TOPIC: Help me pls Dr James

Dear Sir!
We need your advise pls. Our history and therapy by Hepcinat Plus (Natco):

Patient 1 (man) :
Hep type 1A since 1994г., 1.8*10*6, F13.2, ALT 148, AST 58
Start therapy 21.07.19, Sof+Dac+Rib1200
4 week: + 148Ме (test 10), ALT 17, AST 15
7 week: - (test 10), ALT 14, AST 15

Patient 2 (woman) :
Hep type 3А (~20 years), 2.9*10*6, F12.8, 2.3*10*8, ALT 193, AST 113
Start therapy 21.07.19, Sof+Dac+Rib1200
4 week: + (from 10 till 29Ме by test 10), ALT 20, AST 20
7 week: - (test 10), ALT 15, AST 18

Our doctor recommends further treatment because:
1. the virus has been present for a very long time,
2. genotypes 1A and 3A heavy for treatment,
3. stage of fibrosis on the verge of cirrhosis,
4. the "minus" was only the seventh week.
But at the same time our doctor says that 12 weeks may be sufficient.

Do my wife and I need to continue our treatment after 12 weeks, until 16 or 24 weeks?
What do you think?

Waiting for your reply! Thank you!

Best regards,
Alex

Hello Protagor,

Genotype 1 is easier to cure than Genotype 3.

Cirrhosis makes patients harder to cure and both patients have cirrhosis.

Women are (slightly) easier to cure than men

While it is entirely possible both patients will be cured with 12 weeks Sof+Dac+Riba

1) The response of the man with GT1 is slow - a viral load of 148 @ 4 weeks is unusually high. I would estimate his current chances of cure at 85-90% rather than the ~95% we expect

2) The response of the woman with GT3 is much better (at 4 weeks test) but expected cure rate for GT3 with cirrhosis is 90% with 12 weeks treatment.

The effect of extra treatment is small. In rough terms adding 4 weeks (so 16 weeks total) might add 4% to cure rate, adding another 4 weeks (so 20 weeks total) might add an extra 2% and adding another 4 weeks (so 24 weeks total) might add 1%

What you should see is that going from 12 weeks to 16 does add quite a bit to cure rate, but each extra lot of treatment adds less benefit.

For both patients I would suggest going out to 16 weeks total or longer if this can be afforded. For GT3 patient I would like more than 16 weeks if this is possible.

Daclatasvir does have some drug and food interactions that can either raise or lower the levels in the blood. Are any other medications being taken? What does diet of both people look like - is it the same food every day or is there good variety? (if good day to day variety any problem food does not tend to appear for many days in a row).

Dear sir!
Thank you for your advice!!!

We both decided to go on therapy 24 week, but:

1) Should a man take Sofdac with 1200me of Ribavirin all 24 week? (Maybe stop ribavirin after 16 week, or take a less dose?) The hemoglobin level is kept at minimum values, we monitor it every week, but the overall health deteriorates every week-weakness, headaches and shortness of breath.

2) Women with 3a genotype will be treatment with 1200 me Riba full 24 week. Ribavirin is well tolerated, and the question of dose reduction or cancellation is not yet relevant.

About your question:
• We don't take any other medication during therapy (or we check cure on Hepdruginteractions site).
• We eat different food meat, fish, veg, fruits, include fresh carrot juice to increase haemoglobin level. Maybe we must eat smth special food?

Thank you for your participation and responsiveness!

Alex

1) For preference take Ribavirin all 24 weeks but first 4/8/12 are most important. For my patients with bad side effects I first reduce dose, then stop. I think we reduce or stop for this patient. Ribavirin takes 3 weeks to fall to 1/2, 6 weeks to fall to 1/4, 9 weeks to fall to 1/8 and 12 weeks to fall to 1/16 if stopped on day zero.

2) For GT3 with no Ribavirin problem continue full dose.

General) For 1/3 patients we need to stop Ribavirin. For 1/3 a few side effects but is ok. For 1/3 no side effects.

No special food is required. Eat good food like your mother cooked and all will be well.