivudine, which is covered by social security. She has been taking this for a couple of months. Is this also an effective treatment  for hepatitis C? It appears to be used primarily for HIV and hepatitis B.

 

She has been a blood donor for many years, and last donated blood in March of this year. I understand that the hepatitis C virus can lie dormant for many years. If she has had this virus for a long time without symptoms, would it have flagged up during blood donation screenings?

 

If she has only recently contracted the virus (after the last time she donated blood in March), would this increase her chances of recovery as it has been detected early?

 

I'd be very grateful for any advice or suggestions.

[Sheryl]

Lamivudine is not approved/recommended  for use in Hep C, only B. 

 

Pegylated interferon plus ribavirin is the standard treatment for Hep C in Thailand and is one the National Drug List so covered (free) under SS and the universal system,  but only for people with certain HCV s  genotypes 2 and 3.  It is not currently covered for people with genotypes 1 and 6, though there is active discussion about expanding it to them and I expect that will happen in the forseeable future.

 

So it may be that she has genotypes 1 or 6 and that would indeed mean the drug is not covered under SS. If however by chance her hospital is a private one she should investigate to be sure (starting by asking for her lab results to see the genotype) as it is not unknown for private hospitals in the SS system to wrongfully withhold costly treatments they are  actually required to provide, and to lie to patients about it. A government hospital will not do that, but a private one might.

 

If she is genotyppe 1 or 6 then at present , she cannot get treatment for free... and the out of pocket cost is indeed very high.

 

There are newer and better drugs than the standard Pegylated interferon plus ribavirin regimin, and while still under patents and extremely costly, there is a generic version made in India that costs much less (still costly, but a fraction of the patented price - i.e. 12 week course is about US $1500 vs almost $100,000 for the patented brand). And there is a "buyer's club" based in Australia that ships the generic to patients anywhere in the world   though there is some risk in terms of it getting through customs  http://fixhepc.com/

 

Some people travel to India just to buy this there and bring it back.

There is talk of Thailand getting the generic in under its "compulsory licensing" law but not yet happended.

 

In short she should:

 

1. verify the truth of what she has been told re SS by verifying her genotype. If she is 2 or 3, call the SS office and complain.

 

2. If 1 or 6, consider purchasing the Indian generic, if she can manage that cost. Once she has it,  she should of course take it under a doctor's guidance.

 

Her blood donation would have been screened for Hep C but one cannot count on the blood service tracking her down to inform her if her blood was found infected. 

 

[thaivisareader]

 Hello forum readers,

   Here's a personal story about my self treatment for hep C this year that may help someone out there.  Excellent and affordable medicine is available.

 I was diagnosed with the hep C virus/ genotype 1b back in the mid 90's in the U.S. After a conversation about the risk factors which may have exposed me to it,  my doctor was pretty sure it was from a unit of blood that I had received at Balboa Naval Hospital, San Diego in 1972 . I found out recently that lots of Vietnam vets such as myself and others were infected with it back in those days and on into the 80's at various military and civilian hospitals with tainted blood. It was then called non-A/non-B Hepatitis. Hep C wasn't labeled as such till much later.

  Dr. took what he called a watchful waiting approach to it. My liver enzymes were elevated but no cirrhosis or symptoms yet. I continued seeing him for years, still showing elevated numbers. I turned down the peg-interferon therapy offered to me in 1999-  didn't think I could perform my physically demanding job on the stuff. I was lucky to have none of the fatigue or other bad effects that many victims suffer from. Surfed and dove, traveled, played lots of sports, worked hard with lots of overtime, helped raise a son. After working over 30 yrs. in a heavy construction trade, retired to Thailand in 2005. Before leaving the U.S I had some final blood-work done. My HVC load count was 3.5 million - not super high but not low either.

  Flash to 2013-14. I was about 65 and had hep C for over 40 yrs. I started reading about all the celebs. and people who could afford it being cured of hep C by the new miracle drugs made by Gilead Pharma. Solvadii, then, Harvoni. 97% cure rates. One pill a day for 8-12 weeks. $800- $1,000 per pill at first. Around $70,000 for 10 weeks of pills. No way I could afford that. I made a few visits to a big VA hospital on the West Coast. Yes, they said they would probably cover me but it would take time and I must stay in the U.S. and be monitored every few weeks before being given another one month supply of Harvoni. One month at a time. They recommended 8 weeks for me, maybe more. My life is in Thailand with a home and family and I love it,  but I almost did that. Only 2-3 months right? But I would still have to go through a lot of testing and waiting and paperwork before being possibly approved and getting started.

