emo Can anyone help with viral load readings please?

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5 years 1 month ago #24451

Hi Carol,

I have a mental image of you with a sledge hammer from ACME trying to split that damn pill. Hope you can get one of those pill cutting thingies!

Yes I breed them tough! I was a slow responder to the initial medication (12 weeks on Sof/Led) so I did an additional 12 weeks on Sof/Dac. I did clear the virus but I was one of the small percentage of people who relapsed, probably about 8 or 9 weeks after the end of treatment.

I waited a few months and then Dr F recommended 24 weeks of the Viekira Pak, Solvadi and the bigger gun that is Ribavirin. I had minimal side affects on the first treatments but Ribavirin gave me a few more sides such as headaches and insomnia but ofcourse nothing compares to the debilitating affect of having the virus.

I am about to have my 12 week SVR blood test and I think it's going to be fine this time. Even though it was pretty rough to have the relapse I never lost faith in the generic medication. The evidence is in the number of people that have been cured because of these life saving, affordable drugs.

We've all had our weepy times throughout this Carol. Weep away...you're in good company. :cheer: :cheer:


G1a probably early 1980's, Biopsy F1(2010), F2-F3(2015). VL 5+mill; 2+mill (2014) Tx naive. Accessed Sof/Led through Dr Freeman at GP2U and Buyers Club (lifesavers!!!)
Commenced tx 12/11/15. 9 wk: VL <15 Detected but LFT = Normal 12 week results: UND (Yay!) Due to slow response commenced Sof/Dac 4 Feb for 12 weeks. EOT @ 24 weeks 27 April 2016. (With thanks to Dr Freeman et al). SVR11 result: VL 1,950,000. It's back!
New tx 030916 (Viekira Pak, Solvadi, Ribavirin UND @ 111116. EOT 170217.
SVR12 and SVR 24...
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5 years 1 month ago #24453

I think the top of the range model costs under $10!


YMMV

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5 years 1 month ago #24455

I was wondering if such a gadget existed and then got your post. I bought one today so will use it later. So handy - thanks.


2b diagnosed about 10 years ago
Alt was 150 but got it down to a consistent 49 with Chinese herbal medicine
Started dac/sof 27/03/17
4 week test - liver function normal - alt 31
full blood count normal
RNA detected 26 IU/ml Log = 1.42
9 week test 26/05/17
bloods and liver function normal - alt 27
RNA detected <10 IU/ml

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5 years 1 month ago #24456

Only a small selection in Boots, mine was £2.99 - should work fine.


2b diagnosed about 10 years ago
Alt was 150 but got it down to a consistent 49 with Chinese herbal medicine
Started dac/sof 27/03/17
4 week test - liver function normal - alt 31
full blood count normal
RNA detected 26 IU/ml Log = 1.42
9 week test 26/05/17
bloods and liver function normal - alt 27
RNA detected <10 IU/ml

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5 years 1 month ago #24457

I suspect what we may be seeing with the reduction of your side effects is your body getting better at removing the daclatasvir. This is a natural process called induction where you body make more garbage collectors when exposed to a certain type of garbage.

The temporary dose reduction, then change back to normal dose is a way to see if that is the problem with minimal risk.

If you are better on a day or two of 30 and worse back on 60 then there is some logic for trying 45.


YMMV

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  • Gert
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5 years 1 month ago #24462

Hi James Freeman
Hope you can help me ALAT and AST. measurement methods

In Denmark, ALT & AST is measured accordingly
Reference intervals ALAT
The following values apply to the so-called IFCC method at 37 ° C, based on the results of a major Nordic survey 5 and used by Danish laboratories:
Men: 10 - 70 U / L
Women: 10 - 45 U / L

AST
reference intervals
The values below apply to the so-called IFCC method at 37 ° C, which is used in Danish laboratories and is based on the results of a major Nordic survey 2
Men: 15-45 U / L
Women: 15-35 U / L

My ALT is 36 which is within normal range.

Have seen some tests from the USA where there are smaller values - ALAT 10 - 44
Is it another measurement method?
Hope you understand my question,
(Using translation program since I can not spell in English)

Sincerely
Gert
Denmark


Probably infected 30 years ago Genotype: 1a
Fibroscan 4,8 - 18 january 2017
Virus in the blood 18 January 2017 10.400000 / Alat 102
Started treatment January 19, 2017
Feb.15 - Alat 76 - virus: UNDETECTED
March 15 - Alat 34 - virus UNDETECTED
April 12 - Alat 40 Asat 34 - virus UNDETECTED / Taking the last pill
May 10 SVR4 - Alat 36 -virus UNDETECTED
July 5 SVR12 - Fibroscan 3,8 Alat 39 - virus UNDETECTED
Sep. 27 SVR24 - ALAT 24- virus UNDETECTED
Marts 14 - 2018 SVR48 - ALAT 26- virus UNDETECTED
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5 years 1 month ago #24463

Hello Gert,

The "normal range" does not exactly refer to "normal" it really refers to this statistical observation of "normal":





For pretty much any number you can measure in people - from blood pressure, to Hb, to ALT - if you measure enough people you get a curve like this, which is called a bell curve. The distribution of values is called the "normal distribution".

