GT3 just started meds

This topic has 11 replies, 4 voices, and was last updated 4 years, 11 months ago by Dr James.

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10 November 2018 at 9:37 am #28677
Paul2018
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@paul2018
Hello Everyone ! I was recently diagnosed with GT3 (Age – 48, VL 365,495 Fscan 18.2 Kpa) . Got it in the nineties. On sofosbuvir+daclatasvir right now. No outward symptoms at all. No other conditions except hypertension having telmisartan 40 everyday. I have a question regarding another drug that I occasionally take i.e. sildenafil citrate (viagra) . Does this drug have any contraindications ? Could someone please reply.
10 November 2018 at 7:57 pm #28678
Mar
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- Guardian Angel
@mar
Hello Paul, and welcome to the forum . The University of Liverpool in the UK has a dedicated page for checking interactions between the new Hepatitis C medications (DAAs) and other common medications, and when I checked the ‘Sofosbuvir + Daclatasvir’ combo and ‘Sildenafil’, the result was ‘No Interaction Expected’. You can take a look here https://www.hep-druginteractions.org/checker

Making the world a better place – one patient at a time.
11 November 2018 at 10:02 am #28681
Dr James
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@fixhepc
Hi Paul2018,

Welcome to the forum!

There are no interactions between Sofosbuvir and Daclatasvir and Sildenafil. Here’s the report from the Liverpool Hep C Drug Interactions Site.

YMMV
11 November 2018 at 11:50 am #28683
Paul2018
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@paul2018
Thanks Dr James, Mar. As I have mentioned my fscan score is 18.2 kpa which is cirrhosis. But I do not have any noticeable symptoms at all. Is it normal not to have any symptoms even with a fscan score of 18.2?
12 November 2018 at 3:58 am #28684
Dr James
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@fixhepc
Hi Paul,

Yes it is possible to be cirrhotic with few symptoms.

With GT3 and cirrhosis you must have ribavirin with the Sof/Dac. You should also have 24 weeks treatment.

For GT3 cirrhotics Sof/Vel for 12+ weeks (and preferably with riba) is the best 1st line option.

YMMV
19 December 2018 at 7:28 pm #28823
Paul2018
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@paul2018
Hello everyone, after 4 weeks of sof/dac regime my VL is undetected. The doc never prescribed riba. He has said that he may discontinue meds after 8 weeks. I am worried. Is there a possibility of a relapse in future if the recommended 12 weeks is not adhered to?

As I go to a government facility where the meds are given free, I do not have a say in the treatment.
19 December 2018 at 11:54 pm #28824
Songbird
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@songbird
Hi Paul

Thats great about your being UND. @week4, that is certainly what you want to see,however I would say yes it is worrisome for SVR to stop this regime at 8 weeks.

As Dr. freeman pointed out earlier the optimum regime for GT 3 W/ cirrhosis is SOF/VEL for 12 weeks (preferably with Riba added for some insurance.)

However the guidelines do say, and as Dr. Freeman also mentioned if doing SOF/DAC then 24 wks . is recommended also with RIBA.

I would imagine the DR. will chime in and possibly you can chat with him about adding whatever regime he suggests through him to supplement being only given 8 weeks treatment.

If you are only at wk. 4 currently ,hopfully there should still be time to work something out with Dr. Freeman if in fact they will not extend this regime you are on.

Good luck

S

Diagnosed: 2001 GT1a , HCV since mid-70’s.
Biopsy 2010 F1
Fibroscan and Fibrosure 2018 F2

Treated in trial 2010 with Dac/Peg/ Riba and Relapsed.

Resistance test 2017. Have Ns5a Rav Q30r/H58d enhanced from doing Dac.

Start Tx. Jan 18th/18 w/ Vosevi /Riba 12wks. plus 6 wks.Viekira Pak +Sof/Riba(From Dr Freeman @GP2U)

VL start: 1.6mill.ALT 125 AST 88
Wk. 4 Det @LLOQ <15.
VL Wk.8 UND Alt &Ast 22
Wk. 12 UND
EOT:UND

EOT+12 >>>UND (SVR12)! ALT11 AST13
Nov6/18 SVR 24!
20 December 2018 at 2:15 am #28827
Dr James
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@fixhepc
Hi Paul,

You have GT3 and cirrhosis (fibroscan > 12.5kPa)

There are no guidelines anywhere in the world that say 8 weeks of Sof+Dac is appropriate for ANYBODY.

The 8 weeks guideline for Harvoni for treatment naive, GT1, Viral load < 6 million, LOW FIBROSIS patients are well known to produce inferior SVR12 to 12 weeks and do not apply to you anyway. You need 24 weeks treatment and would have a high probability of relapse if you do only 8 weeks treatment - nobody knows how high because nobody gives that short a treatment. You should be having ribavirin.
1. What country are you in?
2. How much longer do you have before you finish the 8 weeks?
3. When you do find see your doctor about more treatment?
Here are the EASL guidelines for treatment of cirrhotic patients

YMMV
20 December 2018 at 12:52 pm #28830
Paul2018
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@paul2018
I am from India.
My 8 weeks come to an end on 4th Jan ’19.
My next doc visit is scheduled on 2nd Jan ’19.
20 December 2018 at 2:30 pm #28832
Mar
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@mar
Hi Paul, if you’re in India, then you should have access to relatively cheap generic HCV medications, and you can ask you doctor where to source 100% authentic high quality generic medications there. I would urge you to follow Dr James’s recommendation of completing 24 weeks of Sof/Dac and Ribavirin instead of the just 8 weeks of Sof/Dac that you may be treated with as that will almost certainly lead to relapse.

Making the world a better place – one patient at a time.
4 December 2019 at 2:52 pm #29586
Paul2018
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@paul2018
It has been a little over nine months since the time I underwent a 3 months treatment at a local Community Health Centre. I was on a Sof + Dac regimen for 12 weeks. The doctor advised HCV RNA test a week ago. Virus was not detected. He has not prescribed any other tests and asked me to come back after six months.

Apart from a LFT what are the tests that are normally done after treatment?
5 December 2019 at 1:56 am #29587
Dr James
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@fixhepc
Hello Paul2018,

Congrats on the cure result.

In terms of other tests, it depends on how sick a patient is and what has been done previously.

So, say I treat a patient who is not cirrhotic and relatively well and 4 weeks into treatment their LFTs are normal and PCR negative. I would not do any more tests until SVR12 and then just do a PCR and LFTs.

At the other end of the spectrum a patient with cirrhosis who was taking ribavirin would get a CBC and CMP (FBC, UEC, LFT) every 2 weeks during treatment and lots of follow up testing including AFP and ultrasound to check for HCC.

Other tests just depend on the patient and their problems.

YMMV
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