Thank you i will go see another Dr today. feeling awful and cannot stop vomiting. I knew this Dr should of done a 12 week end of treatment test as i have read many times. Anyways thanks guys for all your time..

Hi Tanya,

There are many causes for feeling unwell and having elevated liver functions, but in somebody who has just finished treatment for hep c with Zepatier (or Harvoni or Maviret or Epclusa) treatment failure would be top of the list.

While the treatment failure rates are low 95% cure rate means 5% failure rate - so if I treat 20 patients with Hep C this week one will fail.

As Mar has said - you need an HCV PCR RNA test to see if the virus is still present.

If it is, don’t panic. Retreatment is easily done and very effective.

If it isn’t we need to look for other causes of problems.

Either way you probably need a doctor with more of a clue...

Hi Tanya, it's very strange that the doctor told you that you're cured without asking for the 3 months post treatment HCV RNA test, that definitely doesn't sound right as you said. I will let Dr James answer your GGT and ASL results question.

One more thing I forgot to ask about was calcium. I was instructed when I had my sleeve gastrectomy to have 1500 mg of calcium citrate per day.

Is this okay during treatment?

thank you again! I hope it is because I've been taking it and totally forgot about it as a supplement.

Hi Tanya, welcome to the forum, and sorry to hear that you're still feeling sick.
The only way to know if you're cured or not is to take a blood test (called Hepatitis C RNA Quantitative) 3 months after finishing treatment. If the result is undetected, then you're cured (with 99.7% certainty). Dr James Freeman should be giving you his opinion about what you said, but please answer these questions : Have you taken the mentioned test at least 3 months after finishing treatment? Did it show that the virus is undetected?

Hello Oregondaisy,

You're unusual in your supplements in that many of them (not all) have potential benefits or are clinically relevant to you.

Vitamin deficiency following sleeve gastrectomy is known so continuing your vitamins is both a good idea and won't impact treatment. A mutli B (not just B12) and vitamin D are best.

www.emjreviews.com/gastroenterology/arti...e-literature-review/

Milk thistle contains silymarin and there is some evidence it may help untreated patients

www.ncbi.nlm.nih.gov/pmc/articles/PMC4076489/

But, there is also some evidence it does not do anything much

nccih.nih.gov/research/results/spotlight/071812

While I suspect it should not interact, the best treatment for HCV related liver disease is to get rid of the HCV so stopping milk thistle during treatment avoids any worry of interaction. The major benefits are flowing from the DAAs. You can continue it after, but after treatment, you'll find your liver enzymes are normal and you can't get better than that - the cause is gone so...

In general, as far as your body is concerned, collagen and gelatin are just different forms of protein. They will be digested in your gut into their constituent amino acids and from there do no more, no less than eating a little chicken, red meat or fish. I'd rather have the real food myself, it's tastier and more natural.

That said, undenatured type II collagen (UC-II) is not intended to be used by your body as a collagen re-builder. In a process called oral tolerance, very small doses of UC-II are taken to train your body’s immune system to stop attacking its own collagen

Here is a vox pop on it:

blog.arthritis.org/living-with-arthritis...s-helpful-arthritis/

And here is a medical literature review suggesting a net benefit:

www.ncbi.nlm.nih.gov/pmc/articles/PMC4970562/

So UC-II in low dose would be a probable yes. It should not interact with DAAs.

With Chondroitin/Glucosamine there is some weak evidence they may help. I certainly have patients who say they benefit. Here is a review:

www.ncbi.nlm.nih.gov/pmc/articles/PMC5241539/

So I'd suggest that while on the treatment:

1. You should take the B complex + Vitamin D and it won't interact.
2. I'd skip the Milk Thistle for now and don't think there is going to be a reason for it after.
3. General collagen and gelatin are no better than fish/meat based food which is natural and tastier.
4. UC-II collagen at low dose may be useful and won't interact.
5. The chondoitin/glucosamine are fine to continue, probably beneficial and won't interact.

I am not finding a lot of my supplements on the chart for interactions. I stopped everything other than my prescription medications that I found on the chart.

I am not sure what to do because I would like to continue with my supplements but I don't want to take any chances of anything interfering with my treatment. thank you!