You can see that the biggest count of people having that value lies in the middle. As we more to the left (or right) we see less and less values.

Your eyes may have glazed over in maths and statistics when the teacher talked about mean, median, and standard deviation. The mean is the average value and is in the middle of a normal distribution. The median has 1/2 the values above, and 1/2 below. It is the same as the mean in a normal distribution. The standard deviation is interesting in that 95% of all values will fall within 2 standard deviations of the mean. Standard deviation symbol is the sigma σ

So 2 standard deviations to the left of the mean is 2.5% of people who are "a lot less than normal" and 2 standard deviations to the right of the mean are 2.5% of people who are "a lot more than normal". These 2 bits are called "the tail".

You may see that the higher the standard deviation the wider the bell curve must be (to make sure 2.5% of all fall in the left and right tails).

You may also notice that this 2.5% is an arbitrary number. It defines 5% as being outside normal. Always 5%. Even if 99% were "normal" (as in say no disease) we would still have 2.5% above and 2.5% below.

So yes there are different testing machines but the units are standardised across countries. The range in your population simply represents the correct range to find 2.5% of people below, and 2.5% of people above. There is even a note "The following values apply to the so-called IFCC method at 37 ° C, based on the results of a major Nordic survey 5 and used by Danish laboratories" There are plenty of Hep C patients who are (untreated) in your normal range, so it is a crude tool.

With ALT 10-70, the middle of the range is 40 so you are 10% below that and very close to the fat bit in the middle of the normal range.

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Last Edit: 5 years 1 month ago by DrJames.
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5 years 1 month ago #24466

Hi James Freeman
Thank you for your very comprehensive answer, which helped me understand.

I have a question more:

It's about the medical half-life in the blood.
I have received these two effects, Sofosbuvir 400 mg / Ledipasvir 90 mg,
Have read that half the life of Ledipasvir is 47 hours,
How many days are the substances in the blood after the treatment has ended before we can no longer measure them in the blood?
greeting
Gert


Probably infected 30 years ago Genotype: 1a
Fibroscan 4,8 - 18 january 2017
Virus in the blood 18 January 2017 10.400000 / Alat 102
Started treatment January 19, 2017
Feb.15 - Alat 76 - virus: UNDETECTED
March 15 - Alat 34 - virus UNDETECTED
April 12 - Alat 40 Asat 34 - virus UNDETECTED / Taking the last pill
May 10 SVR4 - Alat 36 -virus UNDETECTED
July 5 SVR12 - Fibroscan 3,8 Alat 39 - virus UNDETECTED
Sep. 27 SVR24 - ALAT 24- virus UNDETECTED
Marts 14 - 2018 SVR48 - ALAT 26- virus UNDETECTED

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5 years 1 month ago #24468

Hi James Freeman
I've just received an email from someone I've helped to buy medcine from India.
In his blood test, virus was undetected, his doctor told him that virus could still be seen in his DNA?
Could you explain something about it?
thanks in advance
Gert


Probably infected 30 years ago Genotype: 1a
Fibroscan 4,8 - 18 january 2017
Virus in the blood 18 January 2017 10.400000 / Alat 102
Started treatment January 19, 2017
Feb.15 - Alat 76 - virus: UNDETECTED
March 15 - Alat 34 - virus UNDETECTED
April 12 - Alat 40 Asat 34 - virus UNDETECTED / Taking the last pill
May 10 SVR4 - Alat 36 -virus UNDETECTED
July 5 SVR12 - Fibroscan 3,8 Alat 39 - virus UNDETECTED
Sep. 27 SVR24 - ALAT 24- virus UNDETECTED
Marts 14 - 2018 SVR48 - ALAT 26- virus UNDETECTED

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5 years 1 month ago #24469

Hi Gert,

Have read that half the life of Ledipasvir is 47 hours,
How many days are the substances in the blood after the treatment has ended before we can no longer measure them in the blood?

The short answer is see this long answer fixhepc.com/forum/experts-corner/872-how...etting-pregnant.html where I calculate it exactly for you.....


YMMV
Last Edit: 5 years 1 month ago by DrJames.

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5 years 1 month ago #24470

Hello Gert,

In his blood test, virus was undetected, his doctor told him that virus could still be seen in his DNA?

