Hello Kaju,

Well the undetected is certainly very good.

Can you share your liver function tests (before starting and now)?

Hello suesp_52,

It’s easier if you post all your results.

Your ALP is fine and slight rises are irrelevant.

Your Urea depends only on how much you drink – more water and it’s lower, less water and it’s higher.

Your CRP is non-specific for anything. CRP goes up with any injury or stress. We should just check it again in a few weeks or if you are unwell we should check you on the merits of that unwellness, not on your CRP value.

Wow, how time flies.

It seems like only yesterday we were worrying, and now things are looking great.

It’s important that your boyfriend has regular ultrasounds (every 6 months) of the liver to check for HCC for at least a couple of years, but other than that there is nothing much else that needs to be done.

The new healthy lifestyle sounds good.

Hi Mark,

Dual genotypes are common and patients are neither sicker nor weller.

Before pan-genotypic treatment like Sofosbuvir+Daclatasvir or Sofosbuvir+Velpatasvir we did see the odd patient treated with Harvoni for GT1 relapse with either GT2 or GT3 (Harvoni does not work for these) so presumably they were dual GT1/2 and GT1/3.

So in short there’s no problem treating and it’s more or less the same as for everyone else with Hep C. You get rid of it and you feel better and your long term health outlook is better.

Hello Janet,

Weakness is not something we hear of commonly. Can you explain more about when it started, where, what it is like?

Fatigue is a common and known side effect of the DAA medications.

Hi John,

When you have Hep C (untreated) it is very difficult to pass it on sexually. Essentially straight sex does not do it. There are stacks of couples where one patient is positive and the other has remained negative for decades while normal sexual activity has gone on.

MSM (Men who have Sex with Men) seem to manage it occasionally, but that almost certainly relates to anal sex.

Once you are on treatment by 4 weeks you are almost invariably (80% chance) undetectable and 99.9% certain to have next to no viral load so the risk of sexual transmission, which was close to zero to start with, is not even closer to zero.

So the basic answer to your questions is no, you are very very unlikely to transmit it.

On the pragmatic front, in new relationships, you are given a “blob” of – largely undeserved – trust. That trust is yours to lose as much as it is yours to prove.

So despite the above you are faced with three practical options

1) Lie and say you are saving yourself until you know her better
2) Lie and pretend the pills are vitamins or hide them…
3) Level up and involve her in the discussion.

#1 and #2 are the easy ones and you would probably get away with either

#3 runs the risk of her cutting and running, but, if not, you will have a much deeper relationship and it won’t have started out with a lie you will have to keep to yourself for the rest of your life.

Hello Carolwinnie,

Your father is on a good treatment, however, if it was my father we would be treating for longer than 12 weeks. Most of the extra benefit is adding 4 weeks (maybe 4% extra cure @16 weeks) with another 4 weeks adding 2% extra cure and an extra 4 weeks adding another 1%. The point is that most of the cure is in the first 8-12 weeks, with less and less extra cure the longer we treat.

Your father may have to stop the Ribavirin if his platelets continue to fall.

If this happens he should definitely do more than 12 weeks (I would suggest 24 weeks total if we drop back to just using Sof/Vel)

So 12 weeks with Ribavirin is a good treatment for him. He has a good doctor.

Adding extra weeks is good insurance if he is tolerating the drugs well and can be thought of as being like insurance – probably not required, but nice to have if you need it.