Hep C Discussion Forum

Osy2 · Member

RE: Viral Load

Osy2 · Member

Thank you so much my friend JimmyK biggrin biggrin biggrin biggrin biggrin biggrin biggrin biggrin

JimmyK · Guru

In a chanting mode now...

OSY, OSY OSY,OSY YEAH!

LOL JimmyK

Sydhanrahan · Guru

Hi Osy,

so good to hear that delectable undetectable word. Especially as we can all relate to the anxieties you encountered on the journey.

Chill out for the next 12 weeks and you'll have even better news.

Take care,

Syd

Osy2 · Member

Thanks Loopy, I'm sure you will celeberate your UND soon.

With the spirit you have, no doubt you will get UND and SVR I'm telling you (before you know it !).

wish you and everyone in the forum (or out of the forum) all the best.

Osman

Loopy Lisa · Guru

Woohoooo, another one bites the dust. Congratulations, before you know it, you'll be celebrating SVR. Its always lovely to hear another victorious battle in the making. I hope you are having an easy ride. :)

nightowl · Member

Congratulations Osy ... I am very happy to hear your good news too!!!

Cheddy · Moderator

Osman,

It sure feels good to see those markers, doesn't it. Congratulations on getting through the treatment. Celebrate!

Tig · Admin

Congrats Osy!! The next best thing is that SVR you're going to get in 12 weeks. Nothing sweeter than a dead Dragon..... I'm glad we were able to walk with you on this journey. Keep us informed of your progress and check in when you can. Life is improving as we speak, good job on finishing treatment! Continued good luck to you....

robertsamx · Guru

Way to go Osman!! That's great news. So many people going on to UND and SVR. These new drugs are wonderful. looking forward to your EOT +4 results. Thanks for making my day! RC

Shadowfax · Guru

Undetected! These are great posts and the ones we all hope to see. They are happening so much more as we go along in the year and I expect the number to only rise.

Congtrats and keep us posted.

SF

Osy2 · Member

Sure Linux, many thanks.

biggrin biggrin biggrin biggrin biggrin biggrin biggrin biggrin

Linuxter · Guru

Wonderful News Osman!

Excellent to hear that EOT, "UNDETECTED" ... 12 wks to SVR ... just stay busy getting on with life and that short time will fly by ... smile

Congrats on the UND ... it's a very nice word to see on the labs ... biggrin

Thanks to you for keeping us posted, please do let us know how it's going, we love hearing the news and how you're doing.

Linux

Osy2 · Member

Hello everybody,

Good news, I've just got my end of treatment lab report, it's UNDETECTABLE !!.

It's time to celeberate after 6 weeks of worries and anxiety when my lab result showed 49 VL.

I would like to thank everyone in the forum for the support which releived alot of my worries and made me strongly keep on treatment till EOT.

Thank you and I wish you all speed and sustainable recovery,

Cheers

Osman

Loopy Lisa · Guru

I think you are going to do fine, its only important your end result. I have not had a start viral count (I have had one previously) and won't have another until the 3 month course I am prescribed is finished. I think the Doctors are seeing such positive results they are not worrying so much anymore. I also think its Geno 4 due to the glass syringes that caused mass infection. Either way, I look forward to seeing your UND, keep us updated on how you are doing.

Pablo, you are no longer a lone G4, where are my G3b fellows lol :D

Pablito · Senior Member

Evening chaps

It would be nice to confirm your genotype but you are almost certainly G4 if you contracted HCV in Egypt.

They really should stop doing VLs before the end of treatment for the very reason both you and I went through/are going through, i.e. not being UND at week 4. All it does is cause worry.

Pablo

Osy2 · Member

JimmyK wrote:
I believe the only way it would make a difference regarding Geno Type is if you happened to be a 2.
1, 3, 4, 5 and 6 all have strong response to Harvoni. The fact that you dropped so quickly tells me you are doing fine. ;)
I am just one of those "show me" kind of guys when it comes to Doctors. ( I drive mine crazy. I think he ordered the 24 weeks just to make sure he would be rid of me LOL.)
JimmyK

Don't warry my friend, I'm the same man, may be more; very worrying nature, always anxious, and willing to see results immediately.

