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TOPIC: Dealing with the EOT to SVR period

Dealing with the EOT to SVR period 11 months 2 weeks ago #15798

So you've taken the pills and the last one is down the hatch.

You now enter the stressful time when we have to wait and see if the response is durable - SVR

Over the first few days the medications rapidly wash out of your system (except Riba which is slow). Sofosbuvir's active metabolite - GS-331007 - has a half life of 24 hours, for daclatasvir it is 12 hours, and for Ledipasvir it is 48 hours. The half life is the time taken for your body to get rid of 1/2 the current quantity it contains.

Across days 1-7 the levels of the active Sofosbuvir metabolite GS-331007 reduce by half every day so you have 1/2, 1/4, 1/8, 1/16, 1/32, 1/64, 1/128 etc

So by the end of 7 days off treatment you have 1/128th as much (~ 1%) as you did at EOT. For daclatasvir you reach that point in 3.5 days and for ledipasvir 14 days due the difference in wash out rates (1/2 life).

Most medications have side effects of some description so it's reasonable to assume these will dissipate. Mental side effects can range from high to low - consider alcohol - it can be pretty good while taking it and pretty bad after. Anyway over time we get to the point where there is effectively no medication left in your system and therefore no side effects relating to it being there.

Within a couple of weeks at the most there will not be enough medication left in your system to suppress viral replication so the virus will grow back. The incubation period for a new infection is 2 weeks to 6 months with 6-9 weeks being average, thus the use of SVR12 - 3 weeks washout, 9 weeks to grow.

That said the experience from trials like:

www.ncbi.nlm.nih.gov/pubmed/25314116
www.natap.org/2013/AASLD/AASLD_26.htm

indicate the the vast majority of patients with SVR4 (~98%) will also go on to SVR12 and SVR24 (we are seeing this as well)

So the shortest wait time is 4 weeks post treatment to get a good idea about ultimate cure.

PCR is expensive and if you were in the vast majority with elevated ALT at baseline relapse will show up as an out of range elevated ALT days before the PCR is availabke so the "poor man's SVR4" is just to do an ALT and save the PCR for 12 weeks.

Being anxious during this period is normal. Checking your ALT (remember it's OUT OF RANGE not a tiny blip up) may help, but then again a tiny blip up (normal) may worry you for no reason. There are a few people at SVR who worried about the usual wandering up and down of ALT.

Anyway here's the sunscreen song.....

YMMV
Last Edit: 11 months 2 weeks ago by James-Freeman-facebook.
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Dealing with the EOT to SVR period 11 months 2 weeks ago #15802

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Thanks much for this, sums it up so well
Treatment naive
F 3/4
Genotype 1 a
V/L 17 MILLION
Started Harvoni 11th Dec 2015 for 12 weeks
4 weeks VL UND
6 WEEKS ALT 32, AST 34
EOT 03/03 2016 ! UND
ALT 34, AST 26
04.04.2016 SVR 4
26.05.2016 SVR 12
16.08.2016 SVR 24
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Dealing with the EOT to SVR period 11 months 2 weeks ago #15807

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"So the shortest wait time is 4 weeks post treatment to get a good idea about ultimate cure."
- Dr Freeman

That's made my day. Having achieved SVR4 and into week 6 post tx I feel new already.
Summaries like these answer so many questions succinctly ty very much. Ty for the song too. :+1: #flower
Splashing happy vibes here with such great prospects :)
Ariel

Gen 1a
Peg/inf/riba 2012(!?!) stopped at Week 43 due to potassium level ext. low plus other issues (relapse at week 4 post tx, VL120,000) many secondary niggles eg. adenomas.
pre sof/led VL 240,000 Fibrosc F0
Day 25 VL <30
Day 32 UND
Week 10 UND
EOT UND ALT 11 AST 17 GGT 19
SVR4 UND ALT 10 AST 16 GGT 13
SVR8 UND ALT <9 AST 16 GGT 15
SVR12 UND ALT 14 AST 19 GGT 12 Bili 5
EOT +18 ALT13 AST 20 GGT 9 Bili 5
EOT +21 ALT 11 AST 15
Cured at SVR12
Dysplasia Adenoma removed Aug '16
SVR24 UND ALT 11 AST16
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Dealing with the EOT to SVR period 11 months 2 weeks ago #15825

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Thanks Dr James for clarifying so many questions. I am going for the "poor mans SVR 4" this week :lol: And I think I am fine with that until my 12 week SVR test. Just feeling a bit achy and tired and don't know why, reading people's posts is quite reassuring ( Phoenix, thanks!) And obviously this post with all the good information for us EOT ers. Thanks again Dr James.
It's good to read of peoples experiences on this forum, because we are all different.
#flower #love #duck #flower
Geno 1a, F1, tx naive, had it 35 yrs.
Started Cipla HepcvirL on 12/01/16
Starting VL 490,000
At 16 days in <15
4 week results: UND
8 week results: UND
5 weeks EOT alt 25
SVR 15 - Not Detected
6 months EOT - Not Detected
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Dealing with the EOT to SVR period 11 months 2 weeks ago #15826

