TOPIC: Viral load-acute hcv

Hi,
I was diagnosed last summer with hepatitis c in acute phase. My alt and ast were above 2000 in spring. I had some other symptoms. It was all diagnosed by chance.
First, doctors treated me for toxic hepatitis because all viruses were negative but I was in window period.
It turns out I was infected trough medical procedure.
So after hcv diagnosis and hcv rna 40.000 in july doctors said to wait if I can fight it myself.

I returned in october for genotype and viral load. While waiting for results I did another test privately. because in my country it is not that expensive. So these were results:
3.oct- genotype 1a, and 2. viral load 22 milion
24.october- genotype 2, viral load 1.5 milion

So, that was 6 months after infection, because I know date of infection.

I bought generic epclusa and now I am in 8th week. I have 4 weeks to go. I havent tested by myself yet. Doctor said to come and get tested after end of treatment in february. I started sofosbuvir and velpatasvir exactly 8 months after getting infected.

So, my question to Dr. James and anyone with experience is do you know anything about treating hcv immediately after acute phase. And why did my viral load jump like that? In one laboratory they didn't find genotype 1. Is it possible that I fought 1a myself or was it just low on second test so they didnt detect it?

I was in agony after I got infected and after it all settled I found out to have 2 genotypes, that was another shock.
Are my chances lower because of 2 genotypes? or are my chances good because it was caught so early.


Thanks in advance and sorry for maybe confused post. My case is I am sure interesting to you.
Boba

I forgot to add.
My alt and ast did fluctuate during last year after infection, after dropping from 2000 to 100 initially. Then every other week it was sometimes 300, sometimes 100.

Right before treatment alt was 120, ast 65.

Hello Boba,

It's normal for both ALT and Viral load to fluctuate during the acute phase. It looks roughly like this:



About 25% of patients clear the virus and you can see the comparison here where one patient clears the virus and the other patient does not:




Dual genotypes probably occur ~ 10% of the time but are less often reported. Over time, whatever genotype reproduces fastest will become the dominant one, so in your case, it looks like the GT2 more or less beat the GT1a in the cloning stakes.

Epclusa works on both GT1a and GT2 (and all the other genotypes) so your cure rate is not better/worse because of this.

Early treatment tends to be more effective than later treatment as there has not been time for cirrhosis to develop and we know this makes treatment harder. It's probably only a 2% chance (1 in 50) that you won't clear on 12 weeks of Epclusa. While it's nice to see undetected on treatment if your ALT/AST are good, then things are going well. Once you finish the pills they wash out in a week, giving the virus 11 weeks to grow back (if still present) which is why we wait until SVR12 - 12 weeks after the pills finish - to declare cure (it's 99.7% certain you will remain negative indefinitely if negative at SVR12).

Thank you Dr.Freeman!

I am just curious about viral drop from 20 milion to 1.5 milion in 20 days. Is this normal, maybe in early infection it is?
Just 3 months after infection it was 40.000 iu/ml, and then at 6 months mark it was 20mil.

I hope I will beat this and clear the virus after 12 weeks.
Thanks again

Hi Boba,

If you have a look at the first graph you see an early spike of HCV RNA - this is the viral load. It peaks and then the partially (for some people fully) effective antibodies start to rise and knock it down.

Either the antibodies wipe it out or the vius mutates a bit and starts to go up again. It’s all normal and your treatment success probability is very high.

Trust in the force young Jedi!

Thanks again!
I will trust in the force!