I agree..Good God...it needs attention now. Don’t wait move forward can be taken care of quickly but as you implied “it needs attention now”

Eplusa treatment. He was suppose to be on 12 weeks. 3 bottles. The pharmacy slipped in another bottle. Probably because hes on mass health and its 1000 a pill. I gave him a little more than half of the fourth until I contacted the doctor who said don't give him anymore. He was only supposed to do 12 weeks. I've included a picture of the rash on his back. He has these blisters that form get fluid under them then burst eventually. They gave him an appointment in Sept, just today to see a dermatologist. Good God. Sept! This needs attention now.

Dr James,
Thanks again for your help. I went to my doctor yesterday and we went over my labs. He seems to believe that my bad results may be alcohol related. I didn't know that ALT and AST would remain at normal levels when consuming alcohol and only the GGT would elevate. My doctor did not mention this to me. The reason I'm so concerned, is that having had HepB in the past, I've seen numbers like this when the infection was active. However, the opinions I am getting are that reactivation of my HepB is remote and I show no physical symptoms. OK, that being said, I do not take any medications. The only supplements I take are a multivitamin and fish oil, which I have been doing for many months. I have not been exposed to any environmental toxins that I am aware of. My diet has remained unchanged etc. As for HepA, I was vaccinated for it before I started treatment for HepC. I have not had the six month booster but I don't know if that makes any difference. You can see why I'm a bit perplexed by my bad labs. The bad labs may well be a one off as you suggest, I can hope so. No matter, as you noted, the next step is to do new tests. These are already in work. My doctor scheduled me for new labs in three weeks. He told me to abstain from alcohol for that time to test the theory of alcohol causing the bad labs and to see what changes occur. Hopefully all will be well. Meanwhile, I can only wait. Thanks again.

Dr. James,
Thank you for your response. I finished my treatment about 10 days ago. I have looked at the possible causes of my high Labs. I'm thinking this may be alcohol related. I have always been a moderate drinker but I have never had any issues even though I had HepC for decades. I have reviewed all of my labs and they all are good even though I was drinking. I abstained from drinking beginning in January when I learned I had HepC. I started drinking again after my treatment ended not heavily and not often. Then my labs came back bad. I do not understand how I could drink without any problems for so long then quit and then start having problems when I went back. I guess my question would be, does the Maviret sensitize the liver to alcohol?

Hello Howard,

When did you finish the Maviret?

It certainly needs looking into. We do see some bilirubin rise with both Viekira and Maviret and this we ignore because it happens to most patients and goes away after treatment.

Both AST and ALT are released by damaged muscle as well as liver so we do see this happen occasionally in athletes.

Any drug can cause some liver toxicity (including Maviret) in rare individuals.

The list of causes of liver enzyme increases is quite long - here's the Mayo version:

www.mayoclinic.org/symptoms/elevated-liv.../causes/sym-20050830

You and your doctor are going to need to work through that list.

If you have a positive surface antibody then you should be immune to Hep B. Your positive core antibody shows this is from past infection. This surface antibody wipes out the surface antigen that Hep B produces (in excess) in patients with chronic Hep B. So it's really unlikely to be Hep B - the virus can't assemble without the surface antigen (this is actually part of the stucture of it).

I have seen CMV reactivation do this, but as you can see from the Mayo list there are lots of causes that need to be excluded.

Diabetes is 3x more common in patients with Hep C and it is common full stop. Your 152 suggests you are probably going to be diabetic but should just be checked a few times before doing anything. High blood sugar causes damage over decades and 152 would be pretty good for a diabetic (on treatment) so there is no need to panic about this.

Hey Austincr,

Great to hear it's been going smoothly. That's the rule, rather than the exception. It's so much better than the old treatment with PEG/Riba

Best wishes, and looking forward to hearing about your SVR!

Day 51 and I just can’t believe how smooth sailing this has been, looking forward to day 84 thanks for all the support.

Hello Hopeful,
Congratulations on starting treatment. Mavyret wiped the virus away from my system pretty fast, and it will work for you too.
I was so scared when I started my eight weeks of treatment.
I had all sorts of side effects and remember clearly, at the beginning of the treatment I did not feel like myself, I felt weird, the unknown, the expectations. I even had a serious panic attack!
I also had insomnia but I had the luxury to be in bed really early, as early as 7 pm sometimes, due to feeling extremely tired. In retrospect that fueled insomnia because I would wake up at 1 am and unable to fall back asleep.
Having four children to take care of, is definitely a challenge, but, in the bright side, you are so busy that hopefully, it will allow your mind to distance from the constant thought of "I am taking these powerful pills, I am not feeling well, what's gonna happen next?" even if for a minute.

