Blood Work Not So Good

This topic has 12 replies, 6 voices, and was last updated 8 years, 9 months ago by Dr James.

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11 March 2016 at 6:24 am #13651
panamajo
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- Total: 27
- Treatment Warrior
@panamajo
Hello all.I am in week 21 out of 24. Geno 1a, f4, 5th time treating. Sof/Dac/Riba. I just had my 20th week blood work done and all is normal with the exception of my liver enzymes, Every month they seem to be elevated. I had a PCR after my 4th week and it was 16.

Question: do I still have a good chance of beating this? Also, I only have enough Dac to get me through the middle of next week, which means I’m short 2.5 weeks. I will continue my Sof/Riba. Getting a little worried. Any advice would be appreciated.
11 March 2016 at 7:57 am #13652
Michael-Henry-facebook
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- Recovery Champion
@michael-henry-facebook
I’m G1a, F3-4, Tx exp, Peg Interferon Ribavirin Relapsed.
Also on week 21 with Sofosbuvir Ledisbovir & Ribaveririn .
When did you know that you were going to come up short with the Dac?
Have you had another PCR at week 12 , after still being detected at week 4 ?
I would say that you still would have a very good chance of coming in negitive at EOT.
I wish you all the very best.

AUSTRALIAN
HCV Genotype 1a
2003 Relapsed Peg Interferon / Ribavirin
Pre treatment VL 2,000,000
ALT 65, AST 42, ALP 111, GGT 56
Bridging F3-4
Treatment -24 weeks – Sof , Led with 12 weeks Riba.
4 weeks VL <12 Detected ALP 89 , GGT 21 , ALT 17 , AST14
12 weeks VL Undetected ALP 96, GGT 22, ALT 20, AST 20
24 weeks VL Undetected ALP 83, GGT 20, ALT 21, AST 14
EOT 6th April 2016
SVR 5 weeks VL Undetected ALP 81, GGT 31, ALT 22, AST 20
11 March 2016 at 9:00 am #13654
Dr James
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- Guardian Angel
@fixhepc
Hello PJ,

Chances are very good you will clear and the 4 week result of 16 is within both expectations and practical experience. Yes we do see 0 and <15 but when the trials were being done tests were less sensitive so they were counting down only to <25

Can you post your liver function results - hard to comment without the numbers.

Any drug can cause elevated liver enzymes so it could be the drugs themselves or something else.

The something elses include Hep B and Haemochromatisis high up on the list with a long tail of other possibilities. Just because you have HCV does not mean you can't have gallstones, fatty liver, Gilbert's disease and the list goes on.

Being co-infected with Hep B is a gotcha - patients with Hep B must have entecavir with their DAA treatment because the HCV holds the HBV at bay - like weed mat or ground cover plants in the garden stop the weeds.

You have my email so pop the results through there if you don't want to post publicly.

YMMV
11 March 2016 at 11:40 am #13657
Fara
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- Guardian Angel
@fara
Hello, I have a question for Dr. Freeman, I just started my TX with sof/led 12 wks, now 7 days, and I believe I may also have hep B from 2004. Not sure if I need to alter the Tx at this point with addition medication. Thanks.

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
11 March 2016 at 8:04 pm #13669
panamajo
- Topics: 5
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- Treatment Warrior
@panamajo
Thank You Dr Freeman. I just emailed you.
11 March 2016 at 9:54 pm #13672
Sirchinenge
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- Guardian Angel
@sirchinenge
Hi Jo have you retested your Viral Load since week 4 I wonder if you are in fact
Undetected now.

I’m just curious…..hope all’s well other wise.

Sob/Dac from Oct 29 2015
Geno 1b
Fiberscan 9.9 Pre treatment
Fiberscan 7.4 week 10
VL 1.3 million pre treatment
Week 2.5 VL 96
Week 5.5 VL 17
Week 10 VL UD
SVR 3 UD
SVR 16 UD
Cured:
All liver functions in normal ranges.
12 March 2016 at 3:58 am #13681
Dr James
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- Guardian Angel
@fixhepc
Hello, I have a question for Dr. Freeman, I just started my TX with sof/led 12 wks, now 7 days, and I believe I may also have hep B from 2004. Not sure if I need to alter the Tx at this point with addition medication. Thanks.

Most (95%) immunocompetent adults will clear Hep B whereas only 25% of people can clear Hep C.

To see where you are at please get these 3 tests done ASAP

Hep B surface antigen
Hep B surface antibody
Hep B core antibody

If you do have chronic Hep B you need to take entecavir 0.5 mg daily because without it you will probably have a Hep B flare within a month. Note that Tenofovir is not recommended for Hep B in patients taking DAA agents.

YMMV
12 March 2016 at 6:51 am #13686
Fara
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- Guardian Angel
@fara
Thank you Dr. Freeman, I will get the labs drawn. Can the entecavir it be taken while on sof/led?

I had the hep b surface antibody drawn the past year with result 42. Thanks….

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
12 March 2016 at 8:40 am #13693
Dr James
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- Guardian Angel
@fixhepc
If you have a positive Hep B surface antibody either you are immunised or immune from past infection. Your surface antigen should come back negative and your core antibody will be positive if you gained immunity from exposure rather than immunisation.

Yes entecavir can be taken with Sof/Led and Sof/Dac

Sounds like it may not be needed.

YMMV
20 March 2016 at 9:25 pm #14286
Fara
- Topics: 1
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- Guardian Angel
@fara
Hi Dr.Freeman, I just got the Hep B panel back and was just as you mentioned.

Hep B surface AB quant. 78.8

HBsAg screen- negative

Hep B core AB total – positive

Hopefully I do not need to treat the Hep B. I feel pretty good, and am on day 16 of sof/led Tx.

Thanks, Cbg

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
21 March 2016 at 11:17 am #14313
Dr James
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- Guardian Angel
@fixhepc
This is what you see when

1) You have been exposed to Hep B
2) You have created your own immunity (Hep B surface antigen) and cleared the infection

So you don’t have chronic Hep B and should be at minimal (?no) risk of reactivation.

YMMV
21 March 2016 at 11:50 am #14319
sonix
- Topics: 7
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- Guardian Angel
@sonix
Hmm, I had Hep B in 1977 which cleared afaik, and had immunisation in 1990 required by a job I started. Could that really confuse the test?

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
21 March 2016 at 5:17 pm #14336
Dr James
- Topics: 264
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- Guardian Angel
@fixhepc
Hmm, I had Hep B in 1977 which cleared afaik, and had immunisation in 1990 required by a job I started. Could that really confuse the test?

Probably not. The key thing with NOT being a carrier is that you develop surface Antibodies – carriers don’t, spontaneous clearers do and so do people who are immunised.

About 5% of people who get immunised don’t develop surface antibodies – that would almost certainly be the same 5% who can’t clear the virus themselves. Not that immunisation is a bad thing because acute Hep B is a very unpleasant disease.

YMMV
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