12 weeks of tx/ 3 log drop but not clear ???? whats my chances of zero ??

[jakeone29]

Im 48 r old male .. type 1a  my viral load was pretreatment  (1,084,400) dec /05 ,,,viral load on march/05 (14,747)
after 12 weeks. i was told almost a 3 Log drop so tx will continue till week 24 if not zero at that time off the tx i go.
im on peginterferon alfa-2b  135ug/ weekly  and 1000mg ribavirin daily. Im new to this and this is  my first question so be gentle ,, not sur of all the med terms , what was left of my hair is gone/ and every other side effect it seems i have had to some degree.. however no drop in blood counts. Just curious if anyone else had a responce like this an whats going on with them.. whats my chances of zero in 9 weeks when i go for the 24 week check up blood work..
thanks

[jerialice]

yeah, if i knew what i know now, i would have gone longer. now i gotta start over!
i started a new thread regarding that and you are welcome to email me at ***@****. if you can keep going, it might be a bad idea!
jerialice

[friole]

Wow, your information in timely.I also was not und at 12 weeks and only had a vl of 40 IU/mL.  Now at 40 weeks (tonight) I am wrestling with the issue of extending 36 weeks after a sensitive clear.  For me that means extending 8 more weeks.  I am so glad you have posted this information and I intend to talk to you more about it later.

[GoofyDad]

Ahhhh man.... :(

Kalio, I was sooooo pulling for an un-D (the lingo is an unfortunate consequence of having a seven year old in the house). I was so sure of it.

When you were tested clear before, were you tested by either TMA or ultra-low PCR?

Depending on the study, 4 week clearance rates are about 65-85 percent (from memory). My doc mentioned (after I cleared at 4 weeks, of course) that not doing so is a red flag to him. I hae no idea the implications of the prior tx.

I'll get you a study that shows SVR rates for those who didn't clear at week 4 - not the point of the study, it's secondary data that you can pick-up by reading carefully. If nothing else, it's guaranteed to make your head spin and take your mind off other things.

My gut feel is that I don't share your doc's optimism on this all being one tx for you. I would think that being off meds and the virus breaking through has to set the clock back some, if not to the begining. Just layman's conjecture on my part. I'll also get you an email addy of a bay area doc that might be interested in your case if you want. THey may have souther clinics too.

Try to hang tough Kalio. I can't take the meds for you, but I'll do what I can if I can help you along in any way. BTW, I forget your liver damage - wasn't it stage 2?

[jmjm530]

Full text here: http://www.rxlist.com/cgi/generic2/ribav_cp.htm

Effect of Food on Absorption of Ribavirin

Both AUC tf and Cmax increased by 70% when Rebetol Capsules were administered with a high-fat meal (841 kcal, 53.8 g fat, 31.6 g protein, and 57.4 g carbohydrate) in a single-dose pharmacokinetic study. There are insufficient data to address the clinical relevance of these results. Clinical efficacy studies were conducted without instructions with respect to food consumption. (See DOSAGE AND ADMINISTRATION .)

Effect of Antacid on Absorption of Ribavirin

Coadministration with an antacid containing magnesium, aluminum, and simethicone (Mylanta®) resulted in a 14% decrease in mean ribavirin AUCtf. The clinical relevance of results from this single-dose study is unknown.

###

[jmjm530]

(1)How many weeks have you been on 1600 riba and what was your hgb baseline before you started to re-treat? The reason I ask is because, depending on the timeline, it's possible that the uptick in riba is from when you went off the drugs completely and that the higher dose of riba hasn't kicked in yet. Remember, there's at least a two-week delay between riba dose change and hgb change -- sometimes it can take 4 weeks or even longer to see a significant change. Weekly CBC's in your case would not be out of line until you determine your hgb has stabalized.

(2) How much riba did you take during your first try at treatment and what was your hgb? What was your hgb baseline before treatment?

(2) Did you have a biopsy and what stage are you? Any fatty liver?

-- Jim

[jmjm530]

#1 in part should have read "uptick in hgb" not "uptick in riba"

[jmjm530]

Jake said: however no drop in blood counts.
--------------------------------------------
Don't know your exact odds but in order to give yourself a decent chance at a cure, you'll probably have to treat at least 36 past the point you're non-detectible using a sensitive test that goes down to at least 50 IU/ml -- better still down to 5-10 IU/ml.  So if you're non-detect at 24 weeks, that would mean at least 60 weeks of treatment.

You mention "no drop in blood counts". What is your hemoglobin? How much do you weigh? A normal hemoglobin under treatment is not necessarily good. It could indicate that the ribavirin isn't being absorbed into your blood efficiently enough. Are you taking your ribavirin with meals that have at least a moderate fat content? Are you taking any sort of antacids around the time you take the ribavirin?

In any event, if your hemoglobin is indeed high, you might discuss with your doctor increasing your ribavirn dose. This might give you the push you need to get non-detectible.

As you probably know, none of us here are doctors so don't make any treatment decisions without discussing with your own medical team.

Good luck!

