Hello Sale,

There is no problem moving from 1pm (1300) dose time to earlier time such as 8am (0800)

The absorption of Epclusa is a little better taken with food.

Best wishes for SVR

Dear Dr James,

Thank you for your kind reply.

I stopped the Ribavirin this am. Thank you! I already feel better.

Just for background, I am a 50 kg 63 year old woman. I am very fit and from a generally long lived family. I had a blood transfusion when I was 13 after a (undoubtedly unnecessary) tonsillectomy and some unprotected sex in my early 20s.

Recent pretreatment labs:

I didn’t have a viral load before starting.

EGFR 74, creat 0.84
Na 141 alb 4.3
AST 84 ALT 92 Bili 0.8 Alk phos 69
PT 10.8 INR 1
WBC 4.1 Hb 13.4 HCT 39.3 PLT 149
AFP 2.8 (normal <6
I pretty stressed when I had these done.

A week later on a less stressful day I had a Fibrotest 0.53 F2 and a Metavir score 0.56 A2.

I believe I am probably more fibrotic than F2 despite these latter results.

I had a liver biopsy when first diagnosed 1988 with inflammation and one in the late 1990s with some fibrosis already. I don’t have the reports.

I have been through two rounds of IFN. The first was really not a problem. The second was extremely difficult. I had high fevers with each injection. My weight dropped to 44 kg and I was nearly suicidal. I responded both times and relapsed. The second relapse was devastating.

I’d rather take a DAA for longer than I absolutely need to right now than relapse. I was even wondering about taking generic Epclusa for the second 12 weeks because it seems marginally better than Harvoni.

I can’t thank you enough for your help and for everything you are doing to help people with Hep C.

Thank you Dr.James for your respond!
Well about chronic EBV i am positive Igm for last 9 months constantly,so i am thinking that my immune system is so weak because of Hcv??,what is your opinion about that?
I have also sialadenitis and nobody of doctors here couldn't explain me the cause of desease,and also have tinnitus in my left ear(cause unknown)is it because of hcv or hbv virus?
And the last thing is this large viral load for Ebv virus?(attached medical Report,last one,they Are all approximately similar)

And about epclusa I am taking on pill every day at 1pm so my worry is that I found that is the best time to take in the morning or evening,because of absorption,but I started 5 days ago at 1 pm, my Dr. told me that i can do Like that and also on Gilead site say that yuou can use them with or without food.So Dr.James can I switch my theapy to the next morning without any concequnces,or proceed without any worries at 1pm Like now.

Thank you Dr.James once more and sorry if I made this long and for my English,I am from east Europe.

Good bless you.

Hello Sale-Sale,

Welcome to the forum.

I'm glad to hear you've started treatment. Your viral load is average and this does not impact on treatment success.

What is chronic EBV? We expect anybody infected with EBV to be positive for IgM (acute phase) and IgG (post cure phase). While it is said you can not get EBV more than once I have 2 children who have been IgM positive (acute EBV) twice so this can happen.

Anyway, curing your HCV is the single best health initiative. Once that is cured we may find there are no further problems left to deal with. I have a lot of patients who started with many medical issues, made SVR for HCV, and we were happy to see all the other medical issues simply disappear! Presumably they were part of the many and various extra-hepatic manifestations of HCV.

Hello Hope8,

Welcome to the forum.

Undetectable at 4 weeks is definitely on track!

You are correct that with GT 1a the benefits of adding Ribavirin to Harvoni are minimal. In the context of 24 weeks treatment there is, IMHO, unlikely to be any benefit.

On the topic of Ribavirin the recommended dose is 15mg/kg of body weight, but typically simplified as 1000mg/day for patients < 75kg and 1200mg/day for patients > 75kg. This is usually given as 2 doses. So, that means the dose you are taking is relatively low.

The half life of ribavirin is long so it takes about 21 days to get to its maximum. That means we need a few weeks to see how its going to land side effect wise. You have probably landed but, personally, I monitored the FBC/CBC of my ribavirin patients every 2 weeks. The monitored related to the fact I have not used ribavirin for going on 2 years because... we just don't need to and the treatment journey without it is generally much smoother.

