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TOPIC: Don't undertreat, but don't overtreat either.....

Don't undertreat, but don't overtreat either..... 2 years 1 month ago #21599

  • DrJames
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With generics, for some people at least, affording extra treatment is possible.

There are diminishing returns with extra treatment. A GT1 prior treatment failure has a predicted SVR rate of 94% for 12 weeks of Harvoni, 96% for 12 weeks with Ribavirin and 99% for 24 weeks without Ribavirin.

With GT3 the ALLY-3 + study did hint that there is a 4% better SVR rate with 16 weeks Sof+Dac+Riba than with 12 so extending past the current 12 weeks in the guidelines has some literature backing in GT3.

All drugs have side effects. Long term treatment with HIV medications does have issues. These are largely unknown with DAAs. We think they are pretty safe but there is not a group of patients who've been on them long term that prove that.

Bottom line: do take enough, but do take as little as you can get away with with an SVR number you're happy to live with.
YMMV
Last Edit: 2 years 1 month ago by DrJames.
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Don't undertreat, but don't overtreat either..... 2 years 4 weeks ago #21601

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Do you recommend any tests after treatment?
Genotype 1a
Diagnosed in 2004, had HCV for all my adult life. Until 2016!!!!
Harvoni treatment, started 19 March 2016
4 week results Bilirubin 12 down from 14 pre treatment,
Gamma 25 down from 52, ALT 19 down from 63, AST 19 down from 47,
VL <15 down from a lazy 6 million or so

EOT Results
Bilirubin 10, GGT 18, ALT 19, AST 21, VL UND

12 Weeks post EOT
Bilirubin 11, GGT 16, ALT 22, AST 20, VL UND
Cured baby
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Don't undertreat, but don't overtreat either..... 2 years 4 weeks ago #21602

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Do you recommend any tests after treatment?

It's hard to make blanket recommendations because each patient is different, both in terms of what they have already had done, and what should be done. Leaving aside routine things like SVR viral load testing and routine bloods.....

For cirrhotics looking for HCC via AFP/US/CT/MRI should certainly be there

Diabetes and thyroid issues need a check from time to time

But other than that it really needs to be tailored.
YMMV
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Don't undertreat, but don't overtreat either..... 2 years 4 weeks ago #21621

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Yes we are all made differently and my GP requested these
Here is a real life example of the tailoring James spoke of in the previous post:

Post tx tests for Ariel:
*note (I have had four years of chemicals of various toxic levels eg peginf plus riba (three in morning two at night) no idea why so many, vl was 420,000 liver F0. Also predisolone. For actinic and allunare granuloma. Weaning doses but from 50mg down, that's a lot.) There are others here who have had more chemicals than me.

Post DAAs tests list:
August 2016:
CT KUB, cystic kidneys
Abdo scan; liver, spleen, gall bladder, aorta, pancreas, kidneys
No further action required but for watch kidneys.
Colonscopy; Removal of dysplasia adenoma not invasive, second time so now more frequent colonscopies.
Current: dental work, tooth extraction, root canal filling, resolved oral thrush
Near future: Breasts, pap smear and R axial node check. History: benign tissue and calcification

We are all different and I have an extremely healthy lifestyle and had no illness at all prior to peginf no lumps no nothing.

I don't think that the DAAs are my issue
I'm better than I was definitely.
However I think it's smart to be safe rather than sorry.
My colonscopy is enough to testify to that.

A
Gen 1a
Peg/inf/riba 2012(!) stop @ Wk 43 potassium low +issues (rlps week 4 post tx, VL120,000) scnds eg. adenomas.
pre sof/led VL 240,000 Fibsc F0
Day 25 <30
Day 32 UND
Week 10 UND
EOT UND ALT11AST17GGT19
SVR4 UND ALT10 AST16 GGT13
SVR8 UND ALT <9 AST16 GGT15
SVR12 UND ALT14 AST19 GGT12 Bili 5
EOT +18 ALT13 AST20 GGT9 Bili 5
EOT +21 ALT11AST15
Cured SVR12
Dysplasia Adenomas RemvdAug '16
SVR24 UND ALT11AST16
ColonoscopyClear Nov17
LumpectomyClear ‘18
LithotripsyCytoscopyBiopsy 4/18
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