  Back here at home in late 2015  I heard Gilead Pharma had agreed to license several pharma makers in India & Bangladesh to manufacture generic Solvadi and Harvoni at a drastically reduced price. It was already available in fact but not in Thailand (it may be available here now, not sure). I researched, emailed back and forth to Dhaka and a few Indian drug suppliers for most of a day. I chose to do business with Mr. Sumit Gupta. who runs Aurel Pharma in Delhi. I could either fly to Delhi and pick it up myself or wire him the funds and he would EMS a 12 week supply to my door. I had the funds wired to him from the U.S. within 2 days. About 4 days later the package from Aurel Pharma arrived. Came to about $13 per pill (maybe less now, not sure.) Took 84  pills, never missed a day. Last month, about 6 mos. after taking the last pill, I had blood-work and a liver & spleen ultra sound done back at the U.S. West Coast VA hospital . Results were no detectable virus, liver enzyme levels all normal (in the lower range),  ultra sound negative for liver or spleen disease. My doctor there said she also  was happy for me but couldn't completely go along with my "non monitored self medication/treatment plan" or recommend it for any of her other patients. I was beaming as I thanked her and left with an appointment for another check-up next year.  

    I would encourage anyone who has or knows anyone with hep C to consider doing what I did.

   Very Merry Christmas and Happy New Year to all the forum readers.

  

 

  

[purplesage]

Thank you Sheryl for your comprehensive reply.

 

Indeed, the hospital where she is registered is, as far as I know, private – Lanna Hospital in Chiang Mai.

 

If she had donated blood and not been informed that she had hepatitis C, would she have been refused the next time she showed up to donate blood as this information would have be in their computer records?

 

I'm trying to determine how long she's had the virus, based on the perhaps erroneous principle that the less time she's had it the better chance she has to recover.

 

 

[Sheryl]

Recovery is not really related to how long she has had the virus, though having it for a very long time increases the risk of liver cancer.

 

As she is registered at a private hospital, really do need to investigate why she is not receiving treatment. Check what genotype of Hep C she has.

[Khun Han]

The best favour you could do for your friend is help her to get help on Dr Freeman's fixhepc.com forum. A twelve week supply of a pan-genotype like Sofosbuvir/Daclatasvir or Sofosbuvir/Velpatasvir from Beacon Pharma costs about 30,000Bt, buying direct. Both are the state-of-the-art in hepc medicine, with very high cure rates and minimal side-effects. If your friend has any significant liver fibrosis (she needs to get a fibroscan done), she would have to do 24 weeks treatment.

 

She should avoid the Pegylated Interferon/Ribavirin treatment: it has low cure rates and will make her ill with ridiculously severe side-effects for a long time. It's yesterday's medicine, and would have been stopped being used for treatment of hepc by now, with the advent of the new antivirals, had Gilead et-al priced the new meds more reasonably.

 

Believe it-or-not, coffee is one of the best 'treatments' for staving off fibrosis/cirrhosis, and the drinking of it by hepc patients is now being promoted by liver specialists around the world.

Edited December 24, 2016 by Khun Han

[purplesage]

Thank you thaivisareader and Khun Han for your inputs, which I'll look into once we've determined whether or not my friend's treatment is covered by Thai social security.

 

I also have another question for Sheryl. My friend has sent me a copy of lab results she was given on her recent visit to the hospital, but there is no mention of genotype.

 

My friend had a minor stroke a few years ago and since then she regularly sees a neurologist for check ups, including blood tests every few months, which is how the hep C was detected. Should I assume that there may be another set of results for specific tests done subsequently (perhaps including the genotype number) that she was not given?

 

Does she have the right to request access to such results, for example, for the purposes of showing them to another doctor?

 

[Sheryl]

She has an absolute right to all her medical records.

 

They should certainly have tested for genotype though that is a one time test which ought to have been done when the Hep C was first identified.

 

If they did not do a genotyping, they are remiss.

 

If they did it and it shows type 2 or 3, they are remiss in not providing her with treatment.

 

in either case should complain to the SS Office . They are no strangers to complaints abut private hospitals witholding costly treatments and can intervene. And, regardless of whether there is need to complain, she should contact them to find out when she can change her hospital registration, if possible to CMU Univ Hospital. Lann Hospital is not the best  place for someone with her various conditions.

