Hep C Discussion Forum

Hello Bob,

Glad you have checked back with us! Doesn't matter how often you post, you are welcome at any time. Many prefer to just read the posts and gather knowledge that way. Whatever the participation, we love being able to help!

The testing procedure your doctor is using isn't uncommon. We have had several members on the new protocols mention the same thing. These drugs are so effective and cause such limited adverse effects, the comprehensive testing panels and VL of the past aren't needed as often. Some doctors and patients continue to use the former 2-4 week testing interval and they run them all, including the RNA viral load. It can be a big morale booster for the patient suffering from treatment anxiety. I believe many of the repeat treaters, those that relapsed or didn't respond are more likely to want the more frequent tests. Truth is, we rarely see these new protocols not deliver an undetected result by weeks 4-6-8, and at the cost, they are often limited by insurance or believe themselves that the VL isn't necessary until EOT. Some doctors have waited until EOT +12 to run it. So don't be alarmed. The CMP and CBC is another story. That should be ran a couple times anyway (IMO) during the 12 week period to monitor the drugs effect on metabolism in general. After EOT you'll probably have the final VL CMP and a CBC and at week 12 and if you are still UND, they consider you having achieved SVR. 

Your liver functions are returning to normal and that's an excellent indication of the drugs action. You should be thrilled to see those numbers return to normal. Congrats on that, it looks like things are working! Don't worry, looks to me like you're following a standard testing protocol and they are looking good! Keep in touch...

Tig

Recommended monitoring during antiviral therapy.

Clinic visits or telephone contact are recommended as clinically indicated during treatment to ensure medication adherence and to monitor for adverse events and potential drug-drug interactions with newly prescribed medications.

Complete blood count (CBC), creatinine level, calculated glomerular filtration rate (GFR), and hepatic function panel are recommended after 4 weeks of treatment and as clinically indicated. Thyroid-stimulating hormone (TSH) is recommended every 12 weeks for patients receiving IFN. More frequent assessment for drug-related toxic effects (eg, CBC for patients receiving RBV) is recommended as clinically indicated.

Prompt discontinuation of therapy is recommended for any a) 10-fold increase in alanine aminotransferase (ALT) activity at week 4; or b) any increase in ALT of less than 10-fold at week 4 that is accompanied by any weakness, nausea, vomiting, or jaundice, or accompanied by increased bilirubin, alkaline phosphatase, or international normalized ratio. Asymptomatic increases in ALT of less than 10-fold elevated at week 4 should be closely monitored and repeated at week 6 and week 8.

Rating: Class I, Level B

Quantitative HCV viral load testing is recommended after 4 weeks of therapy and at 12 weeks following completion of therapy. Antiviral drug therapy should NOT be interrupted or discontinued if HCV RNA levels are not performed or available during treatment.

Quantitative HCV viral load testing can be considered at the end of treatment and 24 weeks or longer following the completion of therapy.

Rating: Class I, Level B

Hi Bob:

You certainly seem to be on the right track and every reason to believe that Harvoni is doing it's job. As you see from the AASLD guidelines, an HCV viral load test is recommended at 4 weeks, but not mandatory. A CBC and hepatic function panel at 4 weeks is also recommended and your testing at 3 weeks probably satisfies this criteria.

Frequency of testing is of course subject to your doctor's request and whether insurance will pay for it. I was fortunate to have several VL tests during tx. This may have been a result of my consent to the test results being used as part of a followup to the COSMOS study. In any event, Anthem paid for it.

It certainly doesn't hurt to ask your doctor about more frequent testing. I had a slight increase in Total Bilirubin during tx, but this is not unusual with Olysio. I'm not sure if this is an issue with Harvoni. I would just make sure that nothing in your CBC or panel results is sufficiently abnormal to warrant your doctor's concern. You can also post any results you have questions about over the course of tx.

John