12 PCR

[antman]

well, i got my 12 week PCR and it was 55. i started out at 3mil. is there a chance at SVR with 48 weeks(pegasys 180 riba 1200)- or should i ask the Dr to extend to 72weeks? (geno 1a) i know the drop is big but i was really hoping for UND. thanks.

[jmjm530]

Is there something wrong with your reading comprehension or do you simply not bother to read my (above) and previous posts. I've consistently -- that means "often" btw -- said that the shorter course is best for those with minimal liver damage. I have also equally recommended extended treatment to those who are still detectible at week 12, especially if they have significant liver damage.  I have no idea what your problem(s) are but there's an old saying that once you start arguing with a crazy person, within five minutes you start sounding crazy. So please rant on cause anyone who has read my post (above) will understand that one of us simply isn't listening to the other. As to me only being able to speak for myself, thanks for the rules but try applying them to yourself before you suggest them to others.

[Kalio1]

"I know better?" Heh, yeah I do, which is why people should know you DID extend your therapy.  Truth is Jm, You extended. Try speaking with your own singular voice like the rest of us, you are not allowed to speak for "everybody" you can only speak for you and you alone.
You consistently leave out the fact that you extended ( and double dosed) in your selling of the short course treatment to others. If you said "hey read this, it says you can stop early and still beat it but I did not do that, I in fact I extended MY therapy and took more than the recommended dosages of meds but I think YOU should cut it short" Then people would think, hey wait a minute, YOU didn't do this? YOU treated longer than normal? Why are you trying to sell ME a short course therapy if you didn't even do it?" Why don't you  present BOTH short course AND extending options to people? Why don't you tell them you extended?

Im sure many here are finding out for the first time that you did indeed extend your own therapy. Now you try to minimize that fact by saying you  "only" extended 6 weeks LOL nice try. You extended yet constantly try to get others to cut tx short. Hard to explain that one. If you prefaced your pushing of short course therapy by saying you did NOT do that, you in fact extended and double dosed ( and took so much Riba you ended up in the hospital) then it would take the punch out of the short course sales pitch wouldn't it? Sure it would, people would wonder why you push a therapy you did not believe in enough to follow yourself. Now you are safe, you are SVR likely due in part to  extending and overdosing the meds.

People WANT to do less therapy and still win so you play on that about people, they all want to get out of this mess with the least amount of time on tx, so they will grab onto what you are selling. You sell them what they want to hear, short coursing is risky and likely to result in MORE therapy over time should they relapse and not increase their chances of success which is precisely WHY you extended your therapy, to increase your chances of success and it WORKED.  Why is it you don't recommend the approach that worked for you?


I hope they all still SVR but they really should listen to their doctors who across the board do NOT agree with you and do not sanction short coursing, an approach you yourself did not take. If you want to sell short coursing, fine, but have the honesty to let people know when it came to your treatment you did not follow that path.

Extension is extension, and you extended.

[antman]

well, i'll tell ya, having a vl @ 12 weeks ,even if 55 seems to make my cahnces at svr seem iffy. but, either way, i'm in it for 48 weeks min. who knows, i could be und now. i just did shot 14. i definately will get another pcr after i see the Dr. May 7. we'll see what happens. thanks for all the support, input.
ant

[Kalio1]

The sad fact is that either way you go the tx can still succeed or fail. The whole point of extending tx is to increase your chances of acheiving SVR and your odds of SVR go up substantially if you extend but it's still no guarantee.

In your case it's doubly difficult because you are so close to UND but "close" counts in horseshes but not with tx.  Pushing the tx longer does appear to increase your chances of success but you still have to put in that extra tx time on these meds so it's not an easy decision.

Truth is, you can still SVR with out extension and you could still fail SVR with an extension. Unfortunately we do not have anyway to guarantee our success even after all the meds.
Jm,  who EXTENDED TX HIMSELF to achieve SVR advocates vehemently for the exact opposite treatment approach for others than what he did that worked for him, strangely enough.

It's a decision you have to come to based on your and your doctor's take on the study info available and how well or not well you are handling tx.

Good luck whatever you decide.

[zazza]

Adding 36 weeks is just a mathematical model, not supported by any study. In fact the Berg study states its results contradict Drusano's add-36-week model.

[jmjm530]

Kalio: Jm, who EXTENDED TX HIMSELF to achieve SVR advocates vehemently for the exact opposite treatment approach for others than what he did that worked for him, strangely enough.
----------------------
You know better than that, and so does anyone who has been here any length of time. But for those who don't, your above statement is a bold-face lie. Do I have to be any clearer?

