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If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15521
Hi all, Hope this is not a silly question. As I understand it the new DAAS go to work on the virus that is present in the liver. Say you are UND at week 4 or at some other time prior to week 12, what do the DAAs do? I get that there will be some stragglers coming into the liver via the bloodstream from other parts of the body where they have been doing their evil work but at some stage there will be none left. Just wondering 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 The following user(s) said Thank You: Matt-Kenney-google | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15522
You answered your own question. Yes the DAAs will be mopping up stragglers that are hiding, but as they are not in the bloodstream they can't be detected by a blood test. It's been mentioned that it's better to continue treatment after UND for a while to make sure those hiding viruses have a better chance of being killed. M 61yo HCV+ ~ 30 yrs Gt1a F2 VL 223,000 ALT 54 AST 42 Tx start Sof/Dac 17Dec15. SVR4 at 7Apr16 ALT 22 AST 22 SVR12 at 9Jun16 ALT 23 AST 25 Melbourne, Australia | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15523
As sonix says. The virus that are in your liver and other parts of your body are a bit harder to get the medications to. This is more so with fibrosis or cirrhosis. Think of the scars of cirrhosis as little walled off forts that the virus can hide in, it takes longer to get the medication past those barricades. As we don't know exactly when this happens we rely on the original trials that told us that we needed to treat for x number of weeks in different situations to be reasonably sure of getting all the virus. G3a since '78 - Dx '12 - F4 (2xHCC) 24wk Tx - PEG/Riba/Dac 2013 relapsed 24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed 16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof SVR7 - 22/06/17 UND SRV12 - 27/07/17 UND SVR24 - 26/10/17 UND | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15528
But when there is nothing for them to work on, what do they do? I think I must have let too much sea water into my brain this morning. 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 | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15532
Hi beaches, We can only measure the ones in our blood, we can't directly measure the ones in the liver which take longer for the medications to reach and kill. So we kill the ones in the blood that we can measure and then keep going for long enough to make sure all the others are killed too. G3a since '78 - Dx '12 - F4 (2xHCC) 24wk Tx - PEG/Riba/Dac 2013 relapsed 24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed 16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof SVR7 - 22/06/17 UND SRV12 - 27/07/17 UND SVR24 - 26/10/17 UND | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15541
Beaches, you may not have seen this Vororo put this up 13 weeks ago in Media & News it may help with understanding some of the complexities gt 1a VL 6m F2/3 FibroScan - 9KPa in 2011 and 7KPa in 2015 sof/dac 10 December for 12 weeks pre tx alt 85 ast 51 4 wk alt 34 ast 31 UND <35 8 wk alt 29 ast 32 UND <15 12wk alt 25 ast 25 EOT 3.3.16 SVR24 UND KPa5.3 F0 in normal range I am well .forever grateful to fixhepc | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15546
Thanks for reposting this Pat1 it is an excellent video that is also good to help people who have not ever had the virus to understand the seriousness of a diagnosis. I have seen it before too and think it's an excellent tool for educational communications. For those of us who have told family or a few friends these types of videos help them. High drama and scary things are all over YouTube even herbal retreat things which apparently will cure the universe, you name it it's there! (Back in peginf days I watched many YouTube offerings nothing offensive fortunately but certainly not proper information) Those types of videos only serve to water down the serious nature of HCV I believe. This is an excellent vid. Thanks again Ariel 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 | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15550
Thank You Pat1, that is very very informative. Being a bear of little brain I can't say I understand all of it but I have a better picture for sure. It seems I was misinformed about how the HCV DAAs work too. I thought they acted on the cells in the liver, but it seems they work their magic in the blood stream. My 8 week bloods are due at the end of next week (where did that time go?) so hopefully the only way is up, baby 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 The following user(s) said Thank You: Ariel, Matt-Kenney-google | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15554
At some point along the road to cure we are giving the medication, but there is no virus. This medication simply hangs around in the tissues and is excreted out of your body every minute of every day. After about 5 days on treatment your body is excreting almost exactly a full dose of medication each day. You are taking more medication to top up this loss, but the level remains relatively constant (it actually looks like a saw tooth pattern with the highest level about 1-2 hours post taking your dose, and the lowest just before you take a new dose. The reason that we need a period of over treatment is that UND does not mean "there is no virus". It means there is not enough virus to see and this could represent 0 (as in cured) or something in the range 0.1 - 10 depending on the sensitivity of the test. During the post treatment period if there is remaining virus the drugs wash out of your body, and the virus regrows. If there is no virus left (ie truly undetected because it is not there) you have SVR. YMMV The following user(s) said Thank You: Joy, pat1, Ariel, Gaj, Lynne-Francis-facebook, beaches, isaing4, Matt-Kenney-google, Meg | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15559
Thanks so much for your responses and time, Doctor James aka legend and everyone else 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 The following user(s) said Thank You: Ariel | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15575
Sorry, but this has just prompted another question in my mind. I'm sure I read a thread about Harvoni fatigue, but looking at Dr James' comment, it seems that no matter how long you take it, after the initial 5 days the dosage in your body remains the same (apart from the daily fluctuations). Does that mean that after those first 5 days you should feel pretty much the same apart from feeling better as the virus disappears and apart from any incidental things that might happen such as colds etc? 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 The following user(s) said Thank You: Matt-Kenney-google | |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15595
| Thanks for posing these questions beaches, knowledge will set us free!! GT1a; Got it some time in the 70's; Diagnosed @1976 Tx naive METAVIR: A2-F2 SOT May 18, 2016: CMP: AST 162 ALT 241 VL 13000000 3 weeks after SOT: AST 27 ALT 31 VL 138 Reached EOT Aug. 10, 2016 / Received svr4 results Sept. 20, 2016: AST 22 ALT 24 Hep C RNA "NOT DETECTED" AS OF 3/20/2017 ,Hep C RNA PCR "NOT DETECTED" THAT'S SVR24! |
If you are UND at 4 weeks what are the DAAs doing afterwards? 7 years 11 months ago #15645
I am more concerned about what happens to all the remotes..... When you pick up the remote controller it sprays out remotes, but it only takes 1 remote to turn on the A/C or the TV, so what happens to all the rest? What if they were just hanging around, plotting? Sometimes I wake up in a sweat worrying that all these lost remotes will develop a collective consciousness and take over the world, after all, they already know how to control almost everything! But more seriously if you look at the blood levels as you start taking medication it looks like this: So the levels increase rapidly to start with then reach a steady state where each day almost all you take in is excreted. The almost is because you never quite reach steady state but it goes up like 1/2, then and extra 1/4, then an extra 1/8, 1/16, 1/32 and if you add all those up you never ever quite get to 1. YMMV | |
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