Hi Carol,

I have a mental image of you with a sledge hammer from ACME trying to split that damn pill. Hope you can get one of those pill cutting thingies!

Yes I breed them tough! I was a slow responder to the initial medication (12 weeks on Sof/Led) so I did an additional 12 weeks on Sof/Dac. I did clear the virus but I was one of the small percentage of people who relapsed, probably about 8 or 9 weeks after the end of treatment.

I waited a few months and then Dr F recommended 24 weeks of the Viekira Pak, Solvadi and the bigger gun that is Ribavirin. I had minimal side affects on the first treatments but Ribavirin gave me a few more sides such as headaches and insomnia but ofcourse nothing compares to the debilitating affect of having the virus.

I am about to have my 12 week SVR blood test and I think it’s going to be fine this time. Even though it was pretty rough to have the relapse I never lost faith in the generic medication. The evidence is in the number of people that have been cured because of these life saving, affordable drugs.

We’ve all had our weepy times throughout this Carol. Weep away…you’re in good company.

I suspect what we may be seeing with the reduction of your side effects is your body getting better at removing the daclatasvir. This is a natural process called induction where you body make more garbage collectors when exposed to a certain type of garbage.

The temporary dose reduction, then change back to normal dose is a way to see if that is the problem with minimal risk.

If you are better on a day or two of 30 and worse back on 60 then there is some logic for trying 45.

Hello Gert,

The “normal range” does not exactly refer to “normal” it really refers to this statistical observation of “normal”:

For pretty much any number you can measure in people – from blood pressure, to Hb, to ALT – if you measure enough people you get a curve like this, which is called a bell curve. The distribution of values is called the “normal distribution”.

You can see that the biggest count of people having that value lies in the middle. As we more to the left (or right) we see less and less values.

Your eyes may have glazed over in maths and statistics when the teacher talked about mean, median, and standard deviation. The mean is the average value and is in the middle of a normal distribution. The median has 1/2 the values above, and 1/2 below. It is the same as the mean in a normal distribution. The standard deviation is interesting in that 95% of all values will fall within 2 standard deviations of the mean. Standard deviation symbol is the sigma σ

So 2 standard deviations to the left of the mean is 2.5% of people who are “a lot less than normal” and 2 standard deviations to the right of the mean are 2.5% of people who are “a lot more than normal”. These 2 bits are called “the tail”.

You may see that the higher the standard deviation the wider the bell curve must be (to make sure 2.5% of all fall in the left and right tails).

You may also notice that this 2.5% is an arbitrary number. It defines 5% as being outside normal. Always 5%. Even if 99% were “normal” (as in say no disease) we would still have 2.5% above and 2.5% below.

So yes there are different testing machines but the units are standardised across countries. The range in your population simply represents the correct range to find 2.5% of people below, and 2.5% of people above. There is even a note “The following values apply to the so-called IFCC method at 37 ° C, based on the results of a major Nordic survey 5 and used by Danish laboratories” There are plenty of Hep C patients who are (untreated) in your normal range, so it is a crude tool.

With ALT 10-70, the middle of the range is 40 so you are 10% below that and very close to the fat bit in the middle of the normal range.

Hi James Freeman
I’ve just received an email from someone I’ve helped to buy medcine from India.
In his blood test, virus was undetected, his doctor told him that virus could still be seen in his DNA?
Could you explain something about it?
thanks in advance
Gert

Hello Gert,

In his blood test, virus was undetected, his doctor told him that virus could still be seen in his DNA?

There will be something being lost in translation. Hepatitis C is an RNA virus. There is no involvement of DNA and DNA is not detected in blood it lives in the nucleus of cells.

What is still detected at SVR is Hepatitis C antibodies.

The question about SVR that does come up relates to “Is SVR complete removal of all Hep C RNA” and therefore complete cure. This article suggests YES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711258/

This article suggests NO:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC415836/

So maybe there remains a trace, but in practical terms, it does nothing harmful and this we know from graphs like this which show much better survival with SVR than without SVR. Because DAAs are new (3.5 years) we are making the assumption the pattern will be the same as for Interferon/Ribavirin. We don’t know that for certain, but it looks good.