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Hep C Discussion Forum -> On Treatment -> Sudden elevation of ALT on triple therapy week 25.
Post Info TOPIC: Sudden elevation of ALT on triple therapy week 25.
Midnight


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RE: Sudden elevation of ALT on triple therapy week 25.
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Thanks everyone for the kind words and encouragement.

I'm feeling calmer now and seeing as how the treatment landscape is developing more optimistic too.

I'll be getting on with the day to day stuff from here on in and will let you all know how I get on with future treatments.

 

Best wishes to all



__________________

Genotype 1A, Fibroscan 14, enlarged spleen.
Failed 48Wk triple therapy (Telap) treatment Jan-Dec 2014. 12 Week Harvoni/Riba started 22/12/15...

Week 2; ALT 50 HCV 96
Week 4; ALT 41 HCV 20
Week 8; ALT 34 HCV UND

EOT +4 weeks; ALT 27 UND

SVR 12; ALT 25 UND

SVR 18mths; ALT 26 UND
Tig


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Hey Tony,

I was hoping for better news and am sorry to hear of your relapse. It's never something easy to deal with or understand, but I know you're doing your best. The new protocols keep improving with each trial and after you've had time to recover from 48 weeks of hell, you'll get the opportunity to finally rid yourself of this thing we rightly call "The Dragon". Hang in there and onto the knowledge that your day is coming. We're here for you buddy. Don't hesitate to reach out if you want to talk...

Tig



__________________

Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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malekula man


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Hi Tony,

I'm sorry for your bad news. I know how it feels for first few days. But later you realize that the battle can be won. New drugs, new interferon-free Tx and you will be OK.

Harvoni or Sovaldi + Daclatasvir will be your best weapon if you start now.

The ABBVie's VIEKIRA PAK is not provided for relapsed patients after Tx with any inhibitor (Telaprevir or Incivek/Incivo in your case).

Another player on this market is the combination Grazoprevir/Elbasvir (MK-5172/MK-8742) by Merck (MSD outside USA and Canada) - it will be submitted this year to FDA and probably same time in Europe. I know a guy from Israel who was on studies - he did <15UI/ml 2nd week on Tx, UND for 4th week, SVR-12 and SVR-20, waiting for SVR-24 now.

In same time Gilead announced last November the data of Phase 2 for GS-5816 (Velpatasvir) in combination with Sovaldi (Sofosbuvir)- 100% SVR-12 for relapsed prev TX with cirrhosis, 1Gen without Riba, 12 weeks regiment.

So, you will have soon many option of interferon-free Tx with no side effects, easy going and for 24 weeks max.

Don't give up! My best wishes and good luck!

MM



-- Edited by malekula man on Friday 27th of February 2015 02:05:18 AM

__________________

G1b, stage 4, cirrhosis

Harvoni Tx: Jan-Jun 2015 for 24 wks, SVR12, SVR24

PrevTx : relapser, Sovaldi +Peg+Riba for 12 wks, Jun-Sep 2014

My thread
Cinnamon Girl


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Hi Tony,

I`m so sorry to hear you`ve relapsed after going through the whole 48 weeks of Incivek triple, I can only imagine how totally shocked and disappointed you must be feeling and I really sympathise.

Sovaldi has been delayed by the NHS for general use in England because of budgetary considerations although some people are getting it now with either Ledipasvir (as Harvoni) or with Daclatasvir but only through a compassionate use programme.  The situation should change though later in the year, as Malcolm said, and you`ll need a good break now anyway before starting another treatment.

Give yourself time to come to terms with this and recover, physically and emotionally, from the treatment and try to forget about Hep C for a while.  Your time will come and the next treatment options for you will be far easier and more effective too. 

Wishing you all the best of luck, take care of yourself!  smile



__________________

Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 
mallani


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Hi Tony,

To relapse after going through the 48 week Incivek ordeal is a real bummer.  Next time will be a lot easier.

