emo Day 1 - let's the fight begin

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3 years 8 months ago #27326

Hi MAGA,

Welcome to the forum. If you went through Dr. James redemption trials, you can be sure your medication is 100% genuine. You're on the road to your cure! :cheer: :+1: Follow Dr. James advice and be Hep C free ;)


Gt 1a, F0, VL 6.5 million, AST 59, ALT 62
Started Twinvir 1/15/16
6 wk. labs VL UND, AST 27, ALT 20
EOT labs VL UND, AST 23, ALT 19
SVR 16, VL UND, AST 28, ALT 17
SVR 24 , VL UND, 10/8/16
SVR 125, VL UND, 9/22/18
SVR 230, VL UND, 10/3/20
Last Edit: 3 years 8 months ago by Greedfighter.
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3 years 8 months ago #27327

Hello Maga, welcome to the forum, and congratulations on starting your 84,000 USD treatment :cheer: :cheer: . Looking forward to your 4 weeks test result, there is a very good chance you will be undetected by then, most patients on DAA treatment are, best of luck.

Last Edit: 3 years 8 months ago by Mar.
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3 years 8 months ago #27328

Hello MAGA,

Welcome to the forum. Best of luck with the treatment. It can be a bit lonely but there is really good support here from people who have walked the exact same road.


YMMV
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3 years 8 months ago #27330

Hi MAGA and welcome to the group. Congrats on getting treatment underway and best of luck going forward!


Diagnosed: 2001 GT1a , HCV since mid-70's.
Biopsy 2010 F1
Fibroscan and Fibrosure 2018 F2

Treated in trial 2010 with Dac/Peg/ Riba and Relapsed.

Resistance test 2017. Have Ns5a Rav Q30r/H58d enhanced from doing Dac.

Start Tx. Jan 18th/18 w/ Vosevi /Riba 12wks. plus 6 wks.Viekira Pak +Sof/Riba(From Dr Freeman @GP2U)

VL start: 1.6mill.ALT 125 AST 88
Wk. 4 Det @LLOQ <15.
VL Wk.8 UND Alt &Ast 22
Wk. 12 UND
EOT:UND

EOT+12 >>>UND (SVR12)! ALT11 AST13
Nov6/18 SVR 24!
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3 years 8 months ago #27337

Hi MAGA,

Welcome! Your fighting spirit jumps out of your post. Best of luck. We're here if you need any info or support.

Coral #flower


G1a probably early 1980's, Biopsy F1(2010), F2-F3(2015). VL 5+mill; 2+mill (2014) Tx naive. Accessed Sof/Led through Dr Freeman at GP2U and Buyers Club (lifesavers!!!)
Commenced tx 12/11/15. 9 wk: VL <15 Detected but LFT = Normal 12 week results: UND (Yay!) Due to slow response commenced Sof/Dac 4 Feb for 12 weeks. EOT @ 24 weeks 27 April 2016. (With thanks to Dr Freeman et al). SVR11 result: VL 1,950,000. It's back!
New tx 030916 (Viekira Pak, Solvadi, Ribavirin UND @ 111116. EOT 170217.
SVR12 and SVR 24...
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3 years 8 months ago #27399

HCV NOT DETECTED
HCV RNA, QUANTITATIVE REAL TIME PCR
<15 NOT
DETECTED
NORMAL NOT DETECTED IU/mL 02

Virus is gone. Treatment Started Nov 23rd. Tested Dec 3rd.

Before
PROTEIN, TOTAL 8.5 HIGH 6.1-8.1 g/dL 01
AST 63 HIGH 10-40 U/L 01
ALT 148 HIGH 9-46 U/L 01
MCH 33.7 HIGH 27.0-33.0 pg 01

Now
PROTEIN, TOTAL 7.4 NORMAL 6.1-8.1 g/dL 01
ALKALINE PHOSPHATASE 37 LOW 40-115 U/L 01
AST 538 HIGH 10-40 U/L 01
ALT 244 HIGH 9-46 U/L 01
MCH 33.9 HIGH 27.0-33.0 pg 01

AST, ALT, MCH were increased since last test. Obviously gonna continue taking pills.

