TOPIC:

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

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.

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.

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.

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.

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

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

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

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.

Thanks so much for your responses and time, Doctor James aka legend and everyone else

James-Freeman-facebook wrote: 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.
.

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?

Thanks for posing these questions beaches, knowledge will set us free!!

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.