Hello hovis,

In terms of the treatment testing makes no difference to the outcome.

In terms of predicting if longer than 12 weeks would be beneficial, the only solid data relates to being undetected/detected at 4 weeks. The ~ 20% of people still detected at 4 weeks are 2-2.5x as likely to fail treatment so, if a patient falls into this group it is worth considering extending the treatment past12 weeks.

If you test at 6 weeks you will almost certainly be undetected but that’s all it tells us. If it was still detected that would be a “better do something” kind of a moment, but it’s highly unlikely that this will be the case.

Hello James_mc85,

That bloodwork looks ok and the top of normal haemoglobin, haematocrit, albumin are not a worry. You may have been a little dehydrated when they were taken, and this is really the only cause of urine that is dark, then light, then dark…

It seems pretty common for patients to have liver location sensations under their right ribs after treatment. This settles down.

Your itch is unlikely to be liver related. The itch from liver problems comes from high bilirubin, and yours is not high.

The fact that antihistamines help suggest it is an allergy type itch so you need to look at washing powder, soap, shampoo… any anything else that is in contact with your skin. Often, when patients get a global skin itch it relates to changing one of these (but sometimes the manufacturers change the product).

Hello beahavan,

This change

2/22/18 ALT 19 AST 25
7/10/18 ALT 26 AST 32

is unremarkable. The remarkable thing is that your ALT/AST are so stable! We expect these values to wander:

https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.22109?scrollTo=references

ALT released in the blood is catabolized in the liver with a resulting plasma half life of 47 ± 10 hours, which is considerably longer than that of AST (17 ± 5 hours).1 ALT activity varies day to day, by 10% to 30%. Within a given day, there is a significant diurnal variation, with ALT activities being up to 45% higher in the afternoon than in the early morning.

Did you perhaps have this blood draw in the afternoon?

I would suggest either repeating it in 2 weeks or doing a PCR to put your mind at ease.

Hello Kansuku,

The treatment you need depends on your genotype, stage of fibrosis, and other factors like other medications you are taking.

Do you have any of your medical records about this?

Hello hovis,

Yes, if you are going to extend treatment based on 4-week results it needs to be done without a break.

For 4/5 people – they are undetected – so mostly it’s not something that needs considering.

Hello beahavan,

That’s a good way to look at it.

For a patient with Hep C the single most cost-effective health intervention is to treat the Hep C.

The Gilead price was based (to a degree) on how costly Hep C and associated things are to treat (on average).

While it is common for all sorts of weird medical conditions to simply go away with treatment the usual benefits are:

1. More energy and mental clarity
2. The psychological release of knowing you don’t have it and are not infectious
3. 1/3 the rate of all cause mortality (compared to having Hep C)

So the results of treatment are live longer with a better quality of life.

Hello zippeh,

You may want to consider Herpes 6 which seems to cause chronic fatigue and issues in some people. The significance is that we get generic valganciclovir for the doctors that specialise in this “hard basket” field and I’m told it has magical results on selected cases.

There will be something driving it and there may be a useful treatment.

Best of luck finding it.