 

Chiang Mai Provincial Social Security Office
City Hall 1th floor, Chotana Road,
Muang District, Chiang Mai 50300
Tel. 0 5311 2629-30
Fax. 0 5311 2630 call 114

 

Note that, if she is eligible for  treatment, it  would be Pegylated Interferon/Ribavirin  as that is the current Thai protocol. Sofosbuvir is not yet on the Thai Essential Drug List, though there is active discussion about adding it.  Sofosbuvir-based therapy (it is always used in combo with another drug, which one depends on the genotype of HCV) is indeed preferrable in that it is both of shorter duration and has a higher sustained cure rate (about 75% vs about 50% for Pegylated Interferon/Ribavirin). However at present she would have to pay for that out of pocket and it would run about 35,000 baht.

 

From the information provided it is not clear if she has acute or chronic Hep C.  Anywhere from 15 - 45% of people with acute Hep C will spontaneously clear the infection without treatment so if she is still in the acute phase it might be reasonable to wait to see if she clears the infection spontaneously, however the fact that she was told she is not being treated because SS does not cover it and was given another  antiviral medication leads me to suspect she has the chronic form - but cannot be sure, especially since even that information is coming second hand.

 

In addition, while optimally everyone with chronic Hep C should be treated, the need is more pressing in some people than in others depending on the stage of the disease, and knowing where she fits on that spectrum might help make the decision of whether to go ahead and spend out of pocket on treatment (assuming she does not have the genotypes that qualify for free treatment now) or wait in the hope that free treatment will become available in the not too distant future.

 

What I suggest, if she is willing, is that she get ALL her medical records from Lanna and consult Assoc.Prof. Satawat Thongsawat at CMU Hosp (try through Sripat) for advice -- and that you go with her, if she agrees, as Thais have great difficulty being forthright in questioning doctors, and also not infrequently misunderstand what they are told.  That is true even for fairly simple matters, and Hep C is far from a simple matter.

 

The point of such a consultation would be to get a clearer understanding of what she has - genotype, acute vs chronic, stage of disease - and guidance as to how safe it is for her to delay treatment. This doctor may also have some insight into the likelihood of whether/when national protocols will be expanded to cover treatment of all genotypes (assuming she is not already eligible for treatment)  and/or use of Sofosbuvir.

 

 

 

 

 

 

[purplesage]

Thanks once again Sheryl for your exhaustive reply.

 

I'd like to clarify a couple of points and provide a bit more information. My friend hasn't actually requested any records so far. What she sent me were the lab records of general blood tests ordered by her neurologist. These include records from four separate visits and blood tests. She automatically receives these every time she sees her neurologist.

 

On 1 March her liver values appear to be normal. (On 26 March, as a completely independent event, she donated blood as she had done for years.) On 4 October the neurologist told her she had hepatitis C and prescribed her Lamivudine, and said come back in one month to see if the values have diminished. She returned on 4 November and the values were still high, so she was given an appointment with a liver specialist on 20 December. This specialist told her that hep C treatment for her was not covered by social security. A nurse wrote this information on a slip of paper, presumably indicating the cost of the medicine although I've no idea what amount this corresponds to:

 

Medicine HCV-VL                   5,210 Baht.-

               HCV-Genotype        5,688 Baht.-

 

There's a reference to genotype, so I assume the test has been done.

 

She is due to return to hospital on 14 January to see the liver specialist again and also to have a kidney ultrasound.

 

The next step is to get her to ask Lanna Hospital for the appropriate record. 

 

Unfortunately I'm not in Thailand at the moment, so I cannot accompany her on her medical visits. I'm fully aware of Thais' reluctance to question doctors.

 

 

 

[Sheryl]

Medicine HCV-VL                   5,210 Baht.-

               HCV-Genotype        5,688 Baht.-

 

Refers to lab tests, not medication. "Medicine" might just refer to the department.

 

She either had a viral load (VL) and genotype done (in which case this should be a bill, not a handwrittten notation by the nurse) OR was advised she needed those tests and for some reason asked to pay for them herself and given the test names and the cost.

 

The genotype would   have needed to be done first and the results available in order for him to know that her treatment would not be covered.

 

Not making sense, but second/third hand information often doesn't. You might try to clarify with her if this notation was tests she was told she needed and would have to pay for.