I have always recommended treatment length based on a number of factors not just limited to RVR but including how much liver damage someone has which means I have in many cases recommended extended treatment to others and have cited studies to that effect. In my case, best estimate was my liver damge was  around stage 3 and in spite of that I only extended only six weeks. Also mentioned several times that three liver specialists only recommended 48 weeks. Stop the lies, mischarterizations and nonsense. Statements like yours are a disserservice to everyone here and I hope none of the new people take you seriously because most that have been here for awhile realize you rarely know what you're talking about.

[zazza]

Also what made me make up my mind in favor of 72 weeks was that Berg in an article in the German magazine "Hepatitis & More" concludes that having a viral load of equal to or more than 10 IU/ml at week 12 should lead to extension to 72 weeks.

I just realized I mixed up the limit of the test I did at week 12 in the post above: it was 15 IU/ml, and thus, according to Vertex terminology it would be "14 IU/ml".

[zazza]

Talk about being close to UND at week 12 - I was detectable by a test with the lower limit of 10 IU/ml, but my viral load was so low they called it "borderline" as it was impossible to quantify and give me a viral load number. If one were to use the terminology of the Vertex trials this would have been called "9 IU/ml".

I have decided, after reading the Berg study, and discussing the issue with Friole and NYgirl, to go for 72 weeks. This just about cuts the risk for relapse to half in cases like mine (and yours).

Good luck in making your own decision.

[ladybug52]

Kalio's advice is good, and so is Jim's. Look at all the info available, don't be discouraged since you've had a significant drop, but see how tx effects you. Weigh the benefits against the risks and wait and see what you find out on the next few pcr's. It's all a waiting game here, wait and worry is soo fun isn't it? Try to leave the worry out and keep on fighting. It's a personal decision what to do, and you have plenty of time to decide.
Good luck, your pcr drop WAS big, and tx is slower for geno 1's, hence 48 weeks vs 24.
Bug

[nygirl7]

The Berg study is what I used (in addition with the Sanchez Tapias study) in order to determine this myself.

I had a nice huge drop right away at week 4 but had a number of 411. I STILL had this number at week 12. By older standards it would have said UND but I really was not.

Taking into consideration both of the above studies, and going to Dr. Ira Jacobson who was the lead investigator of the Berg Study - we decided since I was UND at week 24 but NOT at 12 = I should do 72 weeks to give myself the best chance of SVR.

Doing the extra weeks gave me a chance of only a 1/3 relapse compared to a 1/2 chance if I did not.

THAT is HUGE.

As you note some of us have been through this. Friole did "extra" but not "enough"...I am not sure yet if it worked for me or not but I know it was the best chance I had (or I wouldn't have done it LOL)

Look at your own personal situation.  How are you handling treatment?  Are the sides bad enough so that you CANT?  Will insurance cover it (mine would NOT but I got all the meds for free delivered to my house from Commitment to Care yay for them!).

If you feel you can handle it then it would probably be in your best interest to try.

Being pos at week 12 is just a sucky thing - I know it.

But - in life - sometimes we gotta suck it up and do what we gotta do.

I wish you ALL of the best Ant!

Debby

[antman]

the thing is i am so close at week 12 (VL 55). so if there was 6 less it would be UND with this test. i see my Dr. May 7th. i'll get another VL test after that. hopefully then it will be UND, better yet it is now! if so i wonder if the formula where you add 36 weeks to the time you are UND would be appropriate?

[nygirl7]

Some of us not being UND at week 12 might NEVER be able to become SVR using these meds.  I mean is there any guarantee if Friole did 100 weeks she would have? Nope.

It is ALL a big giant gamble.  We try to use the information to evaluate what our best odds might be to get to SVR - but in reality - there is WAY too much that is not known about this disease and NOBODY REALLY knows what they are talking about.

At the end of the day, it's really russian roulette you know?

[jmjm530]

I wouldn't rush into treating 72 weeks just because you weren't non-detectible at week 4. Among other things, the study posted compares SVR rates in a subgroup positive between weeks 8-12 and you're only at week 4 which even by this study gives you four more weeks to get to under 50 IU/ml.

What's more, the study data appears contradicted here http://www.natap.org/2006/AASLD/AASLD_34.htm where EVR's (non-detectible by week 12) have an 80 per cent chance of SVR with 48 weeks of treatment. That gives you another 8 weeks to get non-detectible.

You've definitley had an excellent start with your four week drop so please do not become discouraged. Your next effort is to get  non-detectible by week 12 at the latest. It appears you will do so on your current regimen, but if you're tolerating treatment well, you can always discuss with your doctor upping your meds such as the ribavirin to give you just a little bit of push.  

