4 weeks post treatment test results.

[Dannyboi7]

  I'm a G3 who finished treatment 5 weeks ago,did SOC for 24 weeks.

some pre-treatment tests-
ultrasound showed no signs of inflamation
Fibroscan test only could get a 70% accuracy,results inconclusive,a maybe f2 or f3.
BMI-ok
cholesterol level-normal

Decided to treat anyways

Week 0-no PCR-  ast-85 alt-137
Week 4 PCR qualitative-detected ast-21 alt-31
Week 12 PCR qualitative-UND
Week 24 PCR quantitative-UND
Week 24 liver enzymes drop to its lowest ast-16 alt-19

My platelet counts never really went down during treatment,started at 178 and were at a 190 average range throughout treatment,I don't know if this is uncommon.Most folks they go down.

Neutrophils 1.5 average throughout treatment
hemoglobins low -110 u/l average throughout treatment.

4 weeks post-treatment
blood count all back to normal,liver enzymes even lower,down to ast-12 alt-11,no PCR was done.The next PCR will be done at 12 weeks.My biggest concern is no RVR.What do you knowledgeable folks think?

I apologize about the grammar,english is my second language

Dannyboi7

PS I discovered this forum mid treatment and lurked throughout treatment,just reading the threads gave me a tremendous amount of support and learn a lot of things.I was to brain dead to start a profile or post.A big thanks to everyone.

[Dannyboi7]

Thanks Kristana,Platelet counts is kind of a quarqie thing isn't.For instance I know this athlete who runs marathons,he is  in perfect shape and health,he doesn't have any type of hepatitis or any other diseases.
He as a CBC done regularly  and is closely monitered,His platelet count as always been around 180,just one time it dropped to 160 he freaked and thought he wouldn't perform well  in his race.His sports doctor reassured him and had all kinds of tests done and he was fine.After that they went back to is normal range stayed that way.

   My actual week 4 post tx liver enzymes really dropped at its lowest ast-13 and alt-12...I doubt  they would dropped any lower than that.
Nevertheless if at week 8 post tx they would go to out of normal range I would worry.


Thanks for help and support

Dannyboi7

[Kristina538]

Platelets do vary anyway.  It was my understanding that the platelet drop can be relative to the liver damage i.e. if you start low, it's going to take more of a tumble - I was really nervous about it.   Mine were in 190/170 range prior, but years ago, during my first tx, they dropped from 220's to 170 - with no liver damage, and I felt sure, with the more severe damage, I was borderline.  I know we do scrutinise over our tests for signs of improvement or change;  since tx, after my platelets hit 190 again (and it took a while), I stopped thinking about it.   I would be more inclined to only worry about them during tx, and I'm not sure there an indiciation of the meds - you have enough other indications that the meds were working; and just hoping the course was long enough - I know a couple of people (G3) who fought long and hard to get an extension, and one who did a second tx of 48 weeks.  

My biopsy was so small that the official reading was Stage 2, but my specialist said, because of the portal and spleen damage, and because there was bridging fibrosis, that it was definitely Stage 3 and possibly 4... Ha!  that was when I discovered that biopsies are open to interpretation.  He hurried me into my second tx and treated aggressively.   A naturopath gave me strong B6 tablets which may have helped my hgb which didn't drop lower than 110.    I was hyperthyroid throughout, which worsened attempting sleep (I had the condition prior, but it was exacerbated by tx, and has been a 'mop up' since - it was a toxic nodule, so cause was not related to the treatment.

My ultrasounds and blood tests have looked great since - spleen has rectified and no portal tension :-)!!.   I remember celebrating starting to have regular and normal bowel motions and clear urine, so I would say definite regression, which was expected and my specialist said around two years.

And yes, sx's are worse when it's working (definitely) - I knew two people who hardly noticed being on interferon, and both were non-responders;  luckily they've both obtained SVR on the newer regimin drugs!

Would your dr allow you to do an ALT/AST at 8 weeks?  At 8 weeks mine went down (only slightly), but to me it was such a positive indication, because when I relapsed in 1992, the enzymes had started rising by week 8 as the virus was taking hold again.

... counting the days with you.  

[Dannyboi7]

I was fortunate enough to not have any dose reduction either and I did 100% of the rib and 97% of the peg inter(little spill on my belly on week 18 grrr)
Your platelets were high for early cirrhosis.

My platelet counts during treatment.

week 0-179
week 2-186
week 4-178
week 6-209
week 8- 216
week 12-187
week 16-180
week 20-154
week 24-223

eot week 4-174

Not sure if I'm being a bit obsessive about this but the only time they really dropped from baseline number was at week 20.This seems abnormal to me,from everything I've read everyones platelets drops
during treatment,I know the peg inter was working since I had every sx that is listed and then some more.What is your opinion on this?
BTW you are on you're 3rd  year  SVR right,as there been any regression to your liver damage?

[Kristina538]

You were totally right - my AST/ALT's were high probably because I was tending hyperthyroid (also have alpha1 antitrypsin) and early cirrhosis, so there was a lot going on.  What was wonderful if seeing them come down post tx.

Canada is similar to NZ in that NZ touches on the new technologies, but you have to be a special case or part of this country's pilot trials to get the better tests.  I had to go private to get a 4 week PCR, as I couldn't get past my nurse to request one from the public health specialist!