Yes, I have t be more patient and hang in there! Many many thanks Jimmy for bearing with me.

Osman

JimmyK · Guru

I believe the only way it would make a difference regarding Geno Type is if you happened to be a 2.

1, 3, 4, 5 and 6 all have strong response to Harvoni. The fact that you dropped so quickly tells me you are doing fine. ;)

I am just one of those "show me" kind of guys when it comes to Doctors. ( I drive mine crazy. I think he ordered the 24 weeks just to make sure he would be rid of me LOL.)

JimmyK

JimmyK · Guru

Again, viral load follow up DURING treatment is by many Doctors considered unimportant with Harvoni. The only one that really matters is SVR-12.

The 4 week UND is good for a moral boost, but that is about it and that is coming from someone who is presently UND but with 101 days of remaining treatment. Not that I'm counting mind you LOL.

A 10 fold jump between week 4 and week 6 is cause for a closer look but that is not happened in your case.

Hang in there my friend.

JimmyK

Osy2 · Member

JimmyK wrote:
Osy2 wrote:
You are quite right Jimmy, but waht I mentioned is exactly what he said, I also remember he was happy that I'm still in the pink zone and he confirmed I'm not cirrhotic.
He was quite sure I would respond to the treatment even before starting it.
Cheers
Osman
Yes and that is fine. You are in fact in the "pink". ;) Just not F2-F3. No problem. The study I just posted INCLUDED cirrhotics, which you are not and the results other than the guy who quit were VERY GOOD!
You got this! Hang in there. Ask your Doc how he knows for sure you are type 4. Tell him you realize you are in Egypt but would like to confirm. I am a type 1 which is the most common in The USA, but most common is not necessarily a fact.

Regards

JimmyK

My doc definitely doesn't know exactly what genotype I'm, but he says it's T4 as vast majority of hep c patients in Egypt are T4. the question is how important to know the genotype now especially the response is great and the drop in VL after two weeks is huge. I don't know anyone in Egypt that was asked to do such a test.

Regards

Osman

Osy2 · Member

Although the study doesn't mention anything about the viral load follow up during treatment of the 20 persons, I do find it very optimistic.

Let's wait and see.

Thanks for your effort Jimmy

Osman

JimmyK · Guru

Osy2 wrote:
You are quite right Jimmy, but waht I mentioned is exactly what he said, I also remember he was happy that I'm still in the pink zone and he confirmed I'm not cirrhotic.
He was quite sure I would respond to the treatment even before starting it.
Cheers
Osman

Yes and that is fine. You are in fact in the "pink". ;) Just not F2-F3. No problem. The study I just posted INCLUDED cirrhotics, which you are not and the results other than the guy who quit were VERY GOOD!

You got this! Hang in there. Ask your Doc how he knows for sure you are type 4. Tell him you realize you are in Egypt but would like to confirm. I am a type 1 which is the most common in The USA, but most common is not necessarily a fact.

Regards

JimmyK

JimmyK · Guru

Continuing with the assumption that you are Gen 4.

https://www.hepmag.com/article/Harvoni-genotype-4-26496-508861627

It is true this was a small study consisting of 21 people. Of the 21 people, 20 went on to SVR 12 and 1 failed.

The 1 who failed however quit treatment after the first week so that is pretty good odds!

JimmyK

Osy2 · Member

You are quite right Jimmy, but waht I mentioned is exactly what he said, I also remember he was happy that I'm still in the pink zone and he confirmed I'm not cirrhotic.

He was quite sure I would respond to the treatment even before starting it.

Cheers

Osman

JimmyK · Guru

Greetings Osman,

The only thing I would challenge is the statement that the Dr, Said F2-F3. That would fall into the yellow band. To be clear you are closer to F-3, F-4.

I have taken your color code chart and added a straight line so you could see what I mean.

Gen T4 is assumed but it would be nice if you could ask them to confirm.

Other than that with your ALT / AST in the ranges noted at two weeks, I would ask to rung them now (Liver Panel) to compare.

