Looking for Protocol/Guidelines stopping 3x Vic

[jules2551]

I am on triple therapy with Vic and UND through week 24.  (Week 4 was 2+ log drop).  My question is are there any guidelines/protocol for stopping tx if your ALT/AST reaches 150 each even though you are UND?  Mine have been consistently rising each week and today, week 25,  my AST=130 and ALT=124.  My Hepa Dr said we would have to stop tx if they both reach 150.  I cannot find any information on this anywhere.  So any help would be greatly appreciated!

Happy Holidays
Jules

[flcyclist]

Not much to add, but very happy to hear the pneumonia is behind you.  I hope your AST/ALT stays below 150 so you can continue trt.  Each additional weeks gives you more hope for success.  Its great to hear of the Und's, but hope to hear your enzymes will start behaving :-)

[HectorSF]

Jules -

Glad to hear your pneumonia was caught and treated. Pneumonia can really wreck havoc with other health condition if it is not treated ASAP.

Ah I see. You have a separate iron issue with Hemochromatosis. Sorry my memory is on the blink. Thanks for the info on hemochromatosis treatment. I didn't know that about iron overload and AST and ALT.

I like your attitude of pushing through for 48 weeks so you don't have to treat again. Once is plenty.

I hope your ASL and ALT either come down of stop escalating so you can do 48 weeks.

Good luck with your treatment!!!
To 2013 without hepatitis C!

hector

[jules2551]

A couple of weeks ago I was dx with bacterial pneumonia so I have been on antibiotics which I just finished.  So I was hoping the numbers would go down.  

My Hepa thinks it's the Hemochromatosis.  He said in patients with Hemo that they were stopping treatment at 3 times the upper limit of normal which for me would mean 150-160.  

Yes I know he goes to most of the liver meetings that he can or sends his colleagues.  I am pretty sure he is on top of his game and will spend the time with me answering questions.  (My GP recommended that I get the hell out of the boonies and see a reputable Hepa Dr)!

I probably could have stopped at Week 24 but with the Hemo and PCT we, Dr and myself, decided on the 48 week plan.  I just didn't want to take that chance and relapse.  So I will push this as far as I can.  I don't want to go through this $%^& again :)

[Idyllic]

What does your doctor attribute the rise in your liver enzymes to. Does your doctor think the PI is causing toxicity? I read an article where that can happen in co-infected people treating however this was due to the HCV meds & the HIV "cocktail." The thing is that particular article defined toxicity as five times of the normal level
enzymes ALT (alanine aminotransferase) and/or AST (aspartate aminotransferase) to levels greater than 5 times the upper limit of normal.

How about your hemochromatosis? Could that be a factor? Plus I remember your ferritin was increasing for a while there. I know you are diligent about researching all this so I don't want to reinvent the wheel here but I would hate to see you stop if you are not ready - especially if there could be an underlying factor that could be managed.

I know you trust your Hepa but sometimes an equally qualified pair of fresh eyes viewing your data can help? So you happen to know if your doctor consults with other professionals?

What would you like to see happen here? How have you been otherwise? Please keep us informed & post other info you think might be relevant.

[bbj2856]

Hi ALT and AST  reached around 500 before end of treatmentt and my doctor told  me this happens to lots of his patients. I completed my treatment  in June 2012 and  with in 30 days each dropped like 200 or so then at end of 3 months Alt was normal and AST was about 30 points over.
At end of 6 monhts ALT was normal and AST was about 15 points high so they are almost normal now. I was still UND at end of the 6 months treatment and I am so thankful they are back to normal and I am free of this virus.
Dont give up and keep the faith .
Hoping you  have a great New Year  
bbj

[jules2551]

He's a Hepa Dr in charge of transplant at Temple University in Philly.  He's been treating Hep C patients for years and said that continuing treatment could be doing more damage than good if ALT/AST continue to rise.  He thinks that my iron issues are causing it to rise.  

I have been UND since week 9...I am on week 25 again.  

Jules

[HectorSF]

"My question is are there any guidelines/protocol for stopping tx if your ALT/AST reaches 150 each even though you are UND?"'
No.

The reason you can't find information anywhere is... it doesn't exist.

HIGHLIGHTS OF PRESCRIBING INFORMATION

"2.4 Discontinuation of Dosing Based on Treatment Futility

"Discontinuation of therapy is recommended in all patients with
1) HCV-RNA levels of greater than or equal to 100 IU per mL at TW12;
or 2) confirmed detectable HCV-RNA levels at TW24."

Hepa doc? What kind of doctor is it? I'm afraid your doctor is misinformed. He/she should learn how to treat patients according to treatment instruction label. Ill informed doctors lead to less successful cure rates in patients.

When was your viral load was undetectable?

Good luck!
hector