Recently I have been getting a number of enquires from patients who have just finished their tablets, all asking the same questions, so here is a quick primer. If you are looking for this sort of information you will find a lot more detail in our Frequently Asked Questions and on the Forum.
On treatment 99.5% of patients will drop to <15 on their HCV RNA. This is nice but does not prove cure. We need virtually zero viruses (less than 100 in total) to remain in your system to achieve cure.
When the tablets finish your body starts to remove the medication from your system. Within 24 hours there is less than 1/2, 48 hours 1/4, 3 days 1/8, 4 days 1/16, 5 days 1/32, 6 days 1/64, 7 days 1/128 and by this stage there is definitely not enough of the drugs left in your system to kill the virus.
So with the medicines now below effective levels one of two things happens.
- The virus starts to grow back because there is still some left, or…
- Nothing – ie the virus does not grow back because there is no virus left to grow back
If the virus has not grown back 4 weeks after the last tablet was taken and the HCV RNA PCR remains <15 then there is a 97% chance this will be permanent. We call this Sustained Virological Response (SVR) and because this one happened at 4 weeks we call it SVR4
If the virus has not grown back 12 weeks after the last tablet was taken and the HCV RNA PCR remains <15 then there is a 99.7% chance this will be permanent. We call this Sustained Virological Response (SVR) and because this one happened at 12 weeks we call it SVR12
If the virus has not grown back 24 weeks after the last tablet was taken and the HCV RNA PCR remains <15 then there is a 100% chance this will be permanent. We call this SVR24 but a better word is cure.
Please note this. Your Hepatitis C Antibody (HCV Ab) test will remain positive. Your body produces antibodies in response to infection and these persist for years. For example, if you have Hepatitis B vaccination you will have antibodies that persist for years, and often for life. Similarly to Hepatitis B without an exposure event (booster dose for Hep B, ongoing infection for Hep C) the levels of antibody will slowly fall over time, and may (after 5-10 years) fall below the level we use as a cut off, however, you should expect to remain antibody positive for many years. Cure is a negative HCV PCR RNA and the antibody remains as a marker of past infection.
This period of waiting can be stressful. Forums like https://fixhepc.com/forum can provide useful support.
With the SVR tests liver functions are normally conducted at the same time. These liver function results come back the next day, rather than a week later. If your liver functions remain similar to what they were on treatment (+/- 20%) you can be confident you have not relapsed. I have treated about 3000 patients and, as the statistics predict, seen over 100 relapses. In every case, the patient has been aware of the relapse before the results came back.
If you feel well you almost certainly are, but if you feel unwell it is worth noting that as well as over 100 relapses I have seen about 100 patients assigning every little twinge in their body to relapse (and they did not) so don’t panic if you feel anxious – it’s pretty normal. The result will be what it will be and worrying is about as effective as chewing bubble gum while trying to solve an algebra equation. If you do relapse it’s possible to have another try and the results of take 2 are good although the costs of treatment do double.
It is normal to have some twinges from your liver. It’s been suffering for years and now has the chance to recover. Some patients notice this.
In terms of getting pregnant, you should wait until 6 months after the tablets have finished. Ribavirin, in particular, is known to cause birth defects so you need to leave enough time for it to exit your system.
Finally, if you liver functions are not back to normal after treatment this should be looked into. A small percentage of patients with Hepatitis C also have another liver disease and we (as in doctors) have been assuming it is all due to the Hep C… Here is a list of things to look for if your LFTs do not normalise https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/definition/sym-20050830