As noted there is no 10 fold jump in RNA weeks 4 to 6 so no worries. Just continue yoru 8:00 sharp routine.

Regards

JimmyK

Osy2 · Member

Hi Robert,

Thank you for reply, .. I want to make things clearer for you and for all people in the forum;

First time I discovered I'm Hep C in 2001, with VL 1,887,464 which is almost the same # in 2016 ! (report attached).
Nobody knows when I was contracted.
My genotype is presumably 4 (Egyptian dominant genotype), I never taken any genotype test!.
Since I knew I was infected, I kept monitoring my liver enzymes for the last 15 years which never got higher than normal !
For the last 15 years I kept monitoring my CBC, Lipid profile, kidney functions ..etc, and everything was withing normal range.
A week before starting Harvoni my VL was 1,976,086 (almost same as 15 years ago, doc sais it's a coincidence !), ALT 27, AST 30, Fibroscan F3, KPA 12.
Doc said I'm F2-F3 not exactly F3 (report attached)
Started Harvoni treatment on May 4, 2016.
Two weeks from treatment both ALT & AST were 15. (no PCR done), CBC as is.
Four weeks from treatment VL was 42 ! (I expected it to have been cleared)
Six weeks from treatment VL was 49 ! (I also expected it to have been cleared)
I'm on other medications for Hypertension (Beta-blocker Concor, Amlodipine Norvasc, Asprin infantile, and Atorvastatin 10 mg), doc said it's ok with Harvoni, no interference.
I'm keeping taking Harvoni every day at 8:00 pm sharp, never missed one!, while I do take the other medicines an hour before Harvoni; 7:00 pm.

Hope this data is informative enough for any one on the forum to give an advice, I have attached the reports with this thread.

Thanks to evryone showed interest in my case.

robertsamx · Guru

Hi Osman, I like what I see in your pre-treatment LFT's..Your alt per treatment at 27 and ast 30 are great numbers to start with.Are these pre treatment numbers current or from years ago? Have you had a fibroscan? if so that are the results? It took me 8-9 weeks to go UND on my first treatment, and only 2-3 weeks on my second treatment, but I did go UND on both treatments, my relapses are a result of cirrhosis . You need to find out what condition your liver is in now. Today's gold standard is a liver biopsy, but the fibroscan is just as good in my opinion, and it's a fast easy painless way to find out your livers condition.

There have been reported cases in trials on Harvoni where LFT's did elevate during treatment, but settle down as you get into treatment. It's way to early for you to stare sweating this. What you can and should do is get a fibroscan and if your number comes back above say 9 to 15 or even higher, you should discuss with your Dr going longer on treatment and or adding RIBA. THIS IS JUST MT OPINION.. Stay in touch, hoping you all the best in recovery from HCV. RC

Osy2 · Member

Many thanks Cheddy,

I will definitely change my doc in the next few days, and I will keep on with Harvoni till EOT.

will let you all know,

Cheers

Osman

Osy2 · Member

Many thanks Jimmy for the assuring information and the study which made things clearer to me.

Osman

Cheddy · Moderator

Osy2, As usual, I agree with JimmyK. It's a funny question in this arena, "Is this normal?" because not too much is. I'm glad he provided some research and the reminder that worrying is premature. It just leads to stress and that leads to more side effects, in my experience.

Boy, if you don't like your doctor, by all means, get another one. Let us know what you hear from your doc.

Onward! No falling back! :))

JimmyK · Guru

Osy2 wrote:
Hi everybody, I want to share with you my lab results which are confusing to me hoping some of you will be kind and give me a hope.
I've started Harvoni on May 4th 2016, a couple of days before starting it my numbers were VL 1,976,086 IU/ML, F3 KPA 12, ALT 27, AST 30, BIL 0.6.
After 2 weeks (May 21, 2016) ALT 15, AST 15, CBC OK, no VL done
After 4 weeks (June, 1st 2016) VL was 42 IU/ML, this is amazing to me, I expected it had gone by 4 weeks
After 6 weeks (June, 16th 2016) VL was 49 IU/ML !!!!!! most strange to me.
Is this normal? I know it's not normal, does that mean I'm not responding to Harvoni? Should I stop it and go on something else? I don't trust my doctor and I don't want to go to him again,
I will change the doctor soon, but till then can anyone help interpret these #s for me, I feel disappointed!
Many thanks to all of you.