I would avoid another Interferon treatment as it does not seem to work for you.

You shouldn't take another antiprotease like Simeprevir, as any Incivek RAV's are also resistant to Simeprevir.

Hang out for Sovaldi and Ledipasvir (Harvoni) or Sovaldi and Daclatasvir. They should be available in the UK later this year.

Your liver has had a break, so there's no rush. It'll take a year to get rid of the Interferon nasties. Good luck.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Midnight


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Just to let you know, I completed the 48 weeks and remained UND until 6 weeks post treatment and then relapsed no

I just found out yesterday and the shock has been quite something!

I guess with my ALT's running so high throughout treatment it is no surprise.

I'm wondering how long I will now need to recover from treatment before I can try something else?

As I'm in the UK the options are a little limited at present although I understand that Harvoni is under consideration and a decision should be made this summer.

I know that Sof and Sim are now approved but only with Peg and Riba and I'm not sure I'm in a rush to take that stuff again.

Any advise? as I want to be informed before next seeing my consultant...



__________________

Genotype 1A, Fibroscan 14, enlarged spleen.
Failed 48Wk triple therapy (Telap) treatment Jan-Dec 2014. 12 Week Harvoni/Riba started 22/12/15...

Week 2; ALT 50 HCV 96
Week 4; ALT 41 HCV 20
Week 8; ALT 34 HCV UND

EOT +4 weeks; ALT 27 UND

SVR 12; ALT 25 UND

SVR 18mths; ALT 26 UND
Tig


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Hi Tony,

I think you're going to experience some elevated enzymes until your liver has had time to recover from the inflammation. With a FS score of 14, you've obviously got some fibrosis to deal with. Once you achieve SVR and in time, some fibrosis regression, you'll see those numbers correct. It takes time, and you will see fluctuations during treatment, so try and not stress too much. I know it's difficult, but you're responding well. As long as those VL's keep returning UND, you're looking good!

Tig



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Paul B


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I used to get the stabbing pains intermittently but have had them for about 2 months prior to treatment and all through the 8 weeks so far. Often the side pain is worse than any of the sx from the drugs. I had my gall bladder removed about six years ago so it is not that !!



__________________

57 Yr old, Diagnosed 1994 Geno 1a. 1995: Interferon 12 weeks.  1998: Int/Rib 10 weeks.  2014: VL 106,000. Peg Int, Ribavirin, Victrelis 48 weeks (commenced June 2014). UND after Peg/Int lead in week 4. Still UND at week 8, 24, EOT. SVR 12.

Midnight


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Hi Tig

My pre treatement ALT was 121, then it dropped to 76 about 12 weeks in and then shot up to 191 at 24 weeks.  Not sure about the AST.

My platelets have also jumped about a bit and dropped at one point to 60, then up to 90 and now at 70.

Nurse seems to think its my liver taking a hit from the meds.

They did another PCR test today so hopefully I'll still be UND when I get the results in 1st week Sept.

Sides i getting way with it lightly, Telap was a bit grim but the Inf/Peg doesn't seem to bother me too much, comparatively speaking.

Hopefully the ALT's were a blip but to be honest my liver still seems to be unsettled and I have frequent stabbing pains.

 



__________________

Genotype 1A, Fibroscan 14, enlarged spleen.
Failed 48Wk triple therapy (Telap) treatment Jan-Dec 2014. 12 Week Harvoni/Riba started 22/12/15...

Week 2; ALT 50 HCV 96
Week 4; ALT 41 HCV 20
Week 8; ALT 34 HCV UND

EOT +4 weeks; ALT 27 UND

SVR 12; ALT 25 UND

SVR 18mths; ALT 26 UND
Tig


Admin

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Hi Tony,

I believe you're on triple with Incivek, right? It would help if you would list your treatment protocol in your signature area. It helps greatly when replying to posts. Do you have any additional lab work results that you can share with us? The liver enzymes do tend to fluctuate during treatment, especially on the protease inhibitors like Incivek. The important thing is that you're remaining undetectable! What was your pretreatment ALT/AST levels? That might help to understand what is going on. Those levels will fluctuate, so it's not uncommon to see them do that. Any comments from your doctor on the subject? Let us know how things progress and how much longer you've got left. Good luck!

