Hi Tim,

I presume you’ve been checked for Hep B? If not have that done. Also have your iron checked to see if you have haemochromatosis, and your blood sugar to make sure you have not become diabetic.

B12 supplements seem to have helped some of my patients so they might be worth a try.

I expect to pass through this world but once. Any good, therefore, that I can do or any kindness I can show to any fellow creature, let me do it now. Let me not defer or neglect it for I shall not pass this way again.

https://en.wikiquote.org/wiki/Stephen_Grellet

I’ve signed the petition and sent an email

Hello, I have a question for Dr. Freeman, I just started my TX with sof/led 12 wks, now 7 days, and I believe I may also have hep B from 2004. Not sure if I need to alter the Tx at this point with addition medication. Thanks.

Most (95%) immunocompetent adults will clear Hep B whereas only 25% of people can clear Hep C.

To see where you are at please get these 3 tests done ASAP

Hep B surface antigen
Hep B surface antibody
Hep B core antibody

If you do have chronic Hep B you need to take entecavir 0.5 mg daily because without it you will probably have a Hep B flare within a month. Note that Tenofovir is not recommended for Hep B in patients taking DAA agents.

Hello PJ,

Chances are very good you will clear and the 4 week result of 16 is within both expectations and practical experience. Yes we do see 0 and <15 but when the trials were being done tests were less sensitive so they were counting down only to <25

Can you post your liver function results - hard to comment without the numbers.

Any drug can cause elevated liver enzymes so it could be the drugs themselves or something else.

The something elses include Hep B and Haemochromatisis high up on the list with a long tail of other possibilities. Just because you have HCV does not mean you can't have gallstones, fatty liver, Gilbert's disease and the list goes on.

Being co-infected with Hep B is a gotcha - patients with Hep B must have entecavir with their DAA treatment because the HCV holds the HBV at bay - like weed mat or ground cover plants in the garden stop the weeds.

You have my email so pop the results through there if you don't want to post publicly.

Hi Bob,

Please read the n=468 trial of Sof/Dac+/-Riba here: http://fixhepc.com/forum/gt3/369-gt3-high-svr-rates-with-daclatasvir.html

Mostly F3/F4 so your profile.

SVR rate was slightly higher (not statistically significant) in ALL the -Riba arms who did 24 weeks.

On that basis it’s hard to argue that Riba really helps so it would not be completely insane to not take it.

If you have it you won’t get serious sides starting until about week 4 and it does help rapidly drop viral load so doing a few weeks +Riba and stopping at the first sign of trouble might be one way to look at it.

So I think that deserves the happy dance! # dance