Regret for the things we did can be tempered by time; it is regret for the things we did not do that is inconsolable.

Sydney J. Harris

[video]https://www.youtube.com/watch?v=BQ4yd2W50No[/video]

Besides the fact that I am insanely thirsty all the time

Get your blood sugar checked. Finger prick or urine dipstick – there should be no sugar in your urine.

There are much higher rates of diabetes in HCV patients, and treatment can set it off in some.

Thirst is the most common symptom of diabetes.

From the SVR point of view if you are diabetic ask for metformin to start. SVR rates are better if diabetes is managed properly.

Hi Johnboy,

You are correct that the EOT result is academic, but then again academics are the people who will be looking at the results.

With the late breaker we are putting in a late breaker at EASL. It reports baseline stuff, then EOT, SVR4 and SVR12

With Sof+Dac is it 100% < LLOQ at EOT With Sof+Led it is "only" 96.3% at the moment because we have some missing results. If we can get the missing results then it will be 100% for both at EOT which says "hey, guess what, generics work a helluva lot better than PEG/Riba" So getting the EOT values is important to EASL, and generics, but, as you say, largely academic. Everyone comes up UND at EOT.

We have 33.5% cirrhosis patients in the group we are tracking. This is much higher than most of the published clinical trials.

What we observe is that F3/F4 patients do take longer to reach undetected.

In Gilead’s trials <25 was what was used so you would have been <25 detected, rather than 15 detected at 4 weeks, so it is in line with expectations.

It will go to undetected, maybe through <15, but undetected should really read <10 or <8 because this is closer to the real meaning.

With F4 GT3 you do need 24 weeks treatment to deliver a 90% SVR rate.

Ketogenic diet, B12 and Vit D may assist, but that's speculative at the moment. The "energy slump" some patients get about a month into treatment does seem to respond to B-B-Berocca.

I would not worry too much. It's not the millions of die easy HCV virions that cause relapse. It's the handful of resistant mutants that we simply can't measure.

The observation of slower response does suggest why the extended treatment time is required for F4 GT3

I am not from Russia…
i would serch distribuitors for Romania

I can put you in touch with people in Romania who have accessed generics via 3 different pathways.

You will find:

http://fixhepc.com/getting-treated/how-to-do-it/worldwide-import-regulations.html#ROMANIA

And the section

Medicatie română Regulamentele de import (Romanian Medication Import Regulations)

La sosirea coletului in tara, destinatarul trebuie sa furnizeze firmei de curierat rapid, urmatoarele documente:

1. Fotocopia unui document de identitate valid;
2. O declaratie scrisa si semnata de catre destinatar in care trebuie specificat continutul pachetului, utilitatea produselor, marca, cantitatea, pretul unitar, valoarea totala;
3. Dovada platii la expeditor. In cazul in care plata a fost facuta printr-un tert, acesta din urma trebuie sa furnizeze destinatarului dovada platii catre expeditor. In cazul in care suma platita de catre tert nu corespunde cu valoarea din factura, destinatarul trebuie sa declare scris ca suma aferenta produselor importate este inclusa in dovada de plata furnizata de catre tert.
4. Reteta medicala standard, scrisa in limba romana, semnata si stampilata de catre medical de familie sau specialist.

Taxe aferente importului:

• 9% TVA din valoarea coletului
• 2.5% taxa comision

Plata taxelor poate fi prin transfer bancar in contul ce va fi indicat de catre firma de curierat sau in numerar in momentul livrarii coletului.

I’m sure you can see this was written by a native speaker….

Viral load tests are imperfect.

There is very little viral RNA to to count it we use something called Polymerase Chain Reaction – this amplifies the quantity to something we can count.

The Lower Limit of Quantification (LLOQ) may be 30, 25, 15, 12 or 10 and virus that can be detected, but is at a lower level than this results in a <30 detected, <25 detected, ... <10 detected.

The Lower Limit of Detection (LLOD) is the smallest quantity that can be seen. A test with LLOQ <15 will have an LLOD of around <6 so RNA in the range 0-5 will come back as undetected.

When we see the rapid drop in HCV RNA this is all the easy stuff being killed. The problem is the mutants which are present in low levels. They are present in low levels because they don't grow as fast, but kill off all the faster growing stuff and you are left with the mutants.

Think of it like pulling all the plants out of a garden to leave raw earth. Pretty soon weeds take over the empty space.

So recurrence comes from hard to kill mutants that were present below the LLOD at the end of treatment. In other words the undetected was really "can't detect with the sensitivity required". For this reason we over treat everyone. 8 weeks Havoni for GT1 naive with low fibrosis gets at 121/123 SVR if the viral load is < 6 million to start with. A high viral load is a negative predictor because it says 1) your body is not doing a good job killing it and 2) there are more virions, so more mutants.