 

If so, she would do well to call the SS office and complain to them that she is being denied treatment and asked to pay out of pocket for blood tests and let them sort it out.

[Khun Han]

On Tuesday, December 27, 2016 at 1:09 PM, purplesage said:

Thanks once again Sheryl for your exhaustive reply.

 

I'd like to clarify a couple of points and provide a bit more information. My friend hasn't actually requested any records so far. What she sent me were the lab records of general blood tests ordered by her neurologist. These include records from four separate visits and blood tests. She automatically receives these every time she sees her neurologist.

 

On 1 March her liver values appear to be normal. (On 26 March, as a completely independent event, she donated blood as she had done for years.) On 4 October the neurologist told her she had hepatitis C and prescribed her Lamivudine, and said come back in one month to see if the values have diminished. She returned on 4 November and the values were still high, so she was given an appointment with a liver specialist on 20 December. This specialist told her that hep C treatment for her was not covered by social security. A nurse wrote this information on a slip of paper, presumably indicating the cost of the medicine although I've no idea what amount this corresponds to:

 

Medicine HCV-VL                   5,210 Baht.-

               HCV-Genotype        5,688 Baht.-

 

There's a reference to genotype, so I assume the test has been done.

 

She is due to return to hospital on 14 January to see the liver specialist again and also to have a kidney ultrasound.

 

The next step is to get her to ask Lanna Hospital for the appropriate record. 

 

Unfortunately I'm not in Thailand at the moment, so I cannot accompany her on her medical visits. I'm fully aware of Thais' reluctance to question doctors.

 

 

 

 

The most important test your friend needs to get done is a fibroscan. It's quick, none-intrusive and fairly cheap. This is important to find out the condition of her liver, which dictates treatment length: a damaged liver needs longer treatment in order to get the meds into scar tissue (fibrosis/cirrhosis) which doesn't have good blood supply.

 

With the Direct Acting Antivirals I mentioned in my previous post, a genotype test is not so important because the meds have been created as pan genotypes with non-first world countries in mind, where genotype tests are too expensive to be routinely done.

 

A viral load test is not important at this stage if it has been ascertained that HCV is present. This test is important during treatment to check that the virus is clearing, and post-treatment to find out is sustained viral relief (SVR) has been achieved.

 

If your friend can get the new meds through her healthcare provider, that's great. But I think she might struggle. If she's offered a combination therapy involving PegInterferon and Ribavirin, she should decline it if she can raise the funds for generic meds. Her doctor will probably advise her against this (they usually do), but ignoring this advice will be the best decison she makes in her life.

[Sheryl]

12 hours ago, Khun Han said:

If your friend can get the new meds through her healthcare provider, that's great. But I think she might struggle. If she's offered a combination therapy involving PegInterferon and Ribavirin, she should decline it if she can raise the funds for generic meds. Her doctor will probably advise her against this (they usually do), but ignoring this advice will be the best decison she makes in her life.

 Only if she has the alternative of buying Sofosbuvir. If she does not, then  PegInterferon and Ribavirin,  are better than going untreated.

 

She will not be able to get Sofosbuvir from her doctor under SS, it is not on the Thai Essential Drug list yet.

[Khun Han]

5 hours ago, Sheryl said:

 Only if she has the alternative of buying Sofosbuvir. If she does not, then  PegInterferon and Ribavirin,  are better than going untreated.

 

She will not be able to get Sofosbuvir from her doctor under SS, it is not on the Thai Essential Drug list yet.

 

I agree, but I can't stress highly enough that the PegInterferon should be a last resort. I was fairly sure, as you confirmed, that I'd read somewhere that the new meds would not be available through healthcare providers. I'm fairly sure they're not available to purchase legally in country either.

[purplesage]

Thank you Khun Han and Sheryl for your posts.

 

My friend will go to the social security office in Chiang Mai to find out what she should be covered for when the office reopens after the New Year holiday.

 

From a clue that Sheryl gave me, and after talking to my friend, I'm beginning to suspect she may not have even had a test for hepatitis C. She was told by a neurologist in October she had hepatitis C but was given medication for hepatitis B. A month later she was referred to see a liver specialist, who told her she would need to pay for treatment, which I suspect means they wanted her to pay for the hepatitis C blood tests amounting to around 10,000 baht. When she subsequently asked her neurologist what happens to people who cannot afford to pay for hepatitis C treatment he told her at some point you get liver cancer and die. The mind boggles.