Tig



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Matt Chris


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Hey Tony

Wow! that's great news, to have such a high ALT number and still be clear is amazing.

What does your (LFT) Liver Function Test now read?

Matt



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"And in the end, the love you take is equal to the love you make"

61 year old Geno type A1, F4 Cirrhotic, started 24 weeks on Harvoni 12-17-14 ,EOT-5 week = UND, 8-31-15 =UND , SVR-24 Baby YES! 
Midnight


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Good news still undetectable Very Happy

So I'm still all in...

Very happy Very Happy

Not sure why the levels jumped but treatment team will keep an eye on it.

 

Liver and spleen area still feel intermittently tender.

 

Time to try and relax again.

 

Best wishes to all...



__________________

Genotype 1A, Fibroscan 14, enlarged spleen.
Failed 48Wk triple therapy (Telap) treatment Jan-Dec 2014. 12 Week Harvoni/Riba started 22/12/15...

Week 2; ALT 50 HCV 96
Week 4; ALT 41 HCV 20
Week 8; ALT 34 HCV UND

EOT +4 weeks; ALT 27 UND

SVR 12; ALT 25 UND

SVR 18mths; ALT 26 UND
Huey


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Date:
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My liver pains turns out are from my gallbladder ,, get it checked.



__________________

  HCV Genotype 3a , now Psot-Tx was on S/riba. First VL was 5.8 mil on 7-5-13 then "und" at 3.8 weeks. 06/13/14 still und. off meds 3 days back on 7/29 Last pill 08/10/14 SVR+4

 
AngieV123


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My ALT & AST were both significantly elevated during treatment though I was undetected. My doctor did not seem worried. I was on a different TX (interferon, riba, sovaldi) but I hear that they can be hard on the liver. A month after tx, my levels were slowly dropping. I had the feelings of inflammation in my liver as well. A test will certainly be a good idea just so you can rule out hcv returning. For me, it was the meds. I know it's worrisome.

__________________

Type 1a. Had HCV my entire life via blood transfusion. Did peg & riba in 2000, relapsed. Did triple tx with sovaldi in early 2014 & I am now undetected 
mallani


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Hi Tony,

A significant rise in ALT during Rx is a bit of a worry. You must be due for your 24 week VL, so that should tell the story.

Being Undetected at weeks 4 and 8 on the Incivek triple is regarded as an RVR, so you should feel confident.

There's nothing you can do about it, but I hope you get your results soon. The liver pains may be unrelated. Let us know. Cheers.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Midnight


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Hi all,

Just got back from seeing the nurse and was told my ALT had risen from 76-191 since my last test 2 months ago.

The PCR hadn't been completed so no way to know if the virus has returned.  Although the nurse said not to worry as levels can fluctuate during treatment.

I'm currently doing 48 weeks with Teleprevir.  I was UND at week 4 and also at week 8. Fibroscan 14.

I haven't had another PCR since but noticed some severe stabbing pains in my liver over the last couple of weeks.

Is it of concern that the ALT has risen so sharply?

I worried the virus may have returned.



__________________

Genotype 1A, Fibroscan 14, enlarged spleen.
Failed 48Wk triple therapy (Telap) treatment Jan-Dec 2014. 12 Week Harvoni/Riba started 22/12/15...

Week 2; ALT 50 HCV 96
Week 4; ALT 41 HCV 20
Week 8; ALT 34 HCV UND

EOT +4 weeks; ALT 27 UND

SVR 12; ALT 25 UND

SVR 18mths; ALT 26 UND
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