TOPIC:

Hello all.I am in week 21 out of 24. Geno 1a, f4, 5th time treating. Sof/Dac/Riba. I just had my 20th week blood work done and all is normal with the exception of my liver enzymes, Every month they seem to be elevated. I had a PCR after my 4th week and it was 16.

Question: do I still have a good chance of beating this? Also, I only have enough Dac to get me through the middle of next week, which means I'm short 2.5 weeks. I will continue my Sof/Riba. Getting a little worried. Any advice would be appreciated.

I'm G1a, F3-4, Tx exp, Peg Interferon Ribavirin Relapsed.
Also on week 21 with Sofosbuvir Ledisbovir & Ribaveririn .
When did you know that you were going to come up short with the Dac?
Have you had another PCR at week 12 , after still being detected at week 4 ?
I would say that you still would have a very good chance of coming in negitive at EOT.
I wish you all the very best.

Hello PJ,

Chances are very good you will clear and the 4 week result of 16 is within both expectations and practical experience. Yes we do see 0 and <15 but when the trials were being done tests were less sensitive so they were counting down only to <25

Can you post your liver function results - hard to comment without the numbers.

Any drug can cause elevated liver enzymes so it could be the drugs themselves or something else.

The something elses include Hep B and Haemochromatisis high up on the list with a long tail of other possibilities. Just because you have HCV does not mean you can't have gallstones, fatty liver, Gilbert's disease and the list goes on.

Being co-infected with Hep B is a gotcha - patients with Hep B must have entecavir with their DAA treatment because the HCV holds the HBV at bay - like weed mat or ground cover plants in the garden stop the weeds.

You have my email so pop the results through there if you don't want to post publicly.

Hello, I have a question for Dr. Freeman, I just started my TX with sof/led 12 wks, now 7 days, and I believe I may also have hep B from 2004. Not sure if I need to alter the Tx at this point with addition medication. Thanks.

Thank You Dr Freeman. I just emailed you.

Hi Jo have you retested your Viral Load since week 4 I wonder if you are in fact
Undetected now.

I'm just curious.....hope all's well other wise.

Hello, I have a question for Dr. Freeman, I just started my TX with sof/led 12 wks, now 7 days, and I believe I may also have hep B from 2004. Not sure if I need to alter the Tx at this point with addition medication. Thanks.

Most (95%) immunocompetent adults will clear Hep B whereas only 25% of people can clear Hep C.

To see where you are at please get these 3 tests done ASAP

Hep B surface antigen
Hep B surface antibody
Hep B core antibody

If you do have chronic Hep B you need to take entecavir 0.5 mg daily because without it you will probably have a Hep B flare within a month. Note that Tenofovir is not recommended for Hep B in patients taking DAA agents.

Thank you Dr. Freeman, I will get the labs drawn. Can the entecavir it be taken while on sof/led?

I had the hep b surface antibody drawn the past year with result 42. Thanks....

If you have a positive Hep B surface antibody either you are immunised or immune from past infection. Your surface antigen should come back negative and your core antibody will be positive if you gained immunity from exposure rather than immunisation.

Yes entecavir can be taken with Sof/Led and Sof/Dac

Sounds like it may not be needed.

Hi Dr.Freeman, I just got the Hep B panel back and was just as you mentioned.

Hep B surface AB quant. 78.8

HBsAg screen- negative

Hep B core AB total - positive

Hopefully I do not need to treat the Hep B. I feel pretty good, and am on day 16 of sof/led Tx.

Thanks, Cbg

This is what you see when

1) You have been exposed to Hep B
2) You have created your own immunity (Hep B surface antigen) and cleared the infection

So you don't have chronic Hep B and should be at minimal (?no) risk of reactivation.

Hmm, I had Hep B in 1977 which cleared afaik, and had immunisation in 1990 required by a job I started. Could that really confuse the test?

Hmm, I had Hep B in 1977 which cleared afaik, and had immunisation in 1990 required by a job I started. Could that really confuse the test?

Probably not. The key thing with NOT being a carrier is that you develop surface Antibodies - carriers don't, spontaneous clearers do and so do people who are immunised.

About 5% of people who get immunised don't develop surface antibodies - that would almost certainly be the same 5% who can't clear the virus themselves. Not that immunisation is a bad thing because acute Hep B is a very unpleasant disease.