Hi honker,

Think Em’s gone offline so I’ll try to help.
You don’t need to be in Australia to see Dr if you go via GP2U or similar. The consult can happen over net but you will need to have your Thai medical records with all the details so the Dr can diagnose using those and discussions with you. Then you can forward the script, authorisation and payment. You will need to come to Aust to pick up the meds as the club can’t legally ship overseas though there are other options that could be suggested. How the meds effect you seems to vary from person to person and how badly the hep itself effects you normally. I’m not sure that I would arrange a 7 day wilderness walk but most seem to cope reasonably well with day to day stuff and working and a relaxed holiday should be fairly easy. I started treatment 3 weeks ago and the first couple of weeks was pretty easy, better in fact than pretreatment. I added ribavarin into the mix last Friday and okay till today when I went for my morning walk and to paraphrase Em “whoa, who turned up the gravity?” Still functioning okay, just takes a little more effort to get around. But expected with the ribavarin which I’ve had previously.

Hi Chejai,

That is my fault! They took them away from everyone because I kept Thanking myself and Editing other people’s posts.

Hi miko3,

What we should keep in mind with these slides is that they are intended to provide GIs and heptologists at the conference with the latest available trials results rather than being a means to decide treatment options.

The correct place to be looking for treatment advice is the EASL or IDSP recommendations as linked in the”Getting Treated” section on this site. Those contain a consolidated view of the best recommendations by genotype, liver condition, prior Tx experience taken from a larger database of trials and will have factored in more data recorded during the trial that we are not aware of in the slides. Things such as maybe the cirrhosis patients in one arm of a particular trial turned out to be more forgetful (or headstrong) making them less compliant to the dosage timing causing a biasing of results. Even then you will see that there is a scaling of the recommendations such as Grade A, Class 11 as to how much confidence should be placed in the recommendation.

As to the sample sizes of the dataset, I agree it is not ideal but there are a number of factors that can cause this such as:
– willingness to participate in a trial with a “new” medication
– availability of genotype groupings e.g. Gt2 is relatively easy to treat so less Tx experienced Gt2s around.
– availability of researchers and monitoring staff
– cost of trial (yes I know, but given limited dollars do you trial 1 or 2 new DAAs with thousands or multiple DAAs with 10s or 100s)

As a former trial participant I am very much aware of the massive amounts of data collected during these trials, both physical and psychological. I seemed to be constantly filling in forms, daily forms, weekly forms, monthly forms. What time did I take the tablets? the injections? (within 5 mins), What side effects today? How did I feel physically today? Emotionally? For the week? For the month? All cross referenced with further control questions. Blood tests, physical exams. That was for the 6 months of the trial then continued at a reduced pace as follow up for 18 mths. It exhausted me, goodness knows how the researchers felt! And at the end of the day that trial didn’t prove up the Tx under test so went nowhere*. Oh, and I didn’t end up clearing.
*But gradually all that data comes together in the EASL/IDSP recommendations.

I liked your recent post about real world reporting of results of treatment and hopefully someone is actually doing that diligently other than in the Doc’s Redemption trials.

PS looking at your sig your treatment is going well too!

Hi Panamajo,

I just looked back at your previous posts and see you are F4 cirrhosis. As Archer said please seek medical advice.

G

Just watch out for the Riba rage Paul!

Hi honker,

Do some searching on Google about GP2U Telehealth. If you already have full hep medical history it will make things easier too. The need to treat in Australia would depend on the laws around taking personal prescription meds back into HK. But of course we would love to have you as a tourist for the full time if you want to.

Ah, okay.

Qualitative – just tests whether RNA is present or not. (Yes/No?)

Quantitative – tests whether RNA is present and if so measures how much. (Yes/No? + How much?)

If you have already had an UNDetected/No result then there is no point trying to count how much because the answer is “none”. So you just need the Qualitative from then on to make sure it hasn’t come back. And assuming you keep getting that UNDetected result post treatment then at 24 weeks after finishing treatment you are considered cured with almost zero chance of it coming back. As the Doc says “the Gold standard”!

But so far even those who still had some RNA detected at 4 weeks have all been UNDetected at 12 weeks. Which is what you want.

Hi Lynn,

I suspect that it will be a 12 month rolling calendar for the tests but you will still be entitled to 4 qualitative tests as explained by Dr James below. So you won’t know the amount of RNA on those but if it’s UNDetected then they can’t count it anyway. So once you achieve UND that will be the result that you are given for either test so no point to to doing the qauntitative test then.

In the worst case that you still have significant load at 4 weeks then you could always do one at your own expense (under $200) at 8 weeks but as the Dr. says, all the 12 week results have been UND so far anyway.

http://fixhepc.com/forum/experts-corner/364-viral-load-quantitative-vs-qualitative.html