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3 years 8 months ago #27400

Not trying to fearmongering but googling "AST 538 HIGH" brought the results of Acute Liver Failure livertox.nih.gov/Phenotypes_fail.html

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3 years 8 months ago #27401

You should do the test again.

www.journal-of-hepatology.eu/article/S01...(16)00010-6/fulltext

Whatever the cause, the problem of hepatic decompensation during antiviral therapy calls for heightened awareness and careful monitoring of patients with cirrhosis who receive antiviral therapy for hepatitis C. The first appearance of features of decompensation should lead to rapid initiation of appropriate supportive care and early discontinuation of antiviral treatment. For the research community, an important priority is to establish objective criteria for hepatic decompensation to use in describing results and to standardize reporting rates across clinical trials. The episodes of acute decompensation also need to be better described clinically, particularly in the context of other adverse events, timing of viral clearance, serum enzyme changes and serial bilirubin, albumin, ammonia and lactate levels. These studies are of great priority because treatment of patients with advanced hepatitis C cannot be withheld because of concern for this complication.

What is your HCV genotype?
Do you have cirrhosis? What F-score do you have for your liver?

This is an emergency at least to take another urgent test and schedule an emergent consultation with a hepatologist to see if another test for hepatic decompensation or liver damage is available.


Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.
Last Edit: 3 years 8 months ago by vitrus.
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3 years 8 months ago #27402

What is your HCV genotype? - 2
Do you have cirrhosis? - Hope not
What F-score do you have for your liver? I have no idea what the F- score is.

Ordered new tests. Will post results when available.

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3 years 8 months ago #27403

It's fibrosis score - F0 - healthy liver, F4 - advanced fibrosis.

Done with liver ultrasound or Fibroscan in like one hour.

You may actually need to know it now.

On the one hand, it could be a mistake or another reason for massive liver damage:

www.ueg.eu/education/latest-news/article...d-how-to-avoid-them/

The significance of aminotransferase levels in the diagnosis and prognosis of acute liver failure is often misunderstood. Excessive aminotransferase levels occur in acute viral, toxic or ischaemic liver injury. Although impressive, these levels merely reflect acute hepatocellular damage rather than loss of liver function. Consequently, marked aminotransferase elevations in the absence of jaundice, coagulopathy and encephalopathy should not lead to a diagnosis of acute liver failure.

EASL recommendation:

Patients with decompensated (Child-Pugh B or C) cirrhosis
should be treated in experienced centres with easy
access to liver transplantation and close monitoring during
therapy is required, with the possibility of stopping
therapy with evidence of worsening decompensation
during treatment (A1).

www.easl.eu/medias/cpg/2018/EASL%20Recom...8/English-report.pdf

Nothing else to see here, except for the need for expert monitoring.

Sof/vel is recommended for the decompensated cirrhosis but it can cause effects of decompensation (liver damage) on-treatment, when treatment should be cancelled and emergent measures should be taken.


It is actually important to know your liver fibrosis state now.

Read this.
livertox.nih.gov/Sofosbuvir.htm

Find out if you have or have had Hepatitis B or cirrhosis. If you do, it could be a serious life-threatening condition.
If you don't then probably it is a test mistake.

You may want to schedule other blood and liver tests corresponding to the findings of the sofosbuvir Drug Record (to confirm or exclude Hep B reactivation or hepatic decompensation).

You may even need expert monitoring to assess a need for emergent liver transplantation and to see what other tests including blood tests, liver tests should be done. Or to urgently assess other test values to confirm it was a mistake.

I am not a doctor at all, just would like to say that it's not okay and you should act quickly. Call ambulance, see a doctor to consult with. Do more tests.

Only FDA-documented reasons related to sof+vel are Hepatitis B reactivation and cirhosis decompensation in people with cirrhosis.

www.webmd.com/a-to-z-guides/aspartate_aminotransferse-test#2
Apart from the documented treatment complications, it could be additionally for one of these generic reasons or just a false positive.