-- Jim

[FlGuy]

If you and the doc consider the 36 weeks after non-detectable, as Jim mentioned, you might consider another pcr before 24 weeks, say at 16, 18 or 20 weeks.  Good luck,

[Mister beagle bailey]

First I would like to say welcome to the forum,

I have seen some on the forum not clear until week 24 of tx, so I would say your chances are still good of clearing the virus.

Here are some terms we use here, write them down and keep them  by your computer this is what I did when I first started here:

PCR: POLYMERASE CHAIN REACTION (VIRAL COUNT)
AST AND ALT:  LIVER ENZYME
TX: TREATMENT
SX: SIDES
BX: BIOPSY
HX: HISTORY
VL:  VIRAL LOAD
EVR: EARLY VIRAL RESPONSE
RVR: RAPID VIRAL RESPONSE
SVR:  SUSTAINED VIRAL RESPONSE--- WHICH IS WHAT YOU WANT TO BE AFTER TX IS DONE

Hope this helps,

Beagle

[NYgirl]

I don't know what your "chances" are - but I was not UND until somewhere between week 12 and 24 and my doctor was not concerned AT ALL. I had 400 virus still floating around and never thought they would go away but at week 24 which is the biggie they were GONE.

I had a three log drop as well and THAT is a good indicator so do NOT get depressed or give up!

Just keep on KILLING THOSE VIRUS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[NYgirl]

PS I plan on treating for an additional 36 weeks from at LEAST week 20 but hoping for 24.  I have some other issues that have come because of the Interferon so I'm not sure if I will still be able to but I am going to PUSH for it.  36 weeks after UND is what is best they say so I'm going for it!

[jakeone29]

Thanks guys.. jmjm530 i was just told that the blood work was okay and that they didnt consider any problems there, i am seeing a heptologist. yes in fact i tak ribavarin in the evening and i usually do take a few antiacids,, not a good idea you think.. well the antiacids arnt that important . will watch the fat in my meals .. yes ive been told that numerous times by the doc to get fat into me when i take the pills. Im about 158lbs at this time.. i believe i was 160 something when i started..
Got my list thanks beagle the sx have been hellish the tx is long and im getting an early pcr done for sure ,, hey does tht sound good?? lol
jake

[jakeone29]

thanks nygirl .. i get it now,, you need 36 weeks after you show zero to get the max benefit and chance for svr .. rite

[FlGuy]

You've got the hcv lingo down now.  Pretty soon you'll be able to make no sense at all, like a lot of us, without using any complet words or sentences. BTW, try to get copies of the blood work results as they do cbc's.  It will help you keep track of what the doc's are doing and the methods behind their madness.

[jmjm530]

Antacids can effect ribavirin absorption. Try spacing your antacids at least two hours before and two hours after you take the ribavirin. Same thing with metamucil, flax, or anything else that can interfere with rx drug absorption. If you feel your need some sort of heartburn relief at meal times, ask your doctor about a PPI like Nexium which will not interfere with the ribavirn. Another class of OTC drugs are called H2 Inhibitors like Zantac. I don't believe Zantac will interfere with riba absorption but you might check.

-- Jim

[jmjm530]

As to what I would do --

First, I'd research out re-treatment protocols for geno 3's. Perhaps Goofy has some info here, so you might want to contact him.

Also, this seems like a good time for an outside consult or two.
Sometimes you can do it by email or phone, sometimes you have to travel, but might be well worth it.

Here's a partial list of some well-respected hepatologists you might try and contact with your stats:

Eugene Schiff (Miami)
Douglas Dieterich (New York City)
Nezam Afdhal (Boston)
Ira Jacobson (New York City)
Robert Gish (San Francisco)

[jerialice]

hey i'm still trying to get a response to my queries.....help!
i am in re-treat also.
had a 9600 when i went in for post tx 6 month test. i was one year on riba/pegasys. 45 @ 3 months, UND at 6 and 12. waitied 6 months and wham it's baaack.

stage 0 geno 1.
53 wh f, 111 lbs.

due to my reaction to riba, my doc and i went down to 800 which is what i am on now + 180 peg. so far no bad sx, but only 2 weeks in.
do you think it's worth going through all this again since new stuff right around the corner? it sounds like i have to go a long time. my doc ( who is only working with hep c) says a 3 month course might get it?! it don't sound that way from your discussion. i am confused as to why i had such a great response and it came back
): Also i guess i need to press for more testing. any chance of false positive in my case?

kalio, my PCR quest paper says the same thing as yours.

anybody know of any docs in austin, tx? for 2nd opinion?

[jmjm530]

I don't know the re-treatment protocols for geno 2's but you might want to do further research, such as studies or additional consults. As I understand it, your doctor is lumping together the weeks from your first treatment and your re-treatment. You also might want to check whether or not this is the correct protocol.

I don't know what your pre-tx viral load was -- and it might be cloudy since you re-started so soon -- but 400 IU/ml seems OK for a 4-week PCR at least for a geno 1. Goofy has suggested that geno 2's and 3's have more 4 week negatives, maybe you can check out some studies on this to see if and how the 4-week dectectible impacts SVR. And since you're so close, you might also want to do another PCR at six and eight weeks instead of waiting till week 12.