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Doc,
You are, and continue to be "The Greatest".
Mr. Ali can be the "Second Greatest"...
m
This email address is being protected from spambots. You need JavaScript enabled to view it.
forums.delphiforums.com/generichcvtx

G 1a F-1
Started tx 10/23/15 (Meso sof & led) ALT 48 AST 28 v/l 1.6 mil
11/17/15 4 wk lab ALT 17 AST 16 <15
11/18/15 Started Harvoni
12/16/15 8 wk lab ALT: 15 AST: 13 V/l UND
1/14/16 Fin. Tx
7/07/16 UND SVR 24
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Dealing with the EOT to SVR period 11 months 2 weeks ago #15833

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I might get a 2 week ALT this week- but I must compartmentalise because I genuinely aren't worried either way. I ask myself-
Would I have done anything different? is there anything I could do, now, that worrying might alert me to? Is it the end of the world if I have to retreat? No to all the above- and I am lucky to be feeling so good, as not everyone does either on tx or after, I am just spending time with that feeling.
Genotype 3 30 years, 2x treatment interferon/ribavirin non responder. Cirrhosis 17 years. Fibroscan 40 down to 22 by 29/3/16- 10/16 dropped to 9.5, no cirrhosis. Started Buyers Club Sof/Dac 14 Nov 15. SVR 12 29/0716
Last Edit: 11 months 2 weeks ago by Hazel.
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Dealing with the EOT to SVR period 11 months 1 week ago #16256

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Going for the poor man svr4 today thanks doc
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Dealing with the EOT to SVR period 11 months 1 week ago #16398

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Thanks Dr.Freeman, great info.
After UND at EOT 5 weeks ago, I've done poor mans SVR1, and the LFT's were all great, but will do another one at SVR5 or 6.
I will probably have to wait for PCR at 12 weeks because my public hospital Doc is doing monitoring on his own initiative. Sadly Ledipasvir is not yet approved in Serbia so officially I cant be monitored in public hospital, but Doc is a good fellow and also very interested in outcome of generic tx.
I have all the prerequisites for a SVR like F0, low VL, Fibroscan below 7, but my double genotype and possible further genotype mutations worries me.
Anyway hoping for the best and feeling great just remembering where I was last May after unsuccessful pegi/riba tx when I stumbled on the Greg's blog.
Genotype 1b & 4, F0/A1, failed Peg&Riba TX 2015,
22 Jan. 2016 - Back from Delhi with 12 week Ledifos supply :) Thx to Parag
Started TX on 27.Jan.2016 - AST 41, ALT 59, GGT 39, ALP 74, VL 500.000, Fibroscan 6.8
19. Feb 2016 - ALT 14, AST 14, GGT 19, ALP 107
19. Apr 2016 EOT - Undetected :)
26. Apr 2016 (1 week after EOT) - ALT 14, AST 17, GGT 12, ALP 77
28. Aug 2016 (17 weeks after EOT) - UND, ALT 15, AST 12, GGT 5, ALP 39 :)
Last Edit: 11 months 1 week ago by Geno1b4.
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Dealing with the EOT to SVR period 5 months 2 weeks ago #22725

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James-Freeman-facebook wrote:
So you've taken the pills and the last one is down the hatch.

You now enter the stressful time when we have to wait and see if the response is durable - SVR

Over the first few days the medications rapidly wash out of your system (except Riba which is slow). Sofosbuvir's active metabolite - GS-331007 - has a half life of 24 hours, for daclatasvir it is 12 hours, and for Ledipasvir it is 48 hours. The half life is the time taken for your body to get rid of 1/2 the current quantity it contains.

Across days 1-7 the levels of the active Sofosbuvir metabolite GS-331007 reduce by half every day so you have 1/2, 1/4, 1/8, 1/16, 1/32, 1/64, 1/128 etc

So by the end of 7 days off treatment you have 1/128th as much (~ 1%) as you did at EOT. For daclatasvir you reach that point in 3.5 days and for ledipasvir 14 days due the difference in wash out rates (1/2 life).

Most medications have side effects of some description so it's reasonable to assume these will dissipate. Mental side effects can range from high to low - consider alcohol - it can be pretty good while taking it and pretty bad after. Anyway over time we get to the point where there is effectively no medication left in your system and therefore no side effects relating to it being there.

Within a couple of weeks at the most there will not be enough medication left in your system to suppress viral replication so the virus will grow back. The incubation period for a new infection is 2 weeks to 6 months with 6-9 weeks being average, thus the use of SVR12 - 3 weeks washout, 9 weeks to grow.

That said the experience from trials like:

www.ncbi.nlm.nih.gov/pubmed/25314116
www.natap.org/2013/AASLD/AASLD_26.htm

indicate the the vast majority of patients with SVR4 (~98%) will also go on to SVR12 and SVR24 (we are seeing this as well)

So the shortest wait time is 4 weeks post treatment to get a good idea about ultimate cure.