 

As I said in a previous post, I'm trying to help my friend from a distance as I'm not in Thailand at the moment, so trying to piece together all the elements isn't easy. I hope that the social security office will at least be able to help her sort out what Lanna Hospital is responsible for in terms of treatment.

 

When the coverage issue has been clarified, then we can start thinking about what kind of treatment she can or cannot afford.

[Khun Han]

Just to clarify, purplesage, the test for HCV is a straightforward and cheap test for antibodies. If your friend tests/tested positive for this, she might have cleared the virus naturally (if you've been exposed to HCV, you carry the antibodies for the rest of your life). So, it's then either a viral load test or a set of basic liver function tests (which would indicate infection if levels of ALT, AST, GGT aren't normal).

Edited December 30, 2016 by Khun Han

[purplesage]

Thanks for that clarification, Khun Han.

[Khun Han]

Great article from Greg Jefferys (the godfather of generic HepC med supplies)  in his Jan 1 post here:

 

http://hepatitisctreatment.homestead.com/generic-hepatitis-c-medicines.html

[Sheryl]

On 12/30/2016 at 4:49 PM, Khun Han said:

 

I agree, but I can't stress highly enough that the PegInterferon should be a last resort. I was fairly sure, as you confirmed, that I'd read somewhere that the new meds would not be available through healthcare providers. I'm fairly sure they're not available to purchase legally in country either.

 

Oh it is quite available here. Brand name Sovaldi, costs the earth. And cannot be gotten without a prescription. That said, anyone with the money can easily get it from an upscale hospital. Nothing illegal about it.

[Sheryl]

On 12/30/2016 at 7:40 PM, purplesage said:

Thank you Khun Han and Sheryl for your posts.

 

My friend will go to the social security office in Chiang Mai to find out what she should be covered for when the office reopens after the New Year holiday.

 

From a clue that Sheryl gave me, and after talking to my friend, I'm beginning to suspect she may not have even had a test for hepatitis C. She was told by a neurologist in October she had hepatitis C but was given medication for hepatitis B. A month later she was referred to see a liver specialist, who told her she would need to pay for treatment, which I suspect means they wanted her to pay for the hepatitis C blood tests amounting to around 10,000 baht. When she subsequently asked her neurologist what happens to people who cannot afford to pay for hepatitis C treatment he told her at some point you get liver cancer and die. The mind boggles.

 

As I said in a previous post, I'm trying to help my friend from a distance as I'm not in Thailand at the moment, so trying to piece together all the elements isn't easy. I hope that the social security office will at least be able to help her sort out what Lanna Hospital is responsible for in terms of treatment.

 

When the coverage issue has been clarified, then we can start thinking about what kind of treatment she can or cannot afford.

 

If the only reason for thinking she has Hep C is a positive antigen test then she may not even have it, as Khun Han explained,

 

I would be amazed if it was legitimate for a hospital to refuse to do the needed lab tests (Viral load and genotype -- though should do the VL alone first since if there is no detectable VL, no need for genotype) under Social Security. 

 

And as I explained, AFAIK treatment with PegInterferon and Ribavirin would be covered under Social Security but only if she has certain genotypes.

 

Obviously a neurologist is not competent to diagnose or treat Hepatitis C.  And if even half of what she reports him as having said or done is being accurately understood and reported I am not sure I'd trust this particular neurologist in  the practice of neurology either.

 

Under Soc Sec she has a choice of doctor. If I were her, I'd change neurologists (and also hospitals, but for that she needs info from the SS office as to when and which are the other options).

[purplesage]

Today (Monday 9 January) my friend went to the social security office in Chiang Mai where she was told  she has to pay for the blood tests mentioned above as she is "suspected of having something". Not sure what to make of that, but if nothing else it would seem to support the hypothesis that she hasn't been tested for hepatitis C. 

 

Here's a reminder of the blood tests she's been asked to pay for:

Medicine HCV-VL                   5,210 Baht.-

               HCV-Genotype        5,688 Baht.-

 

Here are the values that were flagged up during a routine blood test at the outset:

Liver function Test # Globulin        High  3.6           Reference Range  2.0 - 3.5

SGOT (AST)                                  High  107                       "               1.0 - 40.0 

SGPT (ALT)                                   High  200                       "               1.0 - 53.0 

 

This coming Saturday she has appointments with the liver specialist she saw last time (who told her she had to pay for treatment) and the neurologist who initially told her she had hepatitis C (presumably on the basis of the above results) and prescribed her Lamivudine. She's also scheduled to have a kidney ultrasound on the same day, which I think was ordered by the liver specialist.