Greetings again.

One more thing. Many people are not UND at week 4. When retested at week 6 the only time there is any reason for concern is a 10 fold jump between week 4 and week 6.

Had your week six test come in at 420 or more, then maybe a cause for concern. To have gone from 42 to 49 is not considered an increase of any significance.

Your ALT drop is a good sign. Attached is some reading for you.

No worries keep up the good work.

JimmyK

Osy2 · Member

Great, I'm sure you will get SVR.

Wish you all the best.

Osman

Sydhanrahan · Guru

Hi Osy,

thats great. And I understand why you want those blood tests too - they are reassuring. I wasn't Virus Free until 8 weeks. Waiting for the 12 weeks after treatment makes 84 days seem like a looooong time.

Syd

Osy2 · Member

Hi Syd,

I'm on 12 weeks treatment protocol (as per my doc recommendation). I've just finished week 6 5 days ago, my doc recommends to complete the whole 12 week period, but I'm too curious to have it cleared. I'm saying I will be waiting for the 8 weeks to go and then I will do the PCR again, but anyhow I will have the 12 weeks completed.

Thanks for encouraging me.

Sydhanrahan · Guru

Hi Osy,

After reading your posts I am still not sure how many weeks your doctor has recommended you do. Is he waiting until the 8 week mark and then going to decide based on your viral load then?

I am hoping that you get to stay on Harvoni for 12 weeks. Your system has responded very well to the treatment so far with the last two results in the 40's but most people on this forum seem to do 12 weeks of Harvoni- unless you're Jimmy who has been given the 24 week option as he's relapsed before.

Now I'm hoping one of the others will correct me if I'm wrong.

Good luck on your journey.

Syd

Osy2 · Member

Thanks for the great information Pablo, I will probably wait for the 8 weeks to complete and then I will do another lab and see what happens.

My doctor (whom I don't much trust!) says we have to go on the 12 week first and then he decides what we ca do.

Thanks

Osman

Pablito · Senior Member

Hi again Osy

Ah, another fellow G4. There are now 3 of us on the forum.

I had my last VL test at week 8, which was the end of my treatment. So I had 4 weeks where I was wondering why I hadn't responded like others but I did in the end. In fact I was sufficiently worried to get a second opinion from a different doctor. This is what I learned which may explain why you are not zero at this point...

1. The DAAs stop HCV from replicating but it's down to your immune system to kill off the remaining copies of the virus. Perhaps, for genetic reasons, your body is slightly less good at killing the virus.

2. When HCV replicates it makes bad copies of itself. It sounds like Harvoni has facilitated the killing of all your regular HCV and what is left are these bad copies. I don't think the science is fully understood yet but it seems that for the small percentage of people who don't achieve SVR it is these RAVs (resistance associated mutations) that are at play. On the other hand, some papers say that these stragglers don't work properly and die off over time so that you get, as Tig points out, people who are not undetected at EOT but still go on to get SVR12.

I think you will be totally fine. But if you want to be absolutely sure then you could ask your doctor if you could add 6 weeks of ribavirin to the last phase of your treatment. Ribavirin works in a completely different way than Harvoni. It's unpleasant stuff but 6 weeks should be OK.

Or just go the regular route and let the last 6 weeks of Harvoni do it's thing. You went from over 1 million to 49 in six weeks so I am sure you will go from 49 to zero in the remaining 6 weeks.

Pablo

Osy2 · Member

Thanks Dave, I do like eating green salads.

Osy2 · Member

Thanks for the info Tig

Linuxter · Guru

Hi again Osman,

If you don't eat a lot of salads then you might enjoy getting your greens as a smoothie.

Putting the greens in a blender actually helps break them down much better than chewing and you get more from them because the blending breaks them down to the cellular level. Caution: You may really like them. I almost always add a banana or a few dates or a little honey to sweeten them up a little. If you freeze pealed bananas, they help make a nice cold smoothie for those hot days you are having. Enjoy!