You say you're on 1600 mg/day of Riba and your hemoglobin is normal? Are you on Procrit? This just seems odd to me. I'd be very hesitant to tell anyone to take more than 1600mg/day of ribavirin but to this unprofessional mind it appears (asssuming you're not on Procrit) that somehow the riba isn't be effectively absorbed into your blood as studies suggest that anemia and riba absorption have a positive correlation.

Lastly, I forgot if you have significant liver damage or not -- but if not, you have to keep in mind that you always have the option for strategic break from treatment and watch and wait for the newer drugs in the pipeline.

-- Jim

[jmjm530]

3 months re-treatment for a geno 1's sounds bogus. I've heard of short-course 6 month treatments, but that was for those with low pre-tx viral loads who were non-detectible at week 4. You weren't non-detc at week 4 and you're a relapser to boot! So, yes, a second opinion is in order if you want to continue to treat.

As far as whether you should call it a day, that's a highly personal decision and a lot of things factor into it. But with a stage 0, AND having failed to get non-detectible at 12 weeks, AND having relapsed once -- personally, I'd give serious consideration to going off treatment and adopting a watch and wait approach for newer drugs now in the testing pipeline. Others may have different opinions here.

Sorry I can't help you with doctors in Texas, maybe someone else can. If not, check out the larger teaching hospitals, then the hepatology deparment.

-- Jim

[GoofyDad]

Sorry if you were missed. And sorry for the difficulties yuor having.

I'm begining to get the impression that there are several camps in the relapse/retreat discussion. One has it that the first tx may have done the heavy lifting, and the subsequent ones leverage that progress. Another is your starting from square on, like a niave patient. And the third say you now carry the stigma of being difficult to cure.

I dunno what's right. My doc seems to think of tx as being a training of the immune system. In that case, it would stand to reason that the first camp might be right.

On the question of treat or wait, I generally have a bias towards waiting when it can be done safetly (e.g. low damage progression). Others seem to strongly disagree. It's a personal decision, in which you balance the risk and QOL life issues of treating against the risk and QOL issues of waiting.

Best wishes to you.

[jmjm530]

Regarding your question about the chances of a false positive during your first round of treatment. Statistically it probably wasn't but a lot of doctors will re-test postitives in a case like yours before making any major treatment decisions.

However, question is academic if you've already started treating again since the drugs will influence the results.

However, if you haven't started re-treatment then I absolutely would not do anything until I took another viral load test. You want as sensitive a test as possible. At least down to 50 IU/ml. Better still down to 5-10 IU/ml.

-- Jim

[friole]

jakeone -- sounds like you got the lingo down really fast.  Wanted to point something out - I actually caught this and responded on the other thread you posted to but you may not have seen it.  You didn't get a 3 log drop at 12 weeks; not even a 2 log drop.  For a 2 log drop, you take your beginning VL and move the decimal place over 2 points.

So with your beginning vl of  1,084,400 you need to have a vl of
10,844 your a 2 log drop, and you had 14,747.  Now hopefully they are not mixing copies and international units on you.  Copies are the unit that most labs show the viral load in, but with each lab, copies mean something different.  Thus, each lab converts its copies to international units (IU) and these IU are supposed to be the same from lab to lab.  The only way to know which you are talking about is to get copies of all your labs.

I had even wondered if they were going to step up your treatment since you didn't make the 2 log drop.  Some of our members have had increased pegasys doses and some have changed to infergen (I think that would depend on your liver damage).  I too welcome you to the forum.

Kalio -- congrats on the PCR. I am sure you would want it to be clear, but it is what it is.  I would go with the 36 weeks of treating after your first sensitive clear test, but an expert I am definitely not.

Jerialice - I have no works of wisdom on retreating but wanted to welcome you to the forum.   I do think since the state of your liver is so good you could wait.  However, since you have started, I would think the 36 weeks after clear would apply to you too.

[jakeone29]

thanks guys ,, and friloe your right ,,not almost 3 .. almost 2 log is what the drop  is.. close but no cigar. i have an appointment to see the hep dr on the 20th april.. so i quess i will learn more.. im in canada to ,, christ knows what units we are using , im 5 foot 10 inches tall but my car goes 120kilmeters an hour.. lol haha have to have some humour.. and who knows it was a phone conversation when she gave me the info and i cant remember my own name half the time.
oh well its nice to hear all these things and at least have a damn idea whts going on around you,,, christ i dont think i could take anymore of a dosage ,, im so sick for the first  3 days i cant move.. i know i couldnt take anymore sx..the nurse said that stress could be a big factor for me also.. well i dont feel as confused about it all , and its GREAT HAVING  people to talk with and get a few su=ggestions from and ideas ,,cant say thanks enough..

[Mister beagle bailey]

That's great about your blood test.

Yes, it's on the bottom of all the tests.  The only one approved by the FDA is:
             HCV NGI ULTRA QUAL TEST
Done by the National Genetics, the co. that