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Author Topic: What test is done 4 week post treatment  (Read 9014 times)

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Offline MommaT

  • Member
  • Posts: 65
  • Tomorrow Is a New Day
What test is done 4 week post treatment
« on: October 06, 2016, 12:36:07 pm »
Hi-Can anyone tell me why my Dr is only checking the Viral Load? why not ALT/AST-as you can see that mine are REALLY HIGH! Thanks!
62 year old Female
Treatment Naive
Genotype 2b
2001 Dx Donated blood after 9/11
2002 Biopsy F1
2016 Fibroscan 15 F4
Comp Cirrhosis Stage 1
pretreatment VL 1,722.660 mil
platelets 122 low
alpha 2 Macroglobulins 647
Apolipoprotein A-1 214
GGT 67 high
AFP Serum Tumor Marker 11.4
ALT 563 AST 332
2016 Sept 16 Epclusa started
4 wk VL <15 HCV Detecte
ALT 19 AST 18
8 wk VL HCV Undetected!
12/8/16 EOT Yipee!
12 wk VL HCV Undetected
SVR 12
SVR  24  10/5/2018 HCV Undetected   12/10/18 DETECTED????????

Offline Gaj

  • Member
  • Posts: 172
  • Optimist
Re: What test is done 4 week post treatment
« Reply #1 on: October 06, 2016, 07:35:56 pm »
Hi MommaT,

While your ALT/AST levels are moderately high they are not alarmingly so and after 4 weeks Tx they will have dropped....a lot! They do for all of us but while knowing how much will probably make you feel better it won't inform your doctor how well you are responding to treatment as the rate of decrease varies from person to person and doesn't directly indicate the rate of cure. On the other hand your VL result will tell him how quickly the Tx is working and whether you are undetected for the virus, he may also be required to submit the VL results to your insurer.

I imagine he will test them at other stages of Tx but if you are really worried by it maybe you could ask him if he will include ALT/AST now for your peace of mind?
« Last Edit: October 06, 2016, 07:39:23 pm by Gaj »
Male - 61 years
Genotype 3a (since 1978?)
Diagnosed 2012
Treated 2013 PEG/Riba/Dac (Relapsed)
F4 - HCC#1 Resected 06/15 - #2 RFAblated 11/15
11/18/15 Commenced Generic Tx - Sof/Dac/Riba (24wks)
Pre Tx = ALT: 270  AST: 209  ALB: 31
05/05/16 = ALT: 34  AST: 32  ALB: 40  VL: Undetected (EOT)
06/16/16 = Relapsed
06/23/16 = ALT: 92  AST: 59  ALB: 40  VL: 290,770
01/12/17 3rd Tx - Zepatier + Sofosbuvir (16wks)
05/03/17 EOT und
06/22/17 SVR7 und
07/27/17 SVR12 UND!
10/26/17 SVR24 UND & Cured!!!

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,544
  • Get tested, get treated, get cured, fight Hep c!
Re: What test is done 4 week post treatment
« Reply #2 on: October 07, 2016, 11:16:36 pm »
Are you asking about 4 weeks while on treatment or 4 weeks after you have finished treatment?
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline MommaT

  • Member
  • Posts: 65
  • Tomorrow Is a New Day
Re: What test is done 4 week post treatment
« Reply #3 on: October 08, 2016, 08:31:02 am »
Hi Lynn-
Yes,,,,, 4th week While ON Epclusa treatment, sorry! I did get scripts VL only 4, 8 and 12 week Started 9/16-so labwork 10/14 11/9 and 12/? forget. I would love to see ALT/AST-and the labs showing how my body is tolerating the meds-I think it is recommended by Liver Associaton? I will find article.

Thanks for all you r great advice!
62 year old Female
Treatment Naive
Genotype 2b
2001 Dx Donated blood after 9/11
2002 Biopsy F1
2016 Fibroscan 15 F4
Comp Cirrhosis Stage 1
pretreatment VL 1,722.660 mil
platelets 122 low
alpha 2 Macroglobulins 647
Apolipoprotein A-1 214
GGT 67 high
AFP Serum Tumor Marker 11.4
ALT 563 AST 332
2016 Sept 16 Epclusa started
4 wk VL <15 HCV Detecte
ALT 19 AST 18
8 wk VL HCV Undetected!
12/8/16 EOT Yipee!
12 wk VL HCV Undetected
SVR 12
SVR  24  10/5/2018 HCV Undetected   12/10/18 DETECTED????????