Thanks again Dr. James for this awesome reply and the links.

Reading your reply and the editorial, I've realized that I've missed something important. PPI may affect the course of the virus and create issues, but for that to happen, you've got to have the virus which is not my case anymore, thankfully.

The main reason I've brought this study, besides my anxiety, is to warn people about in treatment the side effects of PPI.

I know it's silly of me, because I couldn't even read the study properly, but I wasn't take PPIs in my first consultation with my doctor and I had a really minor case of reflux. She encouraged me to use PPI. If I had this information, in my specific case, I would have opted to not use it.

Also, after reading your reply, I've realized that I can certainly use more context in my life. I tend to worry too much about the small things and don't see the obvious ones.

My blood pressure and cholesterol are fine thankfully. The only issue is that during treatment my insulin got to a pre-diabetic level even with the fact that I was losing weight. I've read that the virus is closely tied to diabetes, I just hope that getting rid of the virus didn't open some sort of metabolic pandora's box. I know that this is weight related, but my glucose was always stable around 94 and my glycated hemoglobin was normal at 5.3 and suddenly got to 108 in a few months. That never happened before. That was 108 result was almost six months ago, so I’m worried that the next test might come back diabetic. If it goes from 94 to 108 in a couple months who knows what 6 months can do.

I'm going back to my doctor and I'm gonna ask her another glucose test. When I've get the results I'm gonna to make that appointment with you that we've discussed a couple posts ago. I didn't schedule earlier because I still don't have the results.

Thanks again for your kindness.

Thanks Greedfighter,

Glad your tinnitus has improved. I find using earplugs or putting my fingers in my ears makes the ringing/hissing more pronounced. In order to sleep I use a distraction like a fan, podcasts playing all night or the free app, Atmosphere.

I might try Sound Therapy this spring after I first have some needed dental work. I'm hoping to find someone who has used the treatment before I invest $500.

Hi Rockhard,

my first treatment with Sof/Dac went well with no side effects and I felt great. But some time after end of treatment the virus came back.

Second time around did the same with Riba added. I had the same concerns about side effects because I had the experience with Riba years before when I was on interferon. Still think the stuff is in some ways like a hangover - at least what I remember of one before I had to go on the Hep C wagon. Heaps less so with DAAs. I was using Sof/Dac as well which side effect wise may be different to what you are using?

I tolerated the stuff as best I could, and it is difficult as life and work goes on, but I found it manageable. I am cured now as well and all things equal, the Riba did make the difference.

I don't know what the doctor will suggest to you Riba wise, but I hope knowing that Riba is manageable and others here are supportive, may help any decision you make with your doctor. I like a simple life and just do what I am told.

All the best and hope to see you posting your SVR soon.


Jeff

I just read an article posted on fixhepc's Twitter feed by Super User: Sound Therapy for tinnitus.
fixhepc.com/blog/item/133-sound-therapy-for-tinnitus.html

I developed tinnitus on the 20th day of my Harvoni treatment in August of 2016. I had dizziness and light headedness on the 16th day of treatment and awoke with a stiff neck and ringing in my ears on the 20th day. My ears still ring. The left one is always ringing. The right ear varies in intensity.

I have tried various supplements that have not worked. Has anyone tried Sound Therapy? $500 is quite a lot to pay for an unproven treatment. I would appreciate any advice.

Hi John,

Here is the original article (abstract): onlinelibrary.wiley.com/doi/abs/10.1111/apt.14391

And here is an editorial talking about it: onlinelibrary.wiley.com/doi/full/10.1111/apt.14431

So if you read this:

