Hep C Discussion Forum

Thanks for clarifying the confusion.

The EASL guidelines (European guidelines, attached) report very similar SVR rates for sof/led and sof/dac.  What I would say is that the number of studies for Harvoni is greater than for sof/dac and in that sense this is more reassuring. 

If it is only a matter of weeks then it won't make much difference, but if 40mg of omeprazole is to be prescribed for longer then the sof/dac combo looks a good one.  I'll try and see if the large European compassionate access trial data for sof/dac are available yet.  If the data from this study confirm the high 90s SVR rates for sof/dac found in the smaller studies quoted in the EASL guidelines then it's safe to say that sof/dac is equally as good for G1a as sof/led.  

The real difference would be if RAVs existed for either led or dac...and there would be no way of knowing this prior to treatment unless specific RAV tests are done, and these aren't done in most clinical settings.

He never yet started the Harvoni. The hepatologist puts him on omeprazole 40 mg 2x/day after the endoscopies for healing - so no acid reflux will occur (even though he has never had refllux in his life). She said 2 weeks than he can go off it and start Harvoni. The second endoscopy -she had him on the omeprazole for 4 weeks (not sure why). My husband has fantasic digestion anyway. Of course he will probably decline the TIPS shunt and take his chances and want to get started on treatment right within the next 2 weeks. He was very close to declining he endoscopies completely, but agreed to at least one. We should have done that. Now she is saying the varices are worse, but 4 weeks ago she said they looked better?? So basically, he could not start the Harvoni (which is the drug tx we want) until the omeprazole is done. She said we can do the Dak/Sofos and start now, but we don't feel as confident about that one. I feel we just got sucked in the "band aid" approach instead of getting to the root of the problem. Clinically, he is doing really well.

Thank you. I have pretty good support - I work at an integrative hospital with a full spa, chiropractors, psychologists, emotion code experts, etc. I do realize this is important. My sister-in-law just gave me a gift certificate for a facial. Thank you for the reminder. 

Hi Sue,

I'm sorry your husband has had these set backs, especially after the doctor said he was improving so well a month ago. Did she mention why or what caused this change of events? Perhaps under diagnosed a month ago? Hard to determine really, but I'd be asking for additional reasoning. The TIPPS or TIPS procedure can be very helpful in reducing the portal hypertension. It can also aid in reducing abdominal fluid accumulation (ascites), but may take some time to do that. It can increase the incidence of hepatic encephalopathy in 20-25% of patients. That can be controlled  with standard courses of care, but it remains a possibility because the blood flow into the liver is instead shunted through it to relieve the portal hypertension. The liver's filtering ability is reduced, which allows toxins, like ammonia to increase. That tends to result in the higher incidence of hepatic encephalopathy. Remember, it can be treated, so that shouldn't be reason not to consider the procedure.

The question of whether curing his Hep C will reduce his fibrosis (cirrhosis) is difficult to determine since he's decompensated. There's a lot of fibrosis and scarring involved and if some fibrosis regression does occur, it's going to be a long, slow process. It can happen and has happened, so a definitive "No it won't" may be a bit premature. That's one of those questions you ask and dig a little deeper each time you talk to her about it. Regression from compensated cirrhosis is well known, and as I mentioned, decompensated is far more serious and severe. Curing the HCV, regardless of the desire for fibrosis reversal, remains a very important step toward his future improvements. 

I'm sure you're traumatized after hearing one thing and then finding out another. If I were you, I would stay very involved in discussion with his medical team and demand to know everything under consideration. If you trust his doctors and it appears they are being proactive at this point versus reactive, that's a good indication that they are quickly considering their options. Is he being worked up for possible transplant? That would also be a question that needs to be asked now. Since he will experience a two week lapse in his Harvoni treatment, in my opinion, this round of treatment is a wash. If he restarts a new protocol, they'll have to do some additional testing to determine if he has developed any resistance to the newer DAA's and then make a decision on the best course of action. There are certainly options available and testing will prove what is best recommended and the length of treatment given. 

Keep your spirits up, this is just a big bump in the road to wellness. If they can keep him comfortable, reduce his portal hypertension, which will improve the overall problems presented by the varices (bleeding). Primary concern right now, in my opinion is to get him stable, reduce the pressure and use the time to develop a good game plan for his future and there's every reason to believe he will get some good relief from his current problems. It's a difficult journey and I'm sorry you have to go through this. Stay involved with his care and remember to ask all the questions that come to mind. Stay with us and let us know what you find out. We may not have all the answers, but we have your interest and that of your husband's in our hearts and minds. We'll be right here with you...