12 week post blood work

[PaulG]

Went and had post 12 week blood work and got some of the results back. Still waiting on the viral load results, but not looking good. My Alt and Ast are back to pre treatment level. I was on a 8 week Harvoni treatment and at 4 weeks still had a 35 viral load and was never re tested again that and not having a liver biopsy for over 12 years and could have cirrhosis made me want to have at least a 12 week treatment. But the doctor said no. To say the least I'm not a happy camper today! I'll wait until the viral load to come in but hold little hope.

[dragonslayer]

Hi Paul,

I understand your concern, however I think it's too early to worry, especially since you're basing your fears on fluctuating liver enzymes.

Like you, I completed 8 wks of Harvoni treatment.. My EOT level was detected 29.. I was extremely upset, and proceeded as though I had failed treatment. .My doctor told me to get another test, which I did at the 7 wk mark.. Lo and behold, it was still detected but had been reduced to < LLOQ(12)...  Since viral replication will usually commence rapidly at the end of treatment if the virus isnt cleared, the fact that it went down to unquantifiable  after 7 wks post treatment indicated to my doctor that I was probably  SVR.  We'll know more in a week as I go for an 11 wk post treatment test tomorrow.

You were 35 half way through treatment... You dont know your EOT VL but it was likely lower than that.  There are studies showing that low detectables at EOT are  not predictive of treatment failure with Harvoni... Listen, its possible both of us will exhibit relapse, but for now , until you see your 12 wk VL, relax a little.. Its too early to jump to conclusions.

BTW, how long before you get that result?

[PaulG]

Just talked with doctor and agree most likely return of virus

[dragonslayer]

based just on the liver enzymes?  That sucks.. How high did they go?

[Mike]

Hey Paul G,

Hang in there and  wait for the VL results. It an'it over till it's over!

Best wishes, Mike

[charly8]

Paul,

Sorry to hear this.  Hold out hope for the VL though.  If not newer options are coming soon.

Some questions though. 

You had a biopsy 12 years ago that was F3? 

At 2.5 mil vl and 1a genotype?

If so, I am surprised the doc did not try for the 12 weeks.

[dragonslayer]

>>Some questions though. 

You had a biopsy 12 years ago that was F3? 

At 2.5 mil vl and 1a genotype?<<


Charly, maybe Ive lost my ability to read, but where does he say he had a VL of 2.5 mil or a biopsy result of F3?

[charly8]

>>Some questions though. 

You had a biopsy 12 years ago that was F3? 

At 2.5 mil vl and 1a genotype?<<


Charly, maybe Ive lost my ability to read, but where does he say he had a VL of 2.5 mil or a biopsy result of F3?

I looked at his previous posts to see some background

[dragonslayer]

Ah.. Thanks .. Thought I was going nuts!

[charly8]

Paul (dragon), what was your ALT post tx?

[dragonslayer]

Paul (dragon), what was your ALT post tx?

Right.. this thread is even going to get more confusing with two Paul's in it!   Re liver enzymes, my doctor didnt run any enzyme tests.... I guess he figured they pale in comparison to the Viral Load results.  If a test is ordered for Viral Load, I kind of agree that the enzymes dont have much significance in comparison and if recent biopsies show little to no damage.

I happened to get a physical with my PCP, however,  2 days after EOT... The results of that were AST: 25; ALT: 44, both registering normal.

[charly8]

Its funny how different doctors are about the tests.  My doc (seems way too conservative) has me doing a CBC, VL, LFT and the whole works at weeks 0, 2 on tx, 4tx, 8tx, 12tx, 4 post tx, & 12 post.  It seems a little bit much if you ask me.

[dragonslayer]

I agree.. Seems like a lot .   I think perhaps its got something to do with the condition of your liver, and the fact that this isnt your first go around with treatment. 

BTW, am I reading your sig right?  You improved 2 stages in your Fibrosis score in just a few months?  Or, do you attribute that to the fact that you took 2 different types of tests? ... As weve read, in the mid range, both of your non invasive tests are not terribly accurate, so thats what Im guessing is going on...  Or, it could be rapid improvement in your liver health due to the influence of treatment.. Hard to say, but if its not due to test type difference or inaccuracies, you must be pretty happy about those results!

[PaulG]

Yes I'm waiting on the viral load and hoping. But I fill my doctor didn't do what she should have To assume a over 12 year old liver biopsy F3 holds enough weight to justify a 8 week treatment  with just a 4 week blood test . She also agrees it is probably back

[dragonslayer]

Yes I'm waiting on the viral load and hoping. But I fill my doctor didn't do what she should have To assume a over 12 year old liver biopsy F3 holds enough weight to justify a 8 week treatment  with just a 4 week blood test . She also agrees it is probably back

Paul, you know, Im not saying this applies to your particular doctor, but many doctors are using old lessons learned in earlier treatment methodologies..  When I tested at a VL of 29 at EOT, my doctor too started talking about clinical trials and other retreatment options available to me .... But he also suggested I retest, and when I did, 7 wks later, the VL was no longer measurable.  All Im saying is that AST/ALT have traditionally been poor indicators of viral strength, etc.  If this is the ONLY indicator anybody has right now for your treatment success or failure, ie, a VL of 35 halfway through treatment, and elevated liver enzymes at EOT, thats really not a lot to go on..  She may be right, but its puny evidence.  Youre really better off trying to be positive until you get the VL result.  Stranger things have happened than this working out well for you..   BTW, you never posted how elevated your liver enzymes are.

[Mike]

I'm with Dragonslayer,

You need to wait for the VL. Elevated liver enzymes can be caused by a lot of different things and don't necessarily mean the virus is back.