Compared to my tests during tx I would think your diagnosis of f2-f3 is right.  I was stage 3-4 and my platelets dropped from 190 to 140, and neuts down to .6 (there were no rescue drugs here so I was on stand-by to decrease meds, but luckily wasn't instructed to - nevertheless there was a lot of extra hand washing and meticulousness to cleanliness!).

The RVR was, for me, motivational - I would've found it hard to carry on if it was unlikely that I had a reasonably good chance; I was struggling pre-tx with portal vein, enlarged spleen etc., but even if i'd made UND on week 5 or 6 I would've carried on - if the stats are a little down, I'll still give something a shot.

I am crossing my fingers and toes for your results.

[Kristina538]

My AST and ALT were high throughout my second tx - both in the 60's - they came down again post tx :-) with SVR.

[Dannyboi7]

Dito,there are many reasons they can go up very  high during treatment such as taking  tynenol or aspirin,or thyroid problems,or drinking alcohol.I found out I didn't get an IL28B test.It's not part of protocol yet in Canada.We are so far behind.We should change are moto from "True North Strong and Free" to True North Passive and Polite.Universal care is great but like any  other medical care plan it as it's flaws.I've been feeling so great lately and I want to enjoy that ride as long as possible.So not knowing my IL28B is kind of a good thing.

God bless and wishes

Dannyboi7

[bbj2856]

Hi Danny yes when they kept going up each month I was so scared. My dr said look I am not worried about these now and he  pointed to my blood work where it said UND . He said this is what i am wanting for now. He said they well level out at end of treatment so I go back the 24 for blood work. Praying  for UnD again  Praying for u also  and God bless.

bbj

[Dannyboi7]

Both hypo and hyperthyroidism can increase AST and ALT, usually less than three times the upper limit of normal. Other causes of elevated ALT include hemochromatosis, Wilson disease, autoimmune hepatitis, primary biliary cirrhosis, sclerosing cholangitis and alpha-1 antitrypsin deficiency.

Many medications can increase AST levels. The most common drugs are: acetaminophen, nonsteroidal anti-inflammatory drugs, angiotensin converting enzyme (ACE) inhibitors, nicotinic acid, isoniazid, sulfonamides, erythromycin, griseofulvin, and fluconazole.

http://www.clinlabnavigator.com/Test-Interpretations/aspartate-aminotransferase-ast.html

These could be some the cause your elevated liver enzymes,a lot of women with hep c develop thyroid problems,Your liver enzymes were way up there at end of treatment and still you were UND.What counts was that you are UND

[Dannyboi7]

They came down more then half 4 weeks post tx,thats got to be a good sign.Your GI knows the best,she or he knows all about your case.Mind you liver enzymes levels during treatment is not an official predictor for an SVR,to little studies have been done on that,it.You're very close to your 12 weeks PCR.

Best wishes for an SVR

Dannyboi7

[bbj2856]

Hi while i was on treatment i had high ast and alt levels. I have been off my medication for 9 weks now did 24 weeks of  peg and rib. 30 days after end of treatment my levels were down . They still high but they went up about 25 each month during treatment.  Start of treatment they were 80 and 67 and end of treatment it was around 400 alt and ast now they were down  lots in 30 days around 225 points lower in 30 days . My blood levels stay border line they were good at end of treatment when  I did blood work. My Dr thinks they will get back to normal in about 3 mo. Praying he is right .
God Bless and
good luck
bbj

[Dannyboi7]

" Did your 4 week PCR give a viral load when it showed detected?   While the 4-week is the gold standard, you might have been close to RVR."
--------------------------

Thanks for the kind words and congrats on your SVR,my PCR at 4 weeks and 12 weeks were qualitative.I've read  a couple studies done strictly on those who did the SOC treatment it included all genotypes.Those who's liver enzymes dropped to a normal range throughout treatment then also dropped even more within the first 4 weeks  after eot had 90 % SVR.But this applied mostly to genotype 1.I fall into that category but I'm a G3.

    The first 2 posters provided me with very good links,which indicate    that the genotype 3 who didn't achieve RVR on a 24 week SOC treatment ,the SVR percentage predictor was depended on the IL28B genotype.I will find this out tomorow.

Big thank-you to all.

Best wishes

Dannyboi7



  
  

[Advocate1955]

Congratulations on successfully completing treatment.  Best wishes for SVR.
Advocate1955

[Kristina538]

Clarify - I did two tx's - one in 1993 monotherapy - partial response., and again in 2008 - SVR.  looking forward to you joining me ;-),

[Kristina538]

Your alt/ast may assist to give you an indication.   When I first relapsed my ALT started rising quite rapidly after which it was confirmed I had not been successful.   It was a good sign that your ALT's even went lower; perhaps you can talk your doctor into doing an 8 week liver panel.

(I'm a 3a and post tx my enzymes went down and continued too - so far so good - let us know so we can celebrate with you - toes and fingers x'd).   Did your 4 week PCR give a viral load when it showed detected?   While the 4-week is the gold standard, you might have been close to RVR.

[Dannyboi7]

Thanks guys,I will check that out.

[desrt]

An IL28B Polymorphism Determines Treatment Response of Hepatitis C Virus Genotype 2 or 3 Patients Who Do Not Achieve a Rapid Virologic Response

http://www.gastrojournal.org/article/S0016-5085(10)00841-3/abstract

[can-do-man]

Heres a couple sites you might want to check out, wishing you the best...

http://hepatitiscnewdrugs.blogspot.com/2012/01/treatment-of-patients-with-genotype-3.html


http://www.hivandhepatitis.com/2009icr/ddw/docs/061509_b.html