Without knowing your pre-treatment status it's hard to give specific advice but we do know:

For treatment naive patients with GT1a using only 8 weeks Harvoni is *almost* as good as 12 weeks

The results for GT1a with 12 weeks Harvoni are very good, with patients with cirrhosis or HCC being the only common exceptions

In ballpark terms for GT1a

8 weeks Harvoni => 90% cure
12 weeks Harvoni => 95% cure (+5%)
16 weeks Harvoni => 97.5% cure (+2.5%)
20 weeks Harvoni => 98.5% cure (+1%)
24 weeks Harvoni => 99% cure (+0.5%)

The point here is that a) each extra 4 weeks treatment does add to treatment success rates; but b) there are diminishing returns in terms of extra cure rate.

Do you have any of your pre-treatment bloodwork and tests?

You're welcome, congratulations on starting treatment. Epclusa is a really excellent drug for Hepatitis C, all the best.

Hello Mar,thank you for your reply,
Started epclusa today,12 weeks.

Thanks God.

?

Hello Sale, and welcome to the forum. I'm not a doctor, but I do know that a high Hepatitis C viral load does not negatively affect your cure chances in any way. Regarding treating Hepatitis C if you have EBV, hopefully the forum's resident expert, Dr Freeman, will answer your question when he sees it soon. All the best.

Hello Hope, welcome to the forum! Congratulations on starting your treatment and on the very encouraging results so far. The medicines are obviously working and let's hope for SVR12 in a few months. Looking forward to more good news from you, all the best.

Not sure if anyone is still reading this forum—most posts seem to be a few years old.

I wanted to report some good news.

I am a little over 4 weeks into treatment and just received my 4 week viral load was undetectable.

I have two small lichen planus lesions one near each elbow. I just looked down at them and the one on my left arm is GONE and the one on my right arm is almost gone.

Pretty excited!

Hello,

Well I want to know can i start DAA treatment for Hcv genotype 3 ,11.300.000 viral load,but also have chronic ebv virus(Epstein barr virus).

Thanks

I just ordered harvoni and ribavirin and am really looking forward to getting started on treatment.

I take essential fatty acids and glucosamine and chondroitin daily. I’m not seeing interactions in the interaction checker. Do you think it is really necessary to stop them?

I don’t eat dairy and my diet is low in calcium so I take calcium and D daily. I know calcium carbonate can act as an antacid but is short acting. Could I take the antivirals in the am and the calcium at night?

Hi Sonja, that's great news, congratulations to your friend . Thank you for letting patients with liver fibrosis know that it's indeed reversible with successful Hep C treatment.

Hello everyone
I used to be a daily visitor to this site and was one of your first in treatment, 7 years later and basically forgot we ever had it, so a Huge Huge thank you to you Dr James.

My husband and I both work for NSW Health and are being mandated to take the vaccine, against our wishes. My husband was also cured of Hep C but has cirrhosis, it does not affect his daily life and he has no symptoms, is there a preferred Covid Vaccine for people with cirrhosis or would he be eligible for an exemption do you think?

Thank you

Hi Perecarl,

Sorry for the delayed response. In my other life I founded a Telehealth company that I've just completed selling.

Anyway I would not expect you to be able to donate plasma. The presence of antibodies to HCV is one of the exclusion criteria. This is from the Red Cross in Australia but is representative of the policies around the world.

www.lifeblood.com.au/faq/eligibility/med...procedures/hepatitis

Hepatitis C:
If you currently have or have ever had hepatitis C, you aren’t able to donate even if you completed successful treatment. 

One of the screening tests for hepatitis C tests for the hepatitis C antibody, which usually remains positive for life. Donations can’t be used if they test positive to any screening test for an infectious disease.

Don't be disappointed though, because there are other ways you can help. You can spread the word about how blood saves lives on social media (find us @lifebloodau), register your intent to be an organ donor (if you’re 16 or over), or support the great humanitarian work of the Australian Red Cross.