One of the BIG issues in the current Hep C treatment world is the relapse.
Statistically about 1 in 40 people treating with Sofosbuvir 400 mg + Velpatasvir 90 mg (Epclusa) will relapse.
Why this happens is not entirely clear however factors such as fibrosis level, previous treatment history and length of treatment are certainly factors.
Another factor, one that we can directly control, is what food and supplements we consume during treatment with Epclusa.
In this post I will talk a little about relapse and give you some tips that might help make a small difference, but which might make the difference between clearing the Hepatitis C or relapsing after treatment.
Firstly I will mention treatment times.
If you have failed a previous Hepatitis C treatment then you should seriously consider do the maximum Epclusa treatment period, which is generally considered to be 24 weeks.
One of the reasons for this is because it is likely that the Hepatitis C virus in your body has developed some degree of resistance to treatment. If you can not afford to do 24 weeks you should seriously consider at least 16 weeks treatment. The length of treatment time is something you should discuss with your doctor.
If you have high liver fibrosis levels, F3 or F4, your should also consider doing a longer treatment period.
Epclusa is a very effective treatment for all Hepatitis C genotypes and it is particularly good for treating Hepatitis C genotype 3. However because genotype 3 has proven to be a difficult genotype of Hep C to cure it is worth considering doing more than 12 weeks treatment with Epclusa if you are treating genotype 3. The rule of thumb is “The longer the treatment time the higher the cure rates.
8 Weeks 90%>
12 Weeks 95%> (+5%)
16 Weeks 97%> (+2%)
20 Weeks 98%> (+1%)
24 Weeks 98.5% > (+0.5%)
The first thing to understand when taking Epclusa is that Epclusa is two drugs, Sofosbuvir and Velpatasvir. Velpatasvir is not a water soluble chemical. That is to say it does not dissolve easily.
Sofosbuvir is very soluble, Velpatasvir is not very soluble.
Velpatasvir relies heavily on the stomach acids to dissolve it and make it easy for the body to absorb.
This is why you must never take antacids when you are taking Epclusa or any other substance that might neutralise your stomach acid.
On the instructions that come with the bottle of pills it says that Epclusa can be taken with or without food.
However there is now a general agreement that it is better to take your pill with a small amount of food.
Because having a small amount of food in the stomach will stimulate the stomach acids and assist in the absorption process.
The Epclusa is absorbed in the stomach, through the stomach walls.
Not a large amount of food, not a huge meal, because some of the Velpatasvir is going to get caught up in the mass of food.
Also I would not suggest drinking a large amount of water right after taking your pill.
For the same reason.
We want that Velpatasvir to hang around in some nice strong stomach acid for a while, not get washed away in a flood of H20.
Certain herbal supplements will speed up the rate that the active ingredients in Epclusa are removed from the blood stream, which can lead to ” under dosing” .
Sofosbuvir and Velpatasvir are removed from the body by enzymes created by your liver. These enzymes are from a family of enzymes called CYP Enzymes, which are created to breakdown and remove toxins from the blood. Certain herbs, such as St John’s Wort cause the body to create a lot of CYP enzymes, which in turn will cause the Sofosbuvir and Velpatasvir to be broken down much faster than normal. Because we do not know how many herbal supplements will effect CYP enzyme levels it is wise not to take any form of herbal supplement during your Hepatitis C treatment.
Coffee, or rather caffeine causes the body to produce CYP enzymes because the liver considers caffeine to be a toxin and wants to remove it. If you drink large amounts of coffee while doing treatment with Epclusa it is possible that this may effect treatment outcomes. Please remember that it is the caffeine, not the coffee, that is the problem this means that any drink containing high levels of caffeine should be consumed in moderation during treatment with Epclusa.
One or two cups of coffee a day is not a problem but if you are drinking ten or more cups of coffee a day you should consider reducing this whilst taking Epclusa. The same applies to energy drinks containing high levels of caffeine.
It is also a good idea to get a seven day pill box. This is a small plastic box with a compartment for each day of the week. If you lay out your pills for the week in the pill box you will not miss a
Herbal Supplements During Hepatitis C Treatment
High levels of these CYP enzymes can also be caused by some drugs and herbal supplements, particularly St John’s Wort. It is wise to avoid any herbal supplements while doing Hepatitis C treatment with Sofosbuvir + Daclatasvir.
Energy Drinks such as Red Bull and other brands contain high levels of caffeine and another stimulant called Taurine. Taurine will also stimulate production of CYP enzymes and so Energy drinks should be avoided.
There are no common foods that cause any problematic interactions with Sofosbuvir and Daclatasvir.
There is something of a myth going around that food like grapefruit, papaya and so on should be avoided.
This is not entirely correct.
The reason behind this myth is that certain fruits will slightly suppress production of the CYP enzymes (the enzymes that break down Sofosbuvir and Daclatasvir). What this means is that by eating these foods while doing Hep C treatment the Sofosbuvir and Daclatasvir will remain active in the blood a little longer, which is probably not a bad thing.
To put this simply and in perspective the half-life of Sofosbuvir in your blood is about 20 minutes. That means that if your body absorbs 400 mg of Sofosbuvir 20 minutes later there will be only 200 mg of Sofosbuvir. After 40 minutes there will be about 100 mg and after an hour about 50 mg.
If you were to eat several grapefruit or a couple of papaya the effect might be that at the end of an hour you might have 60 or 70 mg left instead of 50 mg… its not a problem. You would need to eat about several grapefruit to make any real significant difference.
Taking other medication while doing Hepatitis C Treatment.
If you are on other medication you should check with your doctor to make sure there are no clashes between the Hep C medication and your other medicines. If you want to check for yourself there is a very good website which has an interactive chart that lists all Hep C medicines and other medications and you can check you medicine on this. Here is the link:
Whilst taking Sofosbuvir + Daclatasvir (or any DAA) to treat Hepatitis C a sensible diet containing fresh fruit and vegetables is the main requirement. Avoid supplements of any kind during treatment.
Once treatment is complete then, if you use particular herbal or vitamin supplements, then you can resume.
To give your liver the best chance to heal the healthy diet combined with regular exercise is the best path to follow.
Given a chance your liver will be able to completely heal from the damage done by Hep C.
Here are a few tips for people treating their Hepatitis C with Sofosbuvir 400 mg + Daclatasvir 60 mg.
Sofosbuvir and Daclatasvir are both water soluble and are absorbed into the bloodstream through the stomach.
If you have a Sofosbuvir pill and a separate Daclatasvir pill these pills should be taken together at the same time each day.
The pills should be taken with a small amount of food and not too much water or other beverages. The reason for this is taking the pills with a small amount of food will hold the medicines in the stomach for the maximum time, ensuring absorption of the active ingredients.
Because Sofosbuvir can cause insomnia in some people it may be wise to that the pills in the morning with breakfast.
Coffee and tea should only be taken in moderation while using Sofosbuvir and Daclatasvir. The reason for this is that the enzymes, called CYP enzymes, used by the body to remove caffeine from the blood are from the same family of enzymes that the body uses to remove Sofosbuvir and Daclatasvir from the blood. High levels of caffeine may create an “under-dose” situation.
Having said that one or two cups of coffee or tea is no problem at all.