Recommendations Before you Start Treatment

[lporterrn]

Here are the latest pre-treatment guidelines: http://hcvguidelines.org/full-report/monitoring-patients-who-are-starting-hepatitis-c-treatment-are-treatment-or-have:

Recommended assessments prior to starting antiviral therapy
Assessment of potential drug-drug interactions with concomitant medications is recommended prior to starting antiviral therapy.

The following laboratory tests are recommended within 6 weeks prior to starting antiviral therapy:
Complete blood cell (CBC) count; international normalized ratio (INR)

Hepatic function panel (albumin, total and direct bilirubin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels)

Thyroid-stimulating hormone (TSH; if IFN is used)

Calculated glomerular filtration rate (GFR)

The following laboratory test is recommended within 12 weeks of starting antiviral therapy:
HCV genotype and quantitative HCV viral load

[sunrise]

Hi Lucinda
      I hope you are well. I read alot about you and have much respect.  My question is: I am to start S/O treatment in a week. My liver condition is F0-F1  which is unbelievable since I am geno 1a, 23 yrs in and 5 mil VL. I will do this tx but if unsuccessful, will I be able to do the new Gilead one pill? And will the combo im taking hurt my liver? Thanks for a reply

[lporterrn]

Wow Sunrise - I am shocked you could get this treatment. Either you have fantastic insurance or it is a mistake, and you slipped through. I assume you live in the U.S.

I don't know if you will be able to use the new pill - we don't know since the decision will be made by your insurance company. It won't hurt your liver - it will help it.

This is a tough issue, and one that I am going to give you something to discuss with your doc. You haven't asked me this directly, but I think it is worth mentioning, since you brought up the issue of whether or not you will be able to get the new treatment.

You have a "bird in the hand vs 2 in the bush" situation. On one hand, you have been approved for and are ready to start a combo of pills that have quite high response rates. Although we don't really have data that fits your situation, since your disease is so minor. The side effects are not too bad, and you can see this by looking through the other posts on this forum - of which there are quite a few. Photosensitivity is the most troublesome one. It's a good regimen, and one that in 12 weeks, you will likely have a favorable outcome.

Versus - a pill a day that also has high cure rates, slightly easier side effect profile, and may be approved for only 8 weeks (although we won't know for sure until some time in the next 2 weeks). When approved, it will take awhile for insurance and pharmacies to organize, so it probably won't be available immediately.

What makes the Sovaldi/ledipasvir a stronger choice in my mind is the long-term. Read this Hep News: http://www.hepmag.com/articles/Sovaldi_ledipasvir_liver_2501_26199.shtml This coupled with the strong results for genotype 1a, and the milder side effects. But is it worth giving up the bird in the hand? That is for you and your doc to discuss. No wrong decision here.

[sunrise]

Thank you for your response Lucinda. I read the article and that is wby I am concerned. My condition unfortunately is progressing more rapidly so that is why my dr wanted me to start tx as soon as possible. I have anxiety issues and am not a candidate for inf. I do feel blessed to get the S/O treatment. It seems that Olysio and ledaspivir are similiar and the Olysio will do the trick. I am praying. I will keep you up on my progress. Thank you

[lporterrn]

I may be able to help you take your anxiety down a notch - I don't know what you mean by

My condition unfortunately is progressing more rapidly

, but with the minimal liver damage you have, the fact that you are female, and only 23, you likely have 20 to 40 years before this is a huge problem. This will not get you quickly.

[sunrise]

Hi Lucinda
     I think I wrote the facts wrong. I am 58 and have had HCV 23 yrs. I was diagnosed in June. I have inflammation and it is progressing rapidly.  Sorry about that :-)

[lporterrn]

My bad - I read that wrong, but you did say that the fibrosis was 0-1, is that correct? If so, that is even more encouraging if you've had this 23 years and only at that stage.

[sunrise]

Thank you Lucinda
          Yes I was shocked when tbe dr told me it was alittle inflamed. I feel very lucky that for all these yrs I haven't developed cirrhosis. I never drank alot or at least not often. Guess its just our bodies and how things can progress. I took my 1st dose at 6pm. Got my meds today. Also got some troubling news. My followup mammogram and ultrasound.  I have to get MRI. Just worries and didn't need this as I really want to focus on tx. Hope it isn't serious. I will try to stay positive.  Again, thank you for your help :-)

[lporterrn]

Congratulations on beginning your new journey. If you ever feel like you are losing your positivity, check in here - we'll help if we can.

[sunrise]

You bet Lucinda
         I will! Its really a Blessing to have people in the world like you and others that care. Take care and goodnight...

[lporterrn]

OK Sunrise, now I know how your got your name, because I felt the sun rise with your kind words.