PCR is expensive and if you were in the vast majority with elevated ALT at baseline relapse will show up as an out of range elevated ALT days before the PCR is availabke so the "poor man's SVR4" is just to do an ALT and save the PCR for 12 weeks.

Being anxious during this period is normal. Checking your ALT (remember it's OUT OF RANGE not a tiny blip up) may help, but then again a tiny blip up (normal) may worry you for no reason. There are a few people at SVR who worried about the usual wandering up and down of ALT.

Anyway here's the sunscreen song.....


Oh men, another good post that I missed to read when the time was right for me to know this :blush: ....
In fiecare an HCV ucide peste 500000 oameni.Medicamentele generice pentru hepatita C functioneaza. Nu deveni statistica! Cauta pe Google “medicamente generice pentru hepatita C”. Transmite aceasta informatie pentru a salva viata cuiva.
HCV kills more than 500000 people every year. HCV generic drugs work. Don't become a statistic.Google for "generic hep c medication". Share this knowledge to save someone’s life.
My TX: HEPCVIR-L[generic Harvoni]-India
GT 1b.VL before TX:2.5m
Wk4, EOT: VL UND
SVR12! - VL UND
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Dealing with the EOT to SVR period 5 months 2 weeks ago #22736

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Glad you revived this thread, RHF. Coming up on SVR 12 labs next week, and have been doing my best not to think too much about it.

For the most part doing a fair job of it, but those nagging doubts do eat at us a little, don't they?
Failed Interferon 96', G1a, VL = 9 - 5.5 Million, F3/A3, AST 111, ALT 190, Generic DAA treatment Sof/Led (Mylan - India MYHEP LVIR) - 8 June, 2016
2 Week Results 20 June, 2016 AST 19, ALT 32
4 Week Results 06 July, 2016 AST 22, ALT 30, VL = 35
6 Week Results 20, July 2016 VL only = HCV RNA Detected, Non-Quantifiable <15
8 Week Results 04 August 2016, Labs, LFTs Normal, VL = UND
12 Week Results 31 August, 2016 LFTs Normal, VL = UND
EOT + 4 Weeks, LFTs Normal, VL = UND, "SVR4"
SVR12, 21 Nov 2016. CURED!!!
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Dealing with the EOT to SVR period 5 months 2 weeks ago #22738

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Fitz you got this, I can feel it in my waters
Genotype 1a
Diagnosed in 2004, had HCV for all my adult life. Until 2016!!!!
Harvoni treatment, started 19 March 2016
4 week results Bilirubin 12 down from 14 pre treatment,
Gamma 25 down from 52, ALT 19 down from 63, AST 19 down from 47,
VL <15 down from a lazy 6 million or so

EOT Results
Bilirubin 10, GGT 18, ALT 19, AST 21, VL UND

12 Weeks post EOT
Bilirubin 11, GGT 16, ALT 22, AST 20, VL UND
Cured baby
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Dealing with the EOT to SVR period 5 months 1 week ago #22739

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I'm glad I logged in I will wait at the finishing line Fitz
Mermaid splashes too added to Beaches waters coming your way
Yes yes you got this
Gen 1a
Peg/inf/riba 2012(!?!) stopped at Week 43 due to potassium level ext. low plus other issues (relapse at week 4 post tx, VL120,000) many secondary niggles eg. adenomas.
pre sof/led VL 240,000 Fibrosc F0
Day 25 VL <30
Day 32 UND
Week 10 UND
EOT UND ALT 11 AST 17 GGT 19
SVR4 UND ALT 10 AST 16 GGT 13
SVR8 UND ALT <9 AST 16 GGT 15
SVR12 UND ALT 14 AST 19 GGT 12 Bili 5
EOT +18 ALT13 AST 20 GGT 9 Bili 5
EOT +21 ALT 11 AST 15
Cured at SVR12
Dysplasia Adenoma removed Aug '16
SVR24 UND ALT 11 AST16
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Dealing with the EOT to SVR period 5 months 1 week ago #22750

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fitz wrote:
Glad you revived this thread, RHF. Coming up on SVR 12 labs next week, and have been doing my best not to think too much about it.

For the most part doing a fair job of it, but those nagging doubts do eat at us a little, don't they?

Fitz - it's been a while, I hope this short post out finds you well. My post is to say, as you would to me, "you've got this".
In good health my friend
Contracted HCV 1980's
Geno Type 1a
F3 ( doc says once treated I'll be F2 maybe F1)
Meds shipped 6/17/2016 arrived early 7/2016

Viral count - 3,471,080

4 week quantitative bloods: August 17, 2016. I have been diagnosed as <15 (told undetected)

8 week quantitative bloods: September 14th. I have been diagnosed as <15 (told undetected)

11 week PCR RNA Qualitative bloods: September 26th 2016 - Undetected

December 19th 2016: Cured!
Viral count: zero!!!
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