If you had cirrhosis or Hepatitis B, a decision to stop or continue treatment would have to be urgently made by a hepatologist in a hostipal treating people with decompensated cirrhosis.

If if it is something serious, it must be fixed very soon. Or it's just a mistake/something else.

But it's not okay. No such increase of AST/ALT was documented in the sof+vel FDA sheet, except for the mentioned reasons.


Gen 1b
VL pre treatment 29000 ME/ml
AST 32 ALT 94, F0
Started treatment 13 January 2017
Generic sofosbuvir/velpatasvir (Incepta)
VL 9 days into treatment <300 (undetected)
AST 13.8 ALT 22
Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about
Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60.
Last Edit: 3 years 8 months ago by vitrus.
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3 years 8 months ago #27406

Hi vitrus,

Thanks for your valuable input.

MAGA is a patient of mine who should (theoretically) be straightforward. Reassuringly he feels well, despite the AST/ALT rise.

GT2, low fibrosis (0.7 Fib-4 and 0.559 APRI), Hep B core Ab negative, young(ish) and fit.

We're getting follow up bloods done to check the trendline on the enzymes and INR to check liver synthetic capacity. Bilirubin has fallen rather than risen.

He takes quite a lot of supplements and exercises extensively so checking CK as the enzymes could be exercise related and stopping the supplements, one of which has a lot of green tea extract (and this has been known to cause liver toxicity problems).

Exercise wise we have seen enzyme rises with kaju fixhepc.com/forum/new-to-forum/1748-need....html?start=45#26349 where the ALT/AST rise appeared to relate to heavy exercise.

I have also seen an acute CMV reactivation mid-treatment but this was associated with significant unwellness and was similar (clinically) to Hep B reactivation.

Anyway we are onto it and are considering if it is a DAA related drug reaction. With any luck the new bloods will show reduced AST/ALT and we can take an expectant approach.


YMMV
Last Edit: 3 years 8 months ago by DrJames.
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3 years 8 months ago #27417

Got results, significantly lower. Just like the doctor said due to the exercises.

AST 132 HIGH 10-40 U/L 01
ALT 170 HIGH 9-46 U/L 01
CREATINE KINASE, TOTAL 2646 HIGH 44-196 U/L

GLUCOSE 102 HIGH 65-99 mg/dL , Dropped from 107 Last time.
I'm not sure why different labs post different ranges. I guess to shake down easily scaring folks into the new tests. Anyway I eat before the tests both time, so GLUCOSE testing is not really applicable to our case.
Moreover the normal blood glucose level (tested while fasting) for non-diabetics, should be between 3.9 and 7.1 mmol/L (70 to 130 mg/dL).

Last Edit: 3 years 8 months ago by MAGA.
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3 years 8 months ago #27418

Hello MAGA, yes that elevated CK confirms it was related to muscle damage from exercise and the falling AST/ALT are reassuring.

What sort of exercise do you do?

If it is weights you are probably pushing the envelope a bit hard

If it's endurance then you're probably not hydrating adequately and overheating

For the blood sugar

<100 is normal
>200 is definitely diabetic

And between 100-200 is something of a gray area. If you have a look here

www.diabetes.org/are-you-at-risk/prediabetes

You will see <100 fasting and <140 following the glucose challenge - so one lab is using the 100 for fasting, the other the 140 for not fasting.


YMMV
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3 years 8 months ago #27419

All good here B) I guess my next post will be after 21 weeks.

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3 years 6 months ago #27622

EOT TEST RESULTS:

HCV RNA, QUANTITATIVE REAL TIME PCR
<15 NOT
DETECTED
NORMAL NOT DETECTED IU/mL 01
HCV RNA, QUANTITATIVE REAL TIME PCR
<1.18 NOT
DETECTED
NORMAL NOT DETECTED Log IU/mL 01

AST - 17
ALT - 21

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