Background: Proton pump inhibitors are among the most commonly prescribed medications in the United States. Their safety in cirrhosis has recently been questioned, but their overall effect on disease progression in noncirrhotic patients with chronic liver disease remains unclear. Aim: To determine the impact of proton pump inhibitors on the progression of liver disease in noncirrhotic patients with hepatitis C virus (HCV) infection. Methods: Using the electronically retrieved cohort of HCV-infected veterans (ERCHIVES) database, we identified all subjects who received HCV treatment and all incident cases of cirrhosis, hepatic decompensation and hepatocellular carcinoma. Proton pump inhibitor use was measured using cumulative defined daily dose. Multivariate Cox regression analysis was performed after adjusting univariate predictors of cirrhosis and various indications for proton pump inhibitor use. Results: Among 11 526 eligible individuals, we found that exposure to proton pump inhibitors was independently associated with an increased risk of developing cirrhosis (hazard ratio: 1.32; 95% confidence interval: 1.17-1.49). This association remained robust to sensitivity analysis in which only patients who achieved sustained virologic response were analysed as well as analysis excluding those with alcohol abuse/dependence. Proton pump inhibitor exposure was also independently associated with an increased risk of hepatic decompensation (HR: 3.79; 95% confidence interval: 2.58-5.57) and hepatocellular carcinoma (HR: 2.01; 95% confidence interval: 1.50-2.70). Conclusions: In patients with chronic HCV infection, increasing proton pump inhibitor use is associated with a dose-dependent risk of progression of chronic liver disease to cirrhosis, as well as an increased risk of hepatic decompensation and hepatocellular carcinoma.

Then you'd be correct that there appears to be a risk but it needs to be taken in context. With the cirrhosis risk of 1.32 we have a 95% confidence interval of 1.17 to 1.49 which means we think there is a 17% to 49% increase in cirrhosis risk (and are 95% sure it's in that range). So that's an increase in cirrhosis risk, but the biggest risk for cirrhosis in HCV is HCV so if you get SVR then your general risk profile changes like this:





So SVR delivers 1/3 the rate of mortality, 1/5 the rate of HCC and 1/10 the rate of HCC.

It looks like PPIs may compromise that improvement slightly. From memory, your 2 major issues were the HCV (now cured) and being overweight (substantially increasing the probability of fatty liver) and which you're working on. These are the big ticket health issues, and your reflux would almost certainly be improved by weight loss allowing you to use less PPIs.

So, in terms of long term health look after the big ticket items first.

1. Get rid of diseases like HCV and try to be in the healthy weight range
2. Get your blood pressure, cholesterol and blood sugar checked and fix if needs be
3. Don't smoke or drink too much alcohol
4. Do exercise, eat good food, drink water and get enough sleep

Once you have the basics to hand look at the smaller issues like PPIs. There is no such thing as a drug that does not have side effects and you don't get any issues with drugs you're not taking. This advice also applies to supplements, most of which have been shown to have no long term benefits and some long term issues.

Congratulations JohnSmith, that's fantastic news Cure can be declared with 99.7% certainty once a patient is undetectable 12 weeks after end of treatment (called SVR 12). When patients reach SVR 24 (undetected 24 weeks after end of treatment), cure is confirmed. 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. I'll take these odds. Your next step is take the test in 12 weeks one more time to confirm cure, but I would say that you're pretty much cured

So... I've just went to the lab after 3 months and 26 days after ending my treatment and did a viral load exam and came back undetected.

Can I celebrate or can the virus come back to slap me in the face? I don't want to celebrate too early.

I was G1 treated with Viekira Pak and Ribavarin and still don't know if I have cirrhosis or not.

CT normal, MR normal, two ultrasounds normal, Philips ElastPQ no fibrosis and Fibroscan 21.6. Go figure. Labs mostly normal except a 1.16 INR during 45 days into treatment and 108 glucose also during treatment from 94 before treatment. I'm waiting for the numbers after treatment. Also ALP went from 60 before treatment to 112 during treatment. The maximum value is 100. Platelet over 250. And still a lot of abdominal fat to go.

The only thing I've noticed after treatment is that my fingernails got pink again. They were kind of white before, which is weird because my albumin levels were always over 4.2 but still good news. Hands still kind of red though.

So, am I cured? What should it be my next steps?

Also, I would like to give something back to this amazing community. You guys helped me a lot, especially Dr. James, and I was wondering if I can help you in any way.

Thanks

Hi Boba,

If you have a look at the first graph you see an early spike of HCV RNA - this is the viral load. It peaks and then the partially (for some people fully) effective antibodies start to rise and knock it down.

Either the antibodies wipe it out or the vius mutates a bit and starts to go up again. It’s all normal and your treatment success probability is very high.

Trust in the force young Jedi!