TOPIC:

So you've taken the pills and the last one is down the hatch.

You now enter the stressful time when we have to wait and see if the response is durable - SVR

Over the first few days the medications rapidly wash out of your system (except Riba which is slow). Sofosbuvir's active metabolite - GS-331007 - has a half life of 24 hours, for daclatasvir it is 12 hours, and for Ledipasvir it is 48 hours. The half life is the time taken for your body to get rid of 1/2 the current quantity it contains.

Across days 1-7 the levels of the active Sofosbuvir metabolite GS-331007 reduce by half every day so you have 1/2, 1/4, 1/8, 1/16, 1/32, 1/64, 1/128 etc

So by the end of 7 days off treatment you have 1/128th as much (~ 1%) as you did at EOT. For daclatasvir you reach that point in 3.5 days and for ledipasvir 14 days due the difference in wash out rates (1/2 life).

Most medications have side effects of some description so it's reasonable to assume these will dissipate. Mental side effects can range from high to low - consider alcohol - it can be pretty good while taking it and pretty bad after. Anyway over time we get to the point where there is effectively no medication left in your system and therefore no side effects relating to it being there.

Within a couple of weeks at the most there will not be enough medication left in your system to suppress viral replication so the virus will grow back. The incubation period for a new infection is 2 weeks to 6 months with 6-9 weeks being average, thus the use of SVR12 - 3 weeks washout, 9 weeks to grow.

That said the experience from trials like:

www.ncbi.nlm.nih.gov/pubmed/25314116
www.natap.org/2013/AASLD/AASLD_26.htm

indicate the the vast majority of patients with SVR4 (~98%) will also go on to SVR12 and SVR24 (we are seeing this as well)

So the shortest wait time is 4 weeks post treatment to get a good idea about ultimate cure.

PCR is expensive and if you were in the vast majority with elevated ALT at baseline relapse will show up as an out of range elevated ALT days before the PCR is availabke so the "poor man's SVR4" is just to do an ALT and save the PCR for 12 weeks.

Being anxious during this period is normal. Checking your ALT (remember it's OUT OF RANGE not a tiny blip up) may help, but then again a tiny blip up (normal) may worry you for no reason. There are a few people at SVR who worried about the usual wandering up and down of ALT.

Anyway here's the sunscreen song.....

Thanks much for this, sums it up so well

"So the shortest wait time is 4 weeks post treatment to get a good idea about ultimate cure."
- Dr Freeman

That's made my day. Having achieved SVR4 and into week 6 post tx I feel new already.
Summaries like these answer so many questions succinctly ty very much. Ty for the song too.
Splashing happy vibes here with such great prospects
Ariel

Thanks Dr James for clarifying so many questions. I am going for the "poor mans SVR 4" this week And I think I am fine with that until my 12 week SVR test. Just feeling a bit achy and tired and don't know why, reading people's posts is quite reassuring ( Phoenix, thanks!) And obviously this post with all the good information for us EOT ers. Thanks again Dr James.
It's good to read of peoples experiences on this forum, because we are all different.

Doc,
You are, and continue to be "The Greatest".
Mr. Ali can be the "Second Greatest"...
m

I might get a 2 week ALT this week- but I must compartmentalise because I genuinely aren't worried either way. I ask myself-
Would I have done anything different? is there anything I could do, now, that worrying might alert me to? Is it the end of the world if I have to retreat? No to all the above- and I am lucky to be feeling so good, as not everyone does either on tx or after, I am just spending time with that feeling.

Going for the poor man svr4 today thanks doc

Thanks Dr.Freeman, great info.
After UND at EOT 5 weeks ago, I've done poor mans SVR1, and the LFT's were all great, but will do another one at SVR5 or 6.
I will probably have to wait for PCR at 12 weeks because my public hospital Doc is doing monitoring on his own initiative. Sadly Ledipasvir is not yet approved in Serbia so officially I cant be monitored in public hospital, but Doc is a good fellow and also very interested in outcome of generic tx.
I have all the prerequisites for a SVR like F0, low VL, Fibroscan below 7, but my double genotype and possible further genotype mutations worries me.
Anyway hoping for the best and feeling great just remembering where I was last May after unsuccessful pegi/riba tx when I stumbled on the Greg's blog.

James-Freeman-facebook wrote: So you've taken the pills and the last one is down the hatch.

You now enter the stressful time when we have to wait and see if the response is durable - SVR

Over the first few days the medications rapidly wash out of your system (except Riba which is slow). Sofosbuvir's active metabolite - GS-331007 - has a half life of 24 hours, for daclatasvir it is 12 hours, and for Ledipasvir it is 48 hours. The half life is the time taken for your body to get rid of 1/2 the current quantity it contains.

Across days 1-7 the levels of the active Sofosbuvir metabolite GS-331007 reduce by half every day so you have 1/2, 1/4, 1/8, 1/16, 1/32, 1/64, 1/128 etc

So by the end of 7 days off treatment you have 1/128th as much (~ 1%) as you did at EOT. For daclatasvir you reach that point in 3.5 days and for ledipasvir 14 days due the difference in wash out rates (1/2 life).

Most medications have side effects of some description so it's reasonable to assume these will dissipate. Mental side effects can range from high to low - consider alcohol - it can be pretty good while taking it and pretty bad after. Anyway over time we get to the point where there is effectively no medication left in your system and therefore no side effects relating to it being there.

Within a couple of weeks at the most there will not be enough medication left in your system to suppress viral replication so the virus will grow back. The incubation period for a new infection is 2 weeks to 6 months with 6-9 weeks being average, thus the use of SVR12 - 3 weeks washout, 9 weeks to grow.

That said the experience from trials like:

www.ncbi.nlm.nih.gov/pubmed/25314116
www.natap.org/2013/AASLD/AASLD_26.htm

indicate the the vast majority of patients with SVR4 (~98%) will also go on to SVR12 and SVR24 (we are seeing this as well)

So the shortest wait time is 4 weeks post treatment to get a good idea about ultimate cure.

PCR is expensive and if you were in the vast majority with elevated ALT at baseline relapse will show up as an out of range elevated ALT days before the PCR is availabke so the "poor man's SVR4" is just to do an ALT and save the PCR for 12 weeks.

Being anxious during this period is normal. Checking your ALT (remember it's OUT OF RANGE not a tiny blip up) may help, but then again a tiny blip up (normal) may worry you for no reason. There are a few people at SVR who worried about the usual wandering up and down of ALT.

Anyway here's the sunscreen song.....

Oh men, another good post that I missed to read when the time was right for me to know this ....

Glad you revived this thread, RHF. Coming up on SVR 12 labs next week, and have been doing my best not to think too much about it.

For the most part doing a fair job of it, but those nagging doubts do eat at us a little, don't they?

Fitz you got this, I can feel it in my waters

I'm glad I logged in I will wait at the finishing line Fitz
Mermaid splashes too added to Beaches waters coming your way
Yes yes you got this

fitz wrote: Glad you revived this thread, RHF. Coming up on SVR 12 labs next week, and have been doing my best not to think too much about it.

For the most part doing a fair job of it, but those nagging doubts do eat at us a little, don't they?

Fitz - it's been a while, I hope this short post out finds you well. My post is to say, as you would to me, "you've got this".
In good health my friend