 

I think the best I can do ahead of these appointments is help her to prepare some pertinent questions for the liver specialist and hope that she actually manages to ask them and get some answers.

 

At the social security office she also enquired about moving from Lanna Hospital to Suandok Hospital, which I believe is the public hospital most closely associated with Chiang Mai University. However, this is not possible as Suandok registrations are full. 

[Sheryl]

Hepatitis C could not possibly be diagnosed based on those lab tests. All they indicate is something wrong with the liver, could be any number of things including effecst of medication.

 

To have come up with the idea of Hep C there would have to have been a Hepatitis panel run, it is a simple and not very expensive test that looks for antibodies to Hep A,B,C and antigen to A and B.

 

What you quote her as quoting the Social Security office as saying makes zero sense. I have trouble believing that was said. Obviously the reason for the tests is that she is suspecting of having a disease, the issue is why it is not covered by Social Security. It is most unusual for lab tests considered medically necessary to not be covered. Perhaps that is for some reason the case with these tests but then they should have indicated that and why.

 

How fluent is this woman's English? Are you certain you are getting the full story and all aspects of the conversations reported accurately?

 

Assuming she did have a Hepatitis C antigen test done that was positive, then a Hep C Viral Load does need to be done, it is the only way to confirm whether she has active Hep C at present.

 

Did she get any info from SS Office on treatment if she has the correct genotype?

[Khun Han]

Those LFT results are pretty high. There is clearly something  wrong with her liver. If she has not already done so, then she needs to get tested for HCV antibodies. If she tests positive, it's safe to say she has active HCV. As Sheryl says, viral load and genotype tests would be ideal, but not in my opinion absolutely necessary if she can raise the funds for generic DAA treatment. In that case,  as I stated before, a fibroscan is the most important test to get tone  ascertain the state of her liver in order to make the decision on 12 or 24 weeks treatment. If she can't afford generic DAAs, then she will have to have the viral load and genotype tests done (can't understand why they're not available under the healthcare scheme), to find out if she is eligible for the Treatment From Hell (peginterferon and ribavirin).

Edited January 9, 2017 by Khun Han

[Sheryl]

Being positive for antibodies does NOT establish an active Hep C infection. Only that she had Hep C at some point and formed antibodies. The antibodies remain for life even if the body clears the infection.

Her LFTs are elevated but not enormously so. That level of elevation can have many causes.

She needs the VL done. No point in paying for genotype test unless there is detectable VL.

Genotype is important if VL is detectable even if she will pay for her own treatment as the treatment regimens ary slightly by genotype.

[purplesage]

22 hours ago, Sheryl said:

Hepatitis C could not possibly be diagnosed based on those lab tests. All they indicate is something wrong with the liver, could be any number of things including effecst of medication.

 

To have come up with the idea of Hep C there would have to have been a Hepatitis panel run, it is a simple and not very expensive test that looks for antibodies to Hep A,B,C and antigen to A and B.

 

What you quote her as quoting the Social Security office as saying makes zero sense. I have trouble believing that was said. Obviously the reason for the tests is that she is suspecting of having a disease, the issue is why it is not covered by Social Security. It is most unusual for lab tests considered medically necessary to not be covered. Perhaps that is for some reason the case with these tests but then they should have indicated that and why.

 

How fluent is this woman's English? Are you certain you are getting the full story and all aspects of the conversations reported accurately?

 

Assuming she did have a Hepatitis C antigen test done that was positive, then a Hep C Viral Load does need to be done, it is the only way to confirm whether she has active Hep C at present.

 

Did she get any info from SS Office on treatment if she has the correct genotype?

 

My friend's English is good but she tends to be forgetful, more so since she had a stroke five years ago (not sure if that's related). She's only 47. Coupled with this she's likely to be reluctant to ask doctors questions, which you mentioned as being common among Thais in a previous post. Even though I asked her to write down the questions she should ask at the social security office, she forgot to ask about coverage of treatment depending on genotype.

 

For her hospital visit this Saturday I will suggest she asks the liver specialist these questions:

1. Have I had a hepatitis panel? 

2. Should I continue to take Lamivudine as prescribed by my neurologist?

3. What happens if I can't afford treatment?

I will also suggest that she asks for a copy of all her medical records since September when her liver results were first abnormal.

