Congratulations tototo on your SVR 6

That's great news! If you get to SVR 12 it's over 99% guarantee you are cured.

If you need any additional treatment, and you are in USA, I highly recommend going through Fix Hep-C here. You can get exactly what you need from Dr. James, if you need it. For less money than going though your insurance (I live in USA).

You hit the motherlode when you landed on this site. This is where people get cured.


Karma has your back ↓

We had a terrible cold and flu season in the United States last year. A tent was set up outside my local hospital to handle the overflow of patients. I hope you have gotten your flu shot. I got the flu last year even though I got the flu shot. This year I'm taking the usual precautions like frequent hand washing. We still have to go out into the world.

Looking forward to SVR 24 results.

Hello Kansuke, congratulations on securing your treatment

The most common recommendations when starting treatment are :

1. Drink plenty of water as it really helps eliminate/minimize any possible side effects.
2. Take your medication at the same time every day just before or with food, as it helps with the medication absorption.
3. If you're taking 2 pills daily (e.g. Sofosbuvir + Daclatasvir), I believe that you should take them at the same time as they work in tandem (they need each other to eliminate the virus).
4. Try to get enough rest, and eat healthy foods (plenty of fruits and vegetables). If you're taking Daclatasvir, avoid drinking Grapefruit juice (that's the only food to be avoided when taking the modern Hep C medications (DAAs).
5. Be careful not to take any medications that may interact with your Hep C medications. For instance, don't take antacid medications with Harvoni® or Epclusa® generics. This webpage will tell you about any possible medication interactions www.hep-druginteractions.org/checker

Best of luck Kansuke, looking forward to hearing good news soon.

Hi everyone,

I had a talk with Dr James less than 2 weeks ago, and this morning I got the message that the parcel has arrived, I'll pick it up a bit later. It was extremely fast!

So I'll start the treatment today. I'd like to know if there are some things to know about what to do/not to do during the treatment (I found some information here fixhepc.com/faq.html and also in some forum topics) and for instance how to take the pills (with/without water/food, one/both at a time) and when (morning/evening, after/before food/sleep).

Thanks guys

Thank you Mr. James
I hope so ..
My first 4th week hcv rna result was 15 copies and
I have got undedected result from first 6th week of treatment( maybe 5th because I have done test at 6th week) to svr12 and hope still ..
Cheers

Hello kaju,

Your sore tonsils are likely just a cold. The chances of relapse post SVR12 are 1 in 300 - this is very rare, and you are far more likely to be in the 299 than the 1.

Best Regards

James

Hi Mar,
Thank you for positive reply, I hope I had common cold otherwise it will be very tragic for me to catched again in 24th week after eot .
I hope all will be ok .
Cheers.

Hello Kaju, you shouldn't stress out at all, it's extremely unlikely that after you reach SVR12, you will relapse and not reach SVR24. According to this blog post by Dr James fixhepc.com/blog/item/128-understanding-...eatment-success.html "Cure can be declared with 99.7% certainty when a patient has an undetectable test 12 weeks after end of treatment (SVR12)". So your odds of relapsing are extremely small at 0.3%. Besides, stress makes the immune system weaker, and the symptoms you described can easily be common cold. Cheers.

Hi guys,
Maybe this is stupid queston but yesterday was last day after 24 weeks of eot. I got already svr12 and so I should go to doctor for final svr24 test.
But 5 days ago after rainy day I have swollen tonsils ,my voice changed , I had little headache and little heartburn but we can not say say it really heartburn or stomache pain, kind of stomach upset maybe it is because of stress and sure feel little weak.Now I feel better, I am very in stressed because of this and can we say swollen tonsiles or other things can be symptom of relapse? Sure best answer is will be test but I guess I need to hear some comment. Until that day I feel very healty , go to fitness gain muscle and no extra feel weak after fitness. I remember before realized I have hcv after fitness I felt sleep short after exercies .Sorry for my grammer english is not my main laungage.
I guess in 2 weeks I go to doctor for meet with reality. Hope this will be ok .
Cheers.

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.

Hello All,

Just an update to share VL Quantitative
Nov 18 - 3 weeks into treatment with Mavyret . <15 detectable
Dec 3- 5 1/2 weeks undetectable
What a relief to know that the 2 weeks I got left are re-enforcing what is already gone!

As for side effects, to me this has been a roller coaster of sorts.

I experienced thus far:
insomnia
lack of apetite
itching
fatigue
brain fog
Never enough to make me stop.

I still have two more weeks to go!

Few good days intercalated with sh**** ones

I got approved for 8 weeks only

Thank you Dr James, you have been so helpful and generous with your knowledge and time.
Thank you to all of you for your support.
I will post results 3 months past EOT (Dr will not run more tests until then)

Hopefully my posts will be of some help to people starting tx with Mavyret.

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.

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.

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.

DrJames wrote: The metabolism of Kratom has been studied.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4425236/

It is a potent inhibitor of a number of cytochromes including the CYP3A4 one that metabolised daclatasvir so would be expected to cause daclatasvir toxicity or increased side effects.

It is also an inhibitor of P-glycoprotein, but as you note that is allowed for Epclusa.

So the answer is a guarded "it should be ok" but...

DrJames,

Thanks for your advice. I underwent treatment with 12 weeks Epclusa: had serious fatigue as a side effect, but that was the DAA doing its job, everyone responds differently. Reached SVR24 so cured now. I did discontinue kratom use a month before starting treatment as the jury is still out it seems. Felt so much better after finishing Epclusa I never bothered with kratom again. Thanks for the service you provide to the Hep C community!