Offline MommaT

  • Member
  • Posts: 65
  • Tomorrow Is a New Day
Re: What test is done 4 week post treatment
« Reply #4 on: October 08, 2016, 09:10:51 am »
Hi Gaj and Lynn

Here is what I read for Antivirals follow up care -and drug interaction by drug info. etc

http://www.hcvguidelines.org/full-report/monitoring-patients-who-are-starting-hepatitis-c-treatment-are-treatment-or-have

I am Compensated Cirrhosis and No immunity to Hep B-just saw on my blood work
62 year old Female
Treatment Naive
Genotype 2b
2001 Dx Donated blood after 9/11
2002 Biopsy F1
2016 Fibroscan 15 F4
Comp Cirrhosis Stage 1
pretreatment VL 1,722.660 mil
platelets 122 low
alpha 2 Macroglobulins 647
Apolipoprotein A-1 214
GGT 67 high
AFP Serum Tumor Marker 11.4
ALT 563 AST 332
2016 Sept 16 Epclusa started
4 wk VL <15 HCV Detecte
ALT 19 AST 18
8 wk VL HCV Undetected!
12/8/16 EOT Yipee!
12 wk VL HCV Undetected
SVR 12
SVR  24  10/5/2018 HCV Undetected   12/10/18 DETECTED????????

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: What test is done 4 week post treatment
« Reply #5 on: October 08, 2016, 11:15:51 am »
Hi MommaT -- What we've seen on this forum is that lots of doctors order different tests at different time lines, despite what the AASLD guidelines recommend.  It seems to be at the discretion of each care giver. My doctor ordered VL & full comprehensive blood panels, plus INR at 4, 8 & 12 weeks, while many others do not.

I think when new info comes out next month at the AASLD Liver Meeting in Boston we'll be seeing some new guidelines on testing. I understand why you'd like to see your AST & ALT numbers, but if your viral load shows a significant drop (2 log is what is preferred), the inflammation in your liver will also have dropped. It just depends on your doctor's preferences.

But you can ask him/her! No harm in that.  Keep us posted, FT
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline Lynn K

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  • Member
  • Posts: 4,544
  • Get tested, get treated, get cured, fight Hep c!
Re: What test is done 4 week post treatment
« Reply #6 on: October 08, 2016, 11:57:49 am »
Just what I was going to say about ALT and AST viral load testing is of little value on treatment and is a relatively expensive test but as your liver tests are higher I could see you checking with your doctor about having a liver panel done.

I have a history of anemia on ribavirin so when I started with riba I was tested for CBC weekly.

Good luck
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline andrew j

  • Member
  • Posts: 477
Re: What test is done 4 week post treatment
« Reply #7 on: October 08, 2016, 07:32:34 pm »
It's odd.
Usually, if they are going to go for one or the other - they'll go for liver function
at 4 weeks, a) because it is much cheaper than VL, and b) because it indicates 'generally' whether or not the treatment is working.
That's what was scheduled for me at 4 weeks.

Usually if you're getting VL, liver function is automatically included.
Maybe that'll happen in your case?

As the others write: Can you check it out with yr. Dr?
« Last Edit: October 09, 2016, 12:09:52 am by andrew j »

Offline andrew j

  • Member
  • Posts: 477
Re: What test is done 4 week post treatment
« Reply #8 on: October 08, 2016, 09:25:53 pm »
... What yr Dr probably meant was that s/he wants to get a VL test done [in addition to the normal tests (incl. liver function)] - without having said so in as many words.


Offline Lynn K

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  • Get tested, get treated, get cured, fight Hep c!
Re: What test is done 4 week post treatment
« Reply #9 on: October 08, 2016, 10:02:00 pm »
Really everyone will either test not detected or a very low viral load on treatment.

The only thing on treatment viral load testing does is confirm patient compliance and for those who are weakly detected it can cause unnecessary anxiety. That is why on treatment viral load testing is of little value.

The only viral load test that means anything is 12 weeks after treatment was completed.

Being not detected on treatment does not mean cure and for those who are still detected on treatment or even at end of treatment that does not mean failure.
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline andrew j

  • Member
  • Posts: 477
Re: What test is done 4 week post treatment
« Reply #10 on: October 09, 2016, 12:11:53 am »
Yes, Lynn.

(I've modified my first post) ...




Offline Lynn K

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  • Member
  • Posts: 4,544
  • Get tested, get treated, get cured, fight Hep c!
Re: What test is done 4 week post treatment
« Reply #11 on: October 09, 2016, 12:52:56 am »
No worries Andrew I totally understand how it is reassuring to see not detected on treatment. I was quite happy with seeing not detected on treatment but I can't imagine how I would have felt if I had a result of low level detected.

So if someone's doctor does test viral load on treatment just try not to put too much energy into the result no matter what it is.

Best to all
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

 


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