But back to the 72 weeks. While it may make sense for some, I can't see recommending anyone with little or no liver damage exposing themself to the treatment drugs for so long. Risks just outweigh rewards. And very important -- if you do relapse after 48 weeks of treatment, the optionis not solely to treat another 72 weeks --  other options including either watching and waiting or entering one of the newer trials -- like Prove 3 -- which promise better results in less time.

All the best,

-- Jim

[Kalio1]

I have been out today (miracle!) sorry for the delay. Here is a link to the info. I was referring to:

http://www.natap.org/2007/EASL/EASL_32.htm

It is worth condsidering and discussing with your doctor. There is some other info about it out there I thought I had but of course can't find now, I will look for it or maybe someone else has those studies handy.
So many factors have to be considered and weighed and extension might or might not be the best choice for you. It's a hard place to be. My situation involved having relapsed after the first tx in which I was not clear until between weeks 8 and 12 (plus I have substantial damage) and the treatment failed. That does not mean standard length tx will fail you, but your chance of SVR does increase dramatically ( relapse rate goes down) if you run the tx longer according to this link and other recent info.I have read. This is not to say that some people won't still clear the virus within 48 weeks it just means they can better predict who is more likely to relapse.

The importance of clearing the virus in the first 4 weeks in order to SVR seems increasingly clear. It's a lousy odds game we play.
If I was you, I'd be PCR testing weekly to see which week I cleared in so you can then do the math on how many additional weeks you would do if you do decide to extend.

If you do relapse, the clock restarts at the beginning for tx, so say you do 48, relapse, then you'd do 72 on top of the initial 48. This is saying if you don't clear it very early then you can increase your chances of success by adding those extra weeks on the tx.

I hope that makes sense.

[wyntre9]

My 12 week PCR was 3,850 VL but week 16 was down to 90.

I just did 18 week labs and have my fingers crossed for UND before week 24.

I've been reading about extending to 72 as well.

Don't know if you saw it, but there's a good thread halfway down the page posted by Valtod about tx -length formulas.

Wyntre

[LadyY]

i take my 6th shot on friday...so nope to 12 week PCR. I don't even want to think about extending tx at this point...i just wanted Kalio to clarify his statement. I was excited to be a responder and happy that the vl did go done 2 logs and am glad that my CBC looked pretty good all at the 4 week benchmark...but was sad to read that 4 week PCR, best case scenario would be UND and then stick to 48 wk. protocol. If not UND at 4th week PCR..then extend tx...? I think that is what Kalio said. No doubt, I could have it all wrong...I hope so.

[friole]

Touch cookies antman.  Are you speaking in copies or IU's.  I was 3 million copies (1.52 millioin IUs) pretreatment.  I was 40IUs (that is 100 copies) at 12 weeks.  I became clear by 20 weeks and did 56 weeks total.  It wasn't enough.

You need to look at the Berg study, ant.  Extension to 72 weeks may be of value to you.  This study analyzed data in such a way that showed IF your viral load was under 6,000 at week 12 AND UND by week 24, extension may up your odds. You still could be one of the ones who clear in 48, and I could be one of the ones who would not clear, even with 72 weeks. If you would like to read the whole study instead of an abstract you can reach me at my screenname ataoldotcom.

LadyY - the bigger PCR is the 12th week.  Have you had that yet?  It is a little eary to be talking about extensions but it would be advantageous to get another PCR to see how fast the VL is coming down
frijole

[LadyY]

before tx, I was 2.9 million VL, and at 4th wk did PCR came back with 48.000 Vl. I was pretty happy with that until you mentioned being UND at 4th week. Are you saying that I should try to get dr. to agree to 72 weeks?

[Kalio1]

It's definately worth considering, The "new" protocols lean towards UND at week 4 being the onus for ending treatment at 48 weeks however these guidelines have not yet arrived in the "mainstream" for the most part.

Your damage level, length of infection, age, other illnesses and other contributing factors come into play here. Those factors should be weighed in your decision along with how well you are handling treatment.

Best of luck deciding, it's a rough decision with no guarantees either way.
I chose to extend based on previous relapse and the negative factors I had going, substantial damage, etc.

I'd take the latest info from the EASL in Barcelona to your doctor and discuss the approach with him. My doc let me "go long" primarily due to the fact that my blood values were holding well and I have advanced damage. He would like to see me on maintenance if this round of tx fails which Im sure is due to damage level more than anything.

[az hepper]

Hi, long before Heptimax and a few more sensitive test came out, it has been
my undersatnding that <50 , was considered as being undectable, and and many physicians still look at 12 weeks as a critical benchmark, I think the model to test VL sooner is a fairly newer protocol.your very close.I would think  abit early to start thinging about extending.

.I have seen 3 drs here is az and they all use the above standard. Of course there can be other issues, BTW, that's a great log drop.
just an observation, good luck.