Drinking plenty of water helped much.
Eat green and colorful live food.
It will get better : )

Welcome Hopeful425 and congratulations on starting your treatment. As a full time worker and mother of 4 you do have a lot on your plate anyway so your anxiety about being able to juggle everything while you are on treatment is understandable.

I was not treated with Mavyret but I did have headaches and insomnia while I was taking my medication and these side effects seem to be pretty common for all of the treatments. I used to wake up at 2 am every morning and it would take me a couple of hours of reading to get back to sleep. Very frustrating.

Most people get a bit anxious in the beginning but find that the side effects start to ease and they are able to manage much better than they thought they would. Hang in there and I hope this is the case for you.

Lots of good advice from Mar and Dr James about taking care of yourself - something that sometimes gets overlooked for mothers of 4!

Good luck with the rest of the treatment. It may be a bit of a balancing act now but it is so worth it.

B12 is fine to take with Mavyret. So are hydroxizine and nitrates. Here is the interaction checker:

www.hep-druginteractions.org

And here is the report

I was taking a multi- vitamin given by my nutritiinalist, hydroxozine for sleep, and nitro as needed for angina

I was told I could continue the hydroxozine, but the nurse was unsure of the vitamins.
I eat very healthy, but fine that I really lack in b 12,

Is a complex B okay?

Hello felts j,

Sorry to hear you are not feeling better already.

The medication leaves your system quite quickly according to what is called half-life. There are 2 drugs in Mavyret. Glecaprevir has a half life of 6 hours and Pibrentasvir has a half life of 13 hours.

After 1 half life we have 1/2 as much left. So for Glecaprevir:

6 hours 1/2
12 hours 1/4 (1/2 of the remaining 1/2)
18 hours 1/8 (1/2 or the remaining 1/4)
24 hours 1/16 (1/2 of the remaining 1/8th)
2 days 1/256
3 days 1/4064
4 days 1/65024
5 days 1/1040384
6 days 1/16 million
7 days 1/256 million

For Pibrentasvir it takes longer

12 hours 1/2
24 hours 1/4
2 days 1/16
3 days 1/64
4 days 1/256
5 days 1/1024
6 days 1/4064

So it's pretty quick to exit your system.

While not feeling better could be related to side effects from the drugs it could also be related to:

1) On treatment failure (30 is quite high for a viral load at the end of the first month)

The quick check for this is the complete metabolic panel. If your liver functions were elevated prior to treatment, back to normal after the first month, we would see them rise in this case

2) The development of either diabetes or hypothyroidism - both of these are about 3 x more common in patients with Hep C and can happen before, during or after treatment (less likely after) - a simple blood test is a good idea

3) Vitamin B12 (or other vitamin) deficiency particularly in vegans - B12 is involved in the immune response to HCV so probably consumed at higher rates than usual

4) Activation of Chronic Hep B - if you also have chronic Hep B (core antibody positive, surface antibody negative) this weed can start growing once you weed out the Hep C

5) Something else - treating for Hep C provides 0% protection from pretty much all the other diseases that afflict the human condition

So one approach might be to eat a healthy diet, get enough fluids, do some exercise, get enough sleep and wait and see for a week or so. Maybe try some vitamin B12 as it's cheap.

If things are not settling get a CBC, CMP, Blood Sugar, Thyroid function. If you don't know your Hep B status checking HBV surface antibody, core antibody and surface antigen is relevant.

Hello Hopeful425,

What I tell patients to expect is this:

In the first week of treatment you may feel a bit like the feeling you get just before you get influenza. You know something is going on, but it's hard to put your finger on it. A bit tired, muscle aches, joint aches, headaches. This happens for the same sort of reasons. There is a lot of virus being killed.

After a few days on direct acting antivirals like Maviret the major battle is over, there is very little virus left and things settle down. Many patients report they have not felt this well for 10 years.

The same sort of supportive care we use for flu is good. Plenty of fluids, good food, enough sleep and some routine pain killers like aspirin, neurofen or paracetamol (acetaminophen) all help a bit.

The few days to the first week is the hardest. It should get better after that.

Welcome to the forum Hopeful425,

You're right that continuing B12 is important for a vegetarian and you definitely should continue this.

The problem with "one size fits all" information is that it does not.

What supplements are you taking at the moment and what are the reasons/expected benefits? Also what other medications do you take (if any).

Great! Thank you so much