Here's a link to lots of great recipes for smoothies, I have tried and enjoy many of these.

Link: ----> The Green Smoothie Ranch

Dave

-- Edited by Linuxter on Saturday 18th of June 2016 04:39:53 PM

Tig · Admin

The reference to "generation" may be the serological assay used in the testing process. However, I don't believe they were using the 3rd gen assay in 2002. It's a more sensitive assay that adds the NS5 antigen. If you have any more current results, there may be something helpful in them. When did you have your last full genotyping done?

Any information you feel like sharing will help us when replying. You can add information in your signature line (bottom of each post) like most of us have. The red link in my signature will show you how.

Osy2 · Member

Many thanks Linuxter for the recommendations, I really drink much water esprcially nowadays in Egypt as it's too warm, but I don't really eat much vegetables. I will obey your advice from now on.

Many thanks to you and to all great people of the forum.

Osman

Linuxter · Guru

Hello Osman,

Welcome to the forum, It's good to have you here!

I've seen nothing but success with Harvoni treatment, you will achieve SVR.

It's natural to worry a little, I am still waiting for my final labs (which I take in 3-4 weeks) to determine my SVR ... I worry at times too but don't really have reason to ... I'll achieve SVR too. We all tend to think the worst at times. That's why this website is so helpful. Lots of great people here and excellent information.

You probably already know but you should be drinking LOTS and LOTS of water during treatment, 3-4 liters per day. It helps not only with alleviating side effects but it helps the Harvoni do it's job as well. I also recommend eating plenty of green vegetables such as kale and spinich or other leafy greens, they help move toxins from the body which is especially important during treatment.

Wishing you Well,

Dave

Osy2 · Member

Thanks Tig,

If you think I'll get optimising results after 8 weeks of treatment, then I'll definitely do it regardless the cost.

Yes, The domainant genotype in Egypt is 4.

Many thanks for your communication, feeling very happy I'm communicating with you all.

Osman

JimmyK · Guru

OK well GT 4 is a 95% cure rate. Personally I don't think you should be so worried. You had a massive drop so the stuff is working as it should.

Some Doctors don't even mess with a HCV RNA during Harvoni treatment. The only one that matters is 12 weeks after. Oh and there are no Breakthroughs on Harvoni. You are doing fine. No worries.

JimmyK

Osy2 · Member

Thanks JimmyK, I think I'm genotype 4 (this is the Egyptian version!), I quickly went back to my 2002 quantitative report, it says 3rd generation without referring to a genotype.

The genotype is different from the generation isn't it?

But I know alot of people here in Egypt have got SVR on harvoni treatment, and honestlt all people I know here in Egypt have got cured by Harvoni.

Tig · Admin

Osman,

There really is no need to do a week 8 viral load. Unless the curiousity is simply too much. I personally think one at the end of treatment is a good morale booster, but the one that truly counts is the test 12 weeks after treatment is finished.

Since you're from Egypt, are you a genotype 4? I know that is the predominate genotype in your country and it responds very well to Harvoni. It's a great treatment!

JimmyK · Guru

Greetings Osy.

Because you are from Egypt I am curious as to what your Genotype is. Can you let us know?

Thanks and by the way, there are folks that are detected all the way through treatment and come out UND at SVR 12.

JimmyK

Osy2 · Member

Many thanks Tig for your nice words, do you think I wait for the 12 weeks to complete and then do the quantitative PCR or I do another one after 8 weeks of treatment?

Forgot to mention I'm 56 male.

Thanks to everybody trying to help on this community.

Osman

Tig · Admin

Hi Osy,

Welcome to the forum! I agree with Pablo, you're doing fine and responding quite well. There are instances of people that are still detected at the end of treatment but go on to SVR. These drugs are very effective at what they can do, but don't always act similarly in every instance.

You have had a multi log drop in your viral load and while zero is nice to see, 42-49 is mighty close! Don't worry about that. Your other labs definitely indicate an excellent response and I trust your undetected results are right around the corner!

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