Starting tx tomorrow night

This topic has 38 replies, 7 voices, and was last updated 6 years, 4 months ago by Dr James.

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27 April 2018 at 11:59 am #27912
SHarmon
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@sharmon
Thank you Dr Freeman,

I will pass this along to my FD and hold off on the vitamin K. It was the rate of drop that had him concerned . about 35 per month since the pre treatment reading. He said he wanted another reading next week to see if it is still the same rate which would put me at about 50 at EOT if it is. He did run a culture of a blood sample and said he didn’t see any obvious infection. My diet is really bland since the treatment started and I plan on remedying that as soon as it is over . He said he will consult with the hepatologist that saw me for the fibroscan and your experience with treating Hep C vastly eclipses the experience my FD has so I I will go with your advice and hold off to see if it corrects itself once everything gets back to normal.
9 May 2018 at 11:05 pm #27980
SHarmon
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@sharmon
Both results came back today with week 4 and week 8 as UND , AST, ALT is about 35% lower than at baseline at week 8. Platelet count is really low but I am seeing my doctor in an hour and he will go over my options but will likely change my diet back to a normal non-Harvoni diet and retest before doing anything.
10 May 2018 at 10:14 pm #27997
SHarmon
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@sharmon
Hmmm , AST on the latest was 26 and ALT 42. Fibroscan at 12 weeks was F0 so no change. Are the first two numbers supposed to drop ? 2 pills left then EOT test on Monday and I will delay the SVR test until 24 weeks.
11 May 2018 at 9:49 pm #28004
SHarmon
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@sharmon
Just a summary of TX so far (Harvoni 12 weeks prescribed)

Likely infection date summer 1985 , treatment naive

HSV: no exposure (NOT standard with any tests and must be ordered separately and insurance did not cover)
HIV: no exposure
HBV: exposed to and self cleared
HPV: no anti-bodies detected in throat , urethral and anal swabs (Three swabs needed , was told that infections are localized and no approved blood test exists for it yet) . Separate test from standard STI testing and insurance did not cover it.

Baseline in December

6.95 E 5 /ml GT 1a ALT 35 AST 53 Fibroscan F0-F1 at 5..6

Started Feb 17th 2018

At 4 weeks:

VL UND , ALT 36 AST 52 NO FS taken

At 8 weeks:

VL UND ALT 27 AST 43 Fibroscan F0 at 5.4

12 weeks EOT taken today last pill last night :

Observations during treatment :

No side effects
Water intake @ 8X 20 ounces of water per day
No antacids with calcium carbonate, no herbal anything , diet strictly watched for Taurine , Grapefruit and it’s extracts , Seville oranges
Weight loss has stabilized after 8 weeks 238 Lbs to 208 Lbs and it has been 208-210 for the past 4 weeks
Dose at 7pm and was held within 1 hour of this time without fail during entire treatment.
11 May 2018 at 11:14 pm #28011
Mar
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@mar
Results look really good SHarmon, very disciplined during treatment, and no side effects as well, perfect . Looking forward to your SVR 12 announcement

Making the world a better place – one patient at a time.
11 May 2018 at 11:49 pm #28013
Songbird
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@songbird
Hi Sharmon
Yes, as Mar mentions a good disciplined tx. and you have done all that was in your control.
Good luck on your SVR test
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!
13 May 2018 at 3:47 am #28023
Dr James
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@fixhepc
Hello SHarmon,

You are a bit unusual at baseline with the AST > ALT in the context of a fibroscan of 5.6 kPa

You are also correct that for a low fibrosis patient we usually see a more rapid fall in these values at the 4 week test.

I think the key here is your weight 238 -> 208. Assuming you’re a not basketballer height I would expect the weight of 238 probably represented quite a bit of extra fat and that some of this has been in your liver (fatty liver) and that while part of the enzyme fall has been due to the Hep C treatment part of it has also been due to a reduction in fatty liver with the 30 lbs weight loss you’ve had.

When the dust settles, and you are at SVR we do expect somebody with a 5.6 kPa to have totally normal, usually ~20 (say 15-25) AST and ALT values. If your AST continues to be elevated then it should be looked at. Many of the usual suspects have been ruled out but here is the full list of causes:

https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/definition/sym-20050830

YMMV
31 May 2018 at 7:45 pm #28096
SHarmon
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@sharmon
Hmmmm,

3 weeks post treatment and last blood test came back negative but now I have developed a severe lower back ache since about a week before finishing tx. Doctor is doing a PSA test and a prostate exam on the 12th but it doesn’t feel like it’s a constant pain like my father described but just to the left of my tailbone and seems to ebb and flow throughout the day.
2 June 2018 at 4:16 am #28106
Dr James
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@fixhepc
It sounds like your doctor is looking into it.

Odd feelings around the liver area during/after treatment are not unusual, but down near your tailbone is going to be something else.

YMMV
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