1st bloodwork after 4 weeks of treatment - what's riding on this?

[Ian]

Hello,
I'm finishing up my first 4 weeks of a 12 week Viekira (no riba) regimen. I'm going in this week to get my first bloodwork to see how the treatment is working. I'm a bit anxious as you can imagine. What can I hope for at 4 weeks, and what would it mean? If I hopefully find that I'm undetected, would that be a good sign that I'm ultimately going to achieve SVR? Or alternately, if I still have a lot of the virus left would that mean my chances are worse to get SVR?

Thanks!
Ian

Genotype 1a
4 weeks into Viekira (no riba)
treatment naive
33 years old
Viral load at treatment start: approx 5 million

[gnatcatcher]

Ian, if you're only "a bit anxious," you're doing a whole lot better than most of us did at that point   You're extremely likely to see a very large drop in viral load, and if your ALT and AST were high, they will probably be better, too. It doesn't matter if your VL has gone all the way down to undetected -- with the new meds, there are forum members who were still detected at the end of treatment but who went on to achieve SVR12 (meaning HCV was undetected on the 12 weeks post-treatment labs, so they are considered cured).

One of our moderators, Lucinda Porter, RN, posted a Q&A article that explains this. Here's the relevant excerpt:

Q: I just finished HCV treatment, but my viral load was detectable at week 8 and 12.  Does this mean my chances of being cured are low?
A: No. In the old days, back when treatment was long and used interferon, there were clear milestones that helped us know what our chances were of permanently clearing hepatitis C. Now with new direct-acting antivirals (DAAs), things have changed. Research by the NIH Clinical Center showed that low levels of HCV RNA at the end of treatment are not predictive of treatment response among patients with hepatitis C virus treated with interferon-free regimens. (Clinical Infectious Diseases, March 2, 2015) Harvoni was used in this study, but the trend is likely to apply to all treatments using HCV DAAs.

and here's the link to the entire article: http://www.hepmag.com/articles/hepatitis_c_questions_2502_27873.shtml

You can relax now. (Easier said than done -- my mouse hand was shaking when I got the email that 4-week results were posted on my patient portal).

Gnatty

[Philadelphia]

I saw a massive drop in VL and liver markers come back to normal range. I wasn't UND by 4 weeks but I was close (40). I hit UND by 8 weeks.

I think you will see something very similar but better, as your liver is no doubt in better shape than mine. All the best, report back!

[Ian]

Hi,
I'm excited to report, I just heard my results are undetected at 1 month in of viekira (no riba). very grateful for this news. Does this increase my likelihood of svr? I'm curious because I'm 1a but chose to not take the riba (with my dr's support) though it was prescribed, and this reduced my likelihood of svr down from 97 percent down to 90 percent. Since I'm undetected at 4 weeks, would you say I'm out of the woods, and don't have to worry about that 7 percent anymore?

Thanks so much for your insights.
ian

[BillT]

Let me do it this way Ian,
                                    Nobody will tell you it's 100% but showing UD at 4 weeks is very,very promising.Throw their percentages out the window because everyone is different on these meds.There's been some discussions here on whether the riba's are needed but it sounds like you're doing well without them.Just focus on finishing the treatment at this point and getting to the end.You should be thrilled with the news and I'm glad for you.

[dragonslayer]

Ian, I see you are gt 1a..   With the meds you are taking, I thought Riba was part of the protocol?  How come it wasnt prescribed for you?

Regarding  on treatment viral loads, I cant speak specifically about Viekira, but with Harvoni, on-treatment testing often created more anxiety than it was worth.  Most folks cleared while on treatment. However, many others like yours truly were detected at EOT and even at 8 wks post treatment, and still went on to achieve SVR.

[Ian]

Hi,
Thanks for the replies, very good to hear but definitely not counting my chickens yet. Wow, such a strange thing that it could be detected post treatment but ultimately be eradicated.

