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Viewing 15 posts - 796 through 810 (of 1,968 total)
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  • in reply to: Sofosburvir + Daclatasvir Worried about KRATOM usage #25655
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    What genotype are you? Please don’t say 3.

    The extra 4 weeks is $500 worth of damn good insurance.


    YMMV

    in reply to: Sofosburvir + Daclatasvir Worried about KRATOM usage #25653
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Yes this could be a problem for both the Sofosbuvir and the Daclatasvir, both of which would be expected to be at higher levels in your blood stream due to Kratom inhibiting their metabolism. This might be helpful for you as 8 weeks treatment with Sof+Dac for GT1 is borderline – you should take 12 weeks, but is not to be recommended.

    https://www.dovepress.com/pharmacokinetics-of-mitragynine-in-man-peer-reviewed-fulltext-article-DDDT

    Kratom has the potential herb–drug interaction on cytochrome P450 (CYP) enzyme activity. This was shown in one study, with potent inhibitory effect for CYP3A4 and CYP2D6, moderate effect for CYP1A2, and weak effect for CYP2C19,22 whereas in another study, mitragynine and 7-hydroxymitragynine also showed the inhibitory effect on P-glycoprotein.23 However, there were a few reports of Kratom-related fatalities.

    Daclatasvir is metabolised by CYPD3A4 so if you inhibit it with Kratom you will run high levels of Daclatasvir in your blood.

    http://www.medscape.com/viewarticle/842315

    Sofosbuvir, like many drugs, is partially cleared via the p-glycoprotein transporter (P-GP) system.

    So Kratom is also expected to elevate your Sofosbuvir levels and it can be cardiotoxic in high doses.

    Advice

    You should seriously consider not taking Kratom for the duration of treatment.

    You should also seriously consider getting another 4 weeks treatment.


    YMMV

    in reply to: How manny GT3’s on this forum are cured? #25651
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Alcohol is not good for your liver, particularly with the added burden of Hep C BUT…..

    It will make no difference to whether the treatment works or not. Your odds are as good as anyone else’s, which is pretty damn good.

    Here is a piece of research called:

    Alcohol Use Among Veterans with HCV Does Not Blunt SVR Rates from DAAs

    Or in English – Drinking has no impact on cure rates with the new Hep C drugs.

    http://www.clinicaladvisor.com/aasld-2016/alcohol-use-among-veterans-with-hcv-does-not-blunt-svr-rates-from-daas/article/571410/


    YMMV

    in reply to: Thank You Doc Freeman #25642
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hi Barry,

    Sounds like your indomitable spirit has survived the surgeon’s knife!


    YMMV

    in reply to: Soy an inducer of CYP3A4 ? #25638
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    hydrolysed soya extract inhibited all of the cytochrome P450 isoenzymes tested

    So the worst case would be higher levels of Daclatasvir. More sides, but no increased risk of treatment failure.

    A good varied diet – not eating the same stuff day after day – is a good way to avoid interactions (known or unknown) as well as being a pretty good way to eat.


    YMMV

    in reply to: USA – New Hep C cases continue to rise #25634
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hello Teddy,

    This is the Antibody test that shows you have been exposed to HepC. There is a 25% chance you have cleared the virus. Was the result you burnt a PCR RNA test?


    YMMV

    in reply to: I’m so tired! #25633
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    It is not unusual for patients to be a bit tired during the first few days. The way I explain it when discussing what to expect is that it feels a bit like you feel in the days leading up to getting flu. A bit under the weather, but not too bad. This is usually gone within a week or so.


    YMMV

    in reply to: Fibrosis F4 #25617
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    If you go here:

    http://www.hepatitisc.uw.edu/page/clinical-calculators/apri

    You can put in the AST or 27, the upper limit of normal (40) and the platelets of 173 to get an APRI of 0.39.

    This is low and the clinical trials often use 2 for cirrhosis.

    The high fibroscan probably represents relatively low fibrosis with high inflammation. The inflammation causes swelling and is a bit like blowing up a balloon that is caught in a net. It gets stiff not because there is a lot of net (the fibrosis seen in cirrhosis) but because of the swelling.

    I would predict that with treatment AST will end up at 10-15, platelets around 200 and fibroscan drop to 7-9.

    What your BF has is at the very mild end of things and a good response is expected.


    YMMV

    in reply to: Fibrosis F4 #25613
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    What are his platelets from the full blood count? If > 100 that is good and > 150 that is normal


    YMMV

    in reply to: Fibrosis F4 #25601
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hello Sonja,

    23.4 kPa is > 12.5 kPa which is where we say a patient has cirrhosis.

    Yes, this is likely to improve with treatment. I think Hazel here has the record having gone from 40 kPa before treatment to 9.5 kPa after.

    These numerical improvements are nice to see but here is what’s really important:

    curing_chart-2-2.png

    As you can see, patients at SVR are much less likely to die than patients who still have Hep C


    YMMV

    in reply to: any one else have a co-infection with HVB? #25594
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hello Akiniai,

    If you can find a blood test that says “Hepatitis B surface antibody positive” or a number > 10 (ie not <10) or > 12 then you have protective immunity from Hep B and will not be at risk of reactivation.


    YMMV

    in reply to: any one else have a co-infection with HVB? #25589
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hello akiniai,

    These results do not provide an answer to the question of whether you do, or do not have chronic Hep B. While you have certainly had Hep B exposure the results you’ve shared don’t answer that question.

    table-1.gif

    What I would need to tell you is Hep B surface antibody. It sounds like you do have that and are immune to Hep B due to prior exposure.

    The standard set of blood to answer the question of Hep B status are surface antibody, core antibody, surface antigen as well as some liver function tests.


    YMMV

    in reply to: CYP3A4 Inhibitors and Daclatasvir – Fruits #25586
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Quercetin INHIBITS CYPD3A4 so can lead to elevation of Daclatasvir levels which is a side effect risk but not a treatment failure risk.


    YMMV

    in reply to: Any ideas on how the treatment goes? #25575
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Yes, adding Ribavirin now could be of use.

    With 4 weeks to go it is possible to get medication to you within that time.


    YMMV

    in reply to: help interpreting resistance analysis report #25557
    dope-on-a-rope.jpgDr James
    • Guardian Angel
    • ★★★★★
    @fixhepc

    Hi Keith,

    You have neither NS5A or NS5B resistance. This is good, in fact it does not get any better. 12 weeks Harvoni probably would have done the trick first time round, and would probably still do the trick now.

    So really 12-24 weeks of Sof/Led or Sof/Dac or Sof/Vel should all work.

    I expect going a little longer than 12 weeks would be good insurance and that skiping Ribavirin would be ok.

    We can do (and have done) triple Rx now with available meds but I really don’t think you need it. Would not hurt, but a bit more expensive.

    Triples that can be done right now:

    Simeprevir+Sof+Dac
    Asunaprevir+Sof+Dac
    Paritaprevir+Ombitasvir+Sofosbuvir (Viekira+Sofosbuvir)

    The NS3A components are all originator but come from countries where the prices are much more reasonable.

    You could probably use Sof/Vel with Simeprevir or Asunaprevir but I have not looked it up.


    YMMV

Viewing 15 posts - 796 through 810 (of 1,968 total)