Hi Dr Freeman,

I am looking at the ‘Nearly one-third of patients with previous HCC recur after DAA therapy April 14, 2016’.

This article that in the middle states:

1. “A history of previous HCC was the strongest predictor of the development of a new HCC after DAA therapy. The more advanced liver disease and younger age were risk factors for HCC recurrence in the subgroup of patients with previous HCC,” Stefano Brillanti,
MD, assistant professor of medicine, University of Bologna, Italy, said during a press conference at the International Liver Congress 2016.

2.This large, retrospective cohort study included consecutive patients (n = 344) without HIV who had hepatitis C-related cirrhosis of Child Pugh A or B. Patients received various DAA combinations, none of which impacted sustained virologic response or HCC occurrence. Researchers followed them for 24 weeks after therapy concluded.

It is not clear to me with regard to:

1. above – having a previous HCC, by definition seems to be a good predictor of a recurrence of HCC, and I expect regardless of being cured of HepC?

2. above – does this just reflect what is said about HCC recurrence anyway? What was reported about quality of life by participants? Does not really says on the medpage website.

This paper seems to give a double meaning – HepC over the long term causes HCC, but at the same time, getting rid of it precipitates HCC?

The rest makes sense, but does not say how long post HCC the 29 per center’s were were and what treatment they got – transplant, resection, radiation, lipidol?

Have to admit this virus stuff is all very fascinating.

Yours

Jeff

Hi CJ,

hope things go well for your friend and I think that having people that care about him like you has already made him better in his heart.

The RIBA bit on top of sof/dac is something I have an interest in and have two lines of thought.

First it may assist?

Second, I could not cope with it when used with interferon – do I want to make my life miserable on the way through this treatment?

Some of my rationale for treatment given the past HCC is that another HCC can come along for many reasons, and at least feeling better in the mean time is well worth the treatment.

I think this is al individual and something doctors get paid the money to sort out with the individual patient …..

Yours

Jeff.

Hi Mike,

the message I seem to be getting from Ronald Koretz, MD about SVR is that Peg interferon may have done more harm than good??

Otherwise he seems to raise some good points about how this virus will do its best to survive.

Me being F3 in 2012, now probably F4, I have to rely on a common sense view that largely getting rid of the virus and therefore keeping my LFT’s etc under control gives:

1. a small chance that liver and recurrence of a HCC wise, things might get better
2. an assumption that it may slow down the above getting worse.
3. a better quality of life on the way through.

The talk also seems to re-inforce the idea to get treated early before damage occurs. Another thought for me being an early non coper with Interferon is that I may have been lucky – Ronald Koretz, MD’s early part of the talk did not seem to sing its praises too well and my partner at that time comparing it to giving a dog arsenic to cure heart worms come to mind.

yours with thanks for fishing these threads out for us to read.

Jeff.

Hi Gaj,

“On top of all those pathology indicators I feel much healthier, happier and more positive that I have for years. If there is anyone out there reading this and you hasn’t made up your mind about starting treatment, I say “go for it!”. The improved quality of life is a significant payback by itself before you even factor in achieving SVR.”

I get the results of my CT scan tomorrow, and I also had blood tests done which I will find out about as well. Will worry about VL at SVR12 time, or sooner if the old Hep C feelings come back or LFT’s go all over the place. EOT for me is 12th April.

Your last paragraph quoted above rung some chord with me.

I an eternally optimistic about a cure,
but
eternally pessimistic that a cure for me will come anyway but the hard way,
but also
ever grateful that I had a chance to to give this virus a good case of the shits for 24 weeks and have myself feel good while doing it.

Yours

J.

Hi Price,

“And since hep c is glucose dependent, a low carb diet can also help”.

I am into 5 months of Sof/Dac: at EOT, is it worth steering clear of too much sugar in my (occasional) coffee?

Just saw a post on a relapse an starting again yesterday and want to give my my body the best chance of getting rid of any stragglers that are left post treatment.

J.

Hi LG,

“There do seem to be a few with raised BP, some have been really high. Last check mine was up, but not dangerously, must get it checked again. It seems to me it’s the girls who seem to suffer this more or are the boys just being quiet? Maybe it’s something to do with lower body weight ?”

Mine crept up a bit following commencement of treatment and I suspect that a lot of males may be in this category??

Just needed some extra Atacand (checked interactions with DAA’s) and some monitoring a week or so later and things okay. I will know for sure when I finish the DAA’s and plan to ask to halve the Atacand and let the general practitioner see what happens. The surgery I go to is a bit old school and there is always a cuff from the gizmo that measures BP ready to jump on your arm when ever you enter the door.

It is also good to see the percentage chances of having a heart attack reduce on that online calculator they use.

Yours

J.

Hi Dointime,

I agree whole heartedly with the thrust of what you are saying.

Twenty plus years of having my liver stuffed over is not something I expect any doctor or specialist to disregard. But in my case, the automatic fallback is a previous HCC and a hawkish G.P. I have been seeing for yonks sending me back to the specialist all the time.

I think in regard to building some body of knowledge around this subject, we may be at the pointy end of doing so.

As to the future, I am just relying on my belief that competent doctors will both take into account the (hopefully) previous HCV, but at the same time not attribute any and all symptoms to it. Guess that is why they go to uni a lot to be able to do that.

Yours

J.