Dragonslayer, yes as a gen 1a I was prescribed the ribavirin, but after looking at the pearl 4 trials and finding that even without riba the efficacy was at 90%, I talked with my doctor and considering the impact the side effects could have on my work, and the potential for birth defects we felt it was worth the risk to forgo the riba. It was a tough call but I felt it was 100% the right decision for me. Just hope it works out, of course!
Ian

[chino1969]

4 weeks undetected is very good news.  While I realize it is early, keep a positive attitude.  I'm pulling for you to beat this.  I finally did after two previous failed attempts.  Hang in there.

[beto]

Riba Schmiba...dude you so got this

[cfreeby60]

First post on any fourm, I am going for my 4 week Harvoni blood work on Tuesday.
I started nov. 3/15. I`m only oked for 8 weeks by my insurance co.. as they are saying there is no proof the extra 4 weeks are needed in my situation.
Was wondering if being gen type 1a and 1b was more of a problem?
From what I`ve read here I have yet to see anyone else dual effected (thou I`m sure there are).
I have had hepc for probably over 40 years and was diagnosed in 04.
Only asked 3 weeks ago what my vl load was, and it`s 1.333 million.
Thanks for this forum it seems to be a god send for many,many, folks!






 

[BillT]

Hi CF and welcome to the forum,
                                              Wishing you luck on your 4 week labs.That's odd that you mention the 1a/1b co-infection because I was just last night wondering if that was possible.I hate insurance companies and them making decisions that should be left up to the doctors.Wait and see how you labs come out and go from there.If your's decides you need more then I would start pushing for it now.Good luck.

[gnatcatcher]

Welcome, cfreeby60 [nice moniker!] -- coinfections aren't rare, according to Lucinda Porter, our RN moderator: http://forums.hepmag.com/index.php?topic=3056.msg25203#msg25203
   Looking at the Harvoni Prescribing Information Table 6: 1a is the tougher of the two to reach SVR12, but it's still very good at 93% for 8 weeks of treatment. 1b reaches 98% at 8 weeks or 12 weeks. I'm guessing that because you have some 1b in the mix, your odds are better than if you had 100% 1a.
   You don't say what your fibrosis score is, but assuming you don't have cirrhosis and have never been treated for HCV before, you stand an excellent chance of being cured on 8 weeks of treatment. As Bill indicated, if the vl on your 4-week labs isn't undetected or close to it and/or your alt and ast aren't in the normal range, ask your doctor whether it'd be a good idea to push asap for 12 weeks. Please let us know your lab results when you have them. Chances are, we'll be saying Congratulations. However, if need be, I or someone else can find you the links about how to build the strongest case to get the extra 4 weeks.

Gnatty

[Madelief]

Hi cfreeby60,
I started 1 day before you and had bloodworks last monday and the HCV was already undetectable!!
I hope the outcome will be the same for you, it is also possible I read somewhere with both genotypes , good luck!!
Madelief

[cfreeby60]

That's terrific news Madelief. I`m hoping for the same!
Yes Bill insurance companies are nothing more than a necessary evil.
My work just changed carriers as I was getting my Harvoni approved.
The new carrier 3 years ago denied me mortgage ins. because I happened to be hepc
positive. Now they get to foot the bill (no pun)! Timing CAN be everything!!!
I've had 2 fibrascans Gnat and was told other than fatty liver it looked good.
When diagnosed I was told level 1 progress and 0 damage. I've never been told my alt/ast #s. Back in the day I was told I had the opportunity to wait for the new meds.
I`m also dealing with complications from radiation therapy for an eye melanoma, which has damaged my retina. Being off work for that (#2 of a possible 4or5 surgeries)was the perfect time to start treatment.
Thanks for all the good wishes and Happy TGing to all!!! I had mine back in Oct.

[slats1056]

 Hey All You Newbies out there, I have been out of touch for a couple of weeks & am just getting caught up on recent events & posts.
 Thought I would throw this in, just ask the nurse or doctor for a copy of Your file and they should provide it to You no problem. It will have all Your blood work and Labs, to glean all the info. that You see on everyones signatures
  Good Luck, Good Health, And Happy Trails To You. Oh Yea, plenty of good old h2o and laughter is mandatory with treatment.
 THINK YOU ARE GOING CRAZY??? GREAT, LOOK ME UP WHEN YOU GET THERE AND I WILL SHOW YOU AROUND!