How elevated were the enzymes? Were they in range...just higher than the last test?

Best wishes, Mike

[charly8]

BTW, am I reading your sig right?  You improved 2 stages in your Fibrosis score in just a few months?  Or, do you attribute that to the fact that you took 2 different types of tests? ... As weve read, in the mid range, both of your non invasive tests are not terribly accurate, so thats what Im guessing is going on...  Or, it could be rapid improvement in your liver health due to the influence of treatment.. Hard to say, but if its not due to test type difference or inaccuracies, you must be pretty happy about those results!

You are right I was pleasantly surprised at the Fibroscan.  I think both are inaccurate but my doc thinks I am probably an F1 or an F2, as my previous biopsy 4 years ago was a F0 to F1. 

[dragonslayer]

Hi Charly,  Im curious as to why your Dr added Ryb 1 month into treatment to the harvoni?  Usually, Ive only seen this done with some tough cases with Cirrhosis.  Was it because of your treatment failures in the past?  But if so, youd think it would have been prescribed right from the beginning with the Harvoni if that were a particular concern.  I havent read any trial data indicating a particular reason to do this.  And from your sig, it looks like all your on treatment testing before the addition showed Undetectable..... Any thoughts why it was added?

[charly8]

Hi Charly,  Im curious as to why your Dr added Ryb 1 month into treatment to the harvoni?  Usually, Ive only seen this done with some tough cases with Cirrhosis.  Was it because of your treatment failures in the past?  But if so, youd think it would have been prescribed right from the beginning with the Harvoni if that were a particular concern.  I havent read any trial data indicating a particular reason to do this.  And from your sig, it looks like all your on treatment testing before the addition showed Undetectable..... Any thoughts why it was added?

Well at the time I was showing F3 on the Fibrosure.  I am also tx experienced.  So I was pushing for 24 weeks being so close to the 24 weeks protocol.  Wanting to give myself the best chance at being done with this nasty virus.  My doc said that he did not think the insurance would cover it.  So he said I could do the Riba at my option as the next best thing.   I decided to do it because, in my group tx experienced without cirrhosis the relapse rate was 3% with Riba instead of the 6% without Riba.

He also said that he would order me a Fibroscan because of the inaccuracies of the Fibrosure.   If it turns out I was F4 on the fibroscan then that would justify the 24 weeks, but the fibroscan came back much better at F0/F1.

[Lynn K]

Hi

Your liver functions could mean little you should have a better idea soon.

Just for reference here are my results from last year when I relapsed on Sov Oly my pre-treatment  LFT scores were
 
3/14/14           ALT 61 AST 44
EOT 6/11/14     ALT 29 AST 25

I was not detected at week 4 and at week 12 EOT

12 weeks later I got my Liver functions back first
09/03/14         ALT 56 AST 45

a few days later I got my viral load result also drawn 9/3/14

HCV RNA RT-PCR, QT      2,422,260 IU/mL
HCV LOG 10                   6.384  log10 IU/mL

Not to say that is where you are now and I hope not but thought you would like to know.

What was your pre-treatment ALT/AST and what was the result you just received?

best of luck to you

[dragonslayer]

PaulG..

When are you expecting your recent Viral Load test results?  Must be getting close to that time now..

[lovinglife]

Thanks for asking. Expect next results a week from today. At 8 weeks I was undetected.  Wish me luck in the long run -- sick of this problem!!!!  And good luck to you.  I sure hope I am in that 98% of sustained undetected, been waiting years for this!!

[dragonslayer]

LovingLife, are you PaulG?  Namechange?

[debham]

Good Luck Lovinglife!!!

[lovinglife]

Nope, not Paul. Call me Linda- do not post much, but I kinda recognize some of your names.  Best to all!
  (PS: are you guys seeing a good sustained -12 week- undetected post 12-week for MOST Harvoni people?  I think this disease has made me neurotic because I see someone here reportedly fail on Harvoni treatment and get to worrying! I am so tired of worrying!  Is this drug as good as they say in the long run...?). We are Harvoni pioneers I guess - lol.

[PaulG]

HCV RNA Viral Load 4,833,657 twice as high as when I started Not that it means anything. I have learned a lot. First is if a doctor is going to go with a 8 week treatment make sure before you start  go get a old fashion liver biopsy Do not trust a blood LabCrop HCV Fibrosure test  Next make sure and do your own research do not believe it just because your doctor says he or she is following recognized guidelines. If anyone wants more information please message me as I don't feel this is the place to post anymore information then what I have. Thanks and I'm not worried I will beat this  Have a great day
Paul

[charly8]

Sorry to hear this PaulG. 

Thanks for getting back to us and good luck there is a lot of other meds on their way.

[Mike]

PaulG,

I'm really sorry to hear this and I know this wasn't the result you expected.

I know this doesn't mean much now - but I'm confident that you'll beat this in the near future.

Take a step back, get your perspective and we'll help you step forward.

Sincerely, Mike

[dragonslayer]

Wow PaulG.. That really sucks.  I was hoping you'd hit SVR, but I guess youll have to wait til next time.. But dont worry, you will kick this thing.  Loads of options will be available soon, and this episode will be but a distant, bump in the road memory.

[Bituman]

Thanks and I'm not worried I will beat this  Have a great day
Paul

With this kind of outlook PaulG, for sure you will beat this.  No doubt about it.  Have a look at some of the treatments on the horizon.  http://hcvdrugs.com/detailed_ref.html

What cures you will likely be something even more advanced than what all of us are taking.  Not if, but when. 

All the best,

Bob