 

I'm in Italy and she has no close family, so I'm trying to get her to go to the appointments on Saturday with a Thai person who's willing to keep her company and help her ask the right questions. 

 

Thank you once again Sheryl for your time, expertise and patience.

 

 

 

 

 

[Khun Han]

purplesage, if your friend tests positive/has tested positive for HCV antibodies, and can raise the money for generic DAA meds, do the donkey work for her to get her sorted on Jimmy Freeman's fixhepc facility. It will be the best move she makes in her life. If she can't raise the money for this, then you should guide her to follow Sheryl's advice. But the second road is a rocky one if she manages to get treatment on the healthcare scheme. It really is the treatment from hell. Her body will be poisoned, and she will feel ill unlike she has ever felt ill before.

[RavinderS]

Hi purplesage, 

Get a test done for Hepatitis first and then start the prescribed medicines.And I can advise you to get medicines for India, as in India medicines for Hepatitis C and B are available at very affordable and cheap prices. 

But firstly ask her to have a test for hepatitis somewhere else where doctors are reliable.

[purplesage]

Time to revive this thread.

 

My Thai friend who was diagnosed with hepatitis C two years ago has recently had these tests (results in brackets):

 

- FibroScan (CAP (DB/m) Median 207; E/kPa Median 5.4) 

- Viral load (126,623)

- CT 3 Phase Abdomen (IMPRESSION: A 1.0 cm hemangioma in hepatic segment 8. No worrisome nodule is seen in the remaining liver).

She is waiting for the results of a genotype test.

 

She is being treated at Lanna Hospital in Chiang Mai and is covered by social security, although she has had to pay for the FibroScan, viral load and genotype tests. The doctor treating her says that the drugs to treat hepatitis C, depending on the genotype results, will cost around 20,000 baht. The treatment will last around 12 weeks and side-effects should be minimal.

 

The doctor says that she would need higher values to be covered completely by social security (e.g. 7 rather than 5 for the FibroScan), but recommends that my friend should go ahead and have the treatment now if she can afford it.

 

I imagine she would also have to pay for a repeat viral load test (5,300 baht) to determine whether the virus has gone. Is that the case?

 

I would much appreciate any comments.

 

[rumak]

Of foremost importance is WHAT GENOTYPE DOES SHE HAVE?   prevalent amongst westerners are genotypes 1,2 and 3.   Seems like genotype 6 (from what i read) is common in Asia.  

 

Next:  finding out who to believe as to course of action  .   good luck.  google Greg Jeffrys from australia..

Greg Jefferys - Hep

 

https://www.hepmag.com/blogger/greg-jefferys 

 

i don't know if that blog is still present BUT google his name....and try to understand what hep c is and how it can be treated.  ( FIND current info....not from 3 or 4 years ago)

 

I do not think the liver specialist here really know how to best treat it.  I know that is a blanket statement..

but a few years ago they did not even know what drugs (like Harvoni) were curing hep c.  They were (and maybe still are) pushing other meds along with inteferon.  Inteferon has terrible side effects and low cure rate.  Read about it.

 

your friends viral load is very low.  what are her enzymes like now ?   

Anyway....the new generic forms of Harvoni are available from India.  (ask for the name of the med that is 20 k baht.  it probably is one of those generics....look it up !   

and,,,,,as stated first    HAVE TO KNOW WHAT GENOTYPE SHE HAS

There is a LAB across for Sripat hospital   CMU i think its called    Does the tests 

[Sheryl]

Thai doctors have quite a lot of experience in treatment of Hep C.

 

A generic equivalent to Harvoni is now available in Thai govt hospitals and that is the 20,000 baht cost referred to.

 

Harvoni and its generic equivalents can also be used in treatment of genotype 6.

 

The doctor's recommendation that she start treatment now if she can afford it is wise IMO.

 

Yes, a repeat viral load would be done post treatment.

 

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

[purplesage]

Thank you, Rumak and Sheryl, for your advice.

 

My friend is waiting for the result of her genotype test. I haven't seen any recent figures for her liver enzymes, but as far as I understand from the recent liver scan, FibroScan and viral load tests, her liver is currently in reasonable shape.

 

The gastroenterologist treating her assured me that the drug regime for treatment would not be interferon and that side-effects would be minimal. The doctor wasn't able to say exactly which regime will be used until the result of the genotype comes in, but from what you say, Sheryl, I assume it would some version of Harvoni.