There will be something being lost in translation. Hepatitis C is an RNA virus. There is no involvement of DNA and DNA is not detected in blood it lives in the nucleus of cells.

What is still detected at SVR is Hepatitis C antibodies.

The question about SVR that does come up relates to "Is SVR complete removal of all Hep C RNA" and therefore complete cure. This article suggests YES:

www.ncbi.nlm.nih.gov/pmc/articles/PMC2711258/

This article suggests NO:

www.ncbi.nlm.nih.gov/pmc/articles/PMC415836/

So maybe there remains a trace, but in practical terms, it does nothing harmful and this we know from graphs like this which show much better survival with SVR than without SVR. Because DAAs are new (3.5 years) we are making the assumption the pattern will be the same as for Interferon/Ribavirin. We don't know that for certain, but it looks good.


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Last Edit: 5 years 1 month ago by DrJames.
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5 years 1 month ago #24472

Hi Coral,

Strange that I didn't get a notification in my inbox that you had written to me, I only came across your message by chance, and then it isn't visible when I use my ipad - only my computer???

Anyway, it sounds as if you have really been through it! I can only imagine how you felt when you relapsed, but you sound optimistic about the outcome of your current treatment, and I'll keep everything crossed for you that you manage to remain clear in future, and after everything you have done I'm sure that you will beat this disease.

Yes, I did manage to find a pill cutter and it was funny trying to cut it without this gadget. I reduced my dose last night and although I've felt slightly sickly all day my mood has much improved, which is great.

The only fly in the ointment is that an attic ceiling is threatening to fall down in my 250 year old rented house. It's the old lath and plaster, so when the landlord sends someone to pull it down and replace it the mess will be unbelievable, no matter how many dust sheets I put down. It's the sort of soot that permeates everything and continues to settle for weeks after the job is completed. I've had the ceiling propped up temporarily, but next week I have to arrange for the work to be done before it comes down of it's own accord. No biggie in the usual scheme of things, but in the here and now I could so do without it. Thank goodness I'm blessed with lovely friends who have offered to help me clean up the mess, as although I'm feeling slightly better my energy levels are very low.

I hope you're ok and the ribavarin isn't taking it out of you too much, I've read that it's a tough one to deal with sometimes. Thanks so much for your mails, it makes such a difference to hear from nice people who are going through similar times. Sending love to you x


2b diagnosed about 10 years ago
Alt was 150 but got it down to a consistent 49 with Chinese herbal medicine
Started dac/sof 27/03/17
4 week test - liver function normal - alt 31
full blood count normal
RNA detected 26 IU/ml Log = 1.42
9 week test 26/05/17
bloods and liver function normal - alt 27
RNA detected <10 IU/ml
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5 years 1 month ago #24473

I reduced my dosage last night, I probably took about 40mg as didn't cut the tablet exactly in half and I took the biggest bit. I take my meds around 11.30pm so tonight will be the second reduced dose.

Although I don't look well and still feel slightly sickly my mood has much improved. Despite all my best efforts to perk up a bit my default setting seems to have been glum since I started the meds, and it was lovely today to feel more like my old self on a good day.

I'll do a you suggest and increase to 60mg for a couple of days, and then perhaps down to 45mg after that.

Thanks again for your kind attention.


2b diagnosed about 10 years ago
Alt was 150 but got it down to a consistent 49 with Chinese herbal medicine
Started dac/sof 27/03/17
4 week test - liver function normal - alt 31
full blood count normal
RNA detected 26 IU/ml Log = 1.42
9 week test 26/05/17
bloods and liver function normal - alt 27
RNA detected <10 IU/ml

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5 years 1 month ago #24474

Hi 2b...

If you take the remaining portion tonight that will give you 2 days on the same mg/kg dose as a strapping 100 kg man.

If your feeling is that's better we have the suggestion it is dose related.

The confirmation then comes if we increase the dose and the unwell feelings increase.

If both those are true, then it's reasonably suspicious that there is too much pill (or not enough you) so a small dose reduction to 45 would be worth considering.

When we did this before (in fact I had little to do with it, the patient experimented himself) what was observed was that after a few days on a lower dose increasing back up to normal worked ok.


YMMV

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5 years 1 month ago #24481

Thanks Dr. J, I'll go back to 60mg tonight then and see how I am tomorrow.


2b diagnosed about 10 years ago
Alt was 150 but got it down to a consistent 49 with Chinese herbal medicine
Started dac/sof 27/03/17
4 week test - liver function normal - alt 31
full blood count normal
RNA detected 26 IU/ml Log = 1.42
9 week test 26/05/17
bloods and liver function normal - alt 27
RNA detected <10 IU/ml
The following user(s) said Thank You: DrJames

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