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TOPIC: Sigh... GT3a Tx Failure

Sigh... GT3a Tx Failure 2 years 8 months ago #23900

  • hepCat
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Well… that happened.

Six months of Sof/Dac; never missed a single dose. I was pretty hopeful because I tested Undetected at 2 weeks after starting treatment and my starting VL was 14 million. I remained UND through EOT (tested again at 4 wks, 8wks, EOT). EOT + 4wk test saw the virus surge back to 12 million.

Ah well, I guess I am a nice place to live.

While I had almost no notable sx there were a couple curious things. Though I generally felt good throughout tx, I didn’t experience a marked increase in energy and feeling of well-being… until about 2 wks after EOT. At that point I noticed that I felt really good; full of energy and fully engaged with every moment of the day, which seems odd, almost as if my body responded with enthusiasm to the return of it’s previously known state.

Also, my monitoring physician did another Fibroscan at EOT. My pre-tx Fibroscan was 8.9, so high-ish F2 (interestingly, the Fibrotest Pre-tx was F3). At EOT my score dropped to 4.8, so F0/F1. That was even more unexpected than my 2 wk RVR. I don’t know what to make of that exactly except that in my case it seems the non-invasive fibrosis tests more accurately demonstrated liver inflammation rather than actual fibrosis.

Not being cured is frustrating and disappointing, although curiously, not crushing, perhaps because I’ve only known about my hep-C for less than a year. Most frustrating is that there’s no clear explanation of why the tx failed. Most likely it’s RAVs. My dr. took blood Pre-tx to store so we’d be able to test for baseline RAVs in case of tx failure, but his tech accidentally sent it in rather than stowing it in the fridge That test found the Y93H mutation (as well as others that apparently are not clinically relevant). That was tested again after tx failure and showed the exact same mutations, which is good since it says I did not develop any new NS5A resistance. Though I don’t quite understand how they survived the Sof for 6 months, I guess the RAVs got me. Oh, and the whole ‘harder to treat GT3’ thing.

So yeah… tx failure. Like others, I’ve got my eye on the Sof/Vel/Vox combo. So now there’s the wait for the release of Vox and trying to stop my mind from incessantly chewing on the why of my failed tx. One thing I’m confident was not a factor is the choice of generics and I am deeply grateful for Dr. Freeman’s efforts as well as the courage and determination of everyone on this forum.
GT 3a, tx naive, dx 4/12/16
4/12/16 V/L 824,000
2/03/16 AST 119 ALT 239 platelets 109
4/12/16 AST 87 ALT 164 platelets 118 (different lab)
5/5/16 FibroScan 8.9 kPa F2
5/16/16 AST 86 ALT 157
5/16/16 Fibrotest 0.6 F3 Actitest 0.79
5/31/16 VL 14,413,000 (uh... YIKES)
Y93H @ baseline
6/20/16 Started Redemption 2 Sof + Dac
7/516 QUANT VL: NOT DETECTED
7/5/16 AST 34 ALT 60 Platelets 128 (diff lab though)

12/06/16 EOT VL UNDETECTED
1/03/17 EOT+4 VL 12,222,000
no new RAVs; IL28B = CC
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Sigh... GT3a Tx Failure 2 years 8 months ago #23904

  • DrJames
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Hello hepCat,

Really sorry to hear about your relapse.

The sad reality of <100% statistics is that some people fall into the relapse group.

Yes, Sof+Vel+Vox (and probably with Ribavirin) is what you should be chasing. Zepatier + Sofosbuvir is similar.

Happy to have a chat offline, or here.
YMMV
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Sigh... GT3a Tx Failure 2 years 8 months ago #23906

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I don't know how HCV works... In my case after EOT I don't feel much better. In my opinion I feel even worst during the time I had to swallow sofosbuvir and daclatasvir pills.

My situation was quite similar to yours. I was undetected since 18th day of treatment. Additionally I got HCV-RNA test in the middle and in the end of treatement, Both were negative. I followed Doc. Freeman advise and I've extended my treatment to 24 weeks- F2 (9.2 kPa) and VL: 1,23*10^6 IU/ml. Today I received SVR4 HCV-RNA test: HCV virus is not detected. Now I am wait for SVR12... and whatever tomorrow brings.
GT 3a
Contracted: October 2008
Diagnosed: March 2009
First treatement:
VL 250.000 IU/ml
Fibrosis F0
Start: November 2010
Copegus+Pegasys (24 weeks)
EOT: VL UND
SVR24: VL DETECTED
June 2016
Fibrosis F2 (9.1 kPa)
VL 1.230.000 IU/ml
Second treatement:
SoviHep+DaciHep (24 weeks)
Start: 13.08.2016
VL UND: 30.08.2016
VL UND: 27.01.2017 (EOT)
EOT+4 weeks: AlAT 9.8 SVR4
EOT+8 weeks: AlAT 9.7
EOT+12 weeks: AlAT 7.0
EOT+28 weeks: AlAT 7.6 SVR28
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Sigh... GT3a Tx Failure 2 years 8 months ago #23907

  • DrJames
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Hi Lukemeister,

Congrats on the SVR4. The drugs should be mostly washed out of your body now. If you felt unwell taking them it's fair to say they only just agreed with you so we would expect things to improve.

It would be worth trailing some vitamin B12 to see if that helps and checking both thyroid and for diabetes.
YMMV
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Sigh... GT3a Tx Failure 2 years 8 months ago #23934

  • coral
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Hi hepCat,

I'm really sorry to hear about your relapse. There are a few of us here that know exactly how you feel. Like you I was disappointed and also quite sad as I had so looked forward to experiencing a HepC free life after so many years of dragging the baggage around with me. I also did the guilt thing about "what did I do to stuff it up". which is understandable but not useful.

I can see though that you're working your way through it and despite the frustration of "why" you're looking forward. I've now completed another treatment and am sitting in the waiting room again. My second round included one of the big guns Ribavirin and the virus fled very early in my treatment which was a good sign. I don't doubt that this will be the same for you.

Good luck with your next steps. #flower #flower

Coral #flower #flower
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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Sigh... GT3a Tx Failure 2 years 8 months ago #23943

  • Fara
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Hi HepCat, ...I am also very sorry to hear of your relapse. .There are more options now with other new drugs, you will be

able to beat this on the next round. ..Good news though that you are feeling well.; . sounds like you were doing everything

right. Best of luck with the next treatment.... #flower
HCV since 35-40yrs., GT 1a , Dx 2004; VL 4-5 mil, F2-3
Tx sof/led started 3/4/16
4wks VL <15
9 weeks VL UND, ; Alt-15,Ast-13
16 weeks VL UND Alt-20, Ast-22;
EOT 24 wks UND
SVR 4 UND
SVR 12 UND, Alt.15, Ast. 17
SVR 24 UND
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Sigh... GT3a Tx Failure 2 years 8 months ago #23963

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so sorry bro to read about your situation. hope some new med-combinations can bring help for you and you stay tight untill then!
Genotype 1a, since 1990
Results 2009: ISHAK 2, METAVIR Score 1, Fibrose Stiffness 6.4 kPa
Results 20/12/2016: HCV RNA (2016) >10 Mio. / AST 60 / ALT 88 / GGT 248
Starting Therapy: 29/12/2016 with Panovir (Incepta, for 84 days)
Results 18/01/2017: CV RNA quant. PCR * < 10 / AST 23 / ALT 31 / GGT not tested
Results 02/02/2017: AST 25, ALT 38, GGT 54, HCV RNA UNDETECTED
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Sigh... GT3a Tx Failure 2 years 8 months ago #23965

  • sabrecat
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Hi HepCat,

I have just finished 6 months re-treatment and understand that the virus does not want to leave us cats alone.

Second time around I found that AFP was down to 2, rather then 4, and LFT's were all normal without the slight elevation the first time around.

Red cells and platelets were a sad storey ........

Keep up the fight as I think the virus takes some convincing it s not welcome anymore.

yours


Jeff
GT3a 1990 Failed Inter 1998, comb in 2000. HCC 2012
Started 24/52 Sof/Dac 27th October 2015.
1. Bloods 2 October 2015: AST - 165 (20-40), ALT - 265 (5-40), GGT 189 (5-50)
2, Bloods 20 November 2015: ALT etc normal; VL 19
3. Bloods 8 January 2016: AST - 40, ALT - 59, GGT 48 VL RNA UND
4. EOT 12 April 2016 - blood tests: all is well, CT scan: okay
5. AFP 11 June 2016: 4 ref< 11
6. VL July 2016: DET
7. Oct16 start treat - June17 UND
8. Jun 18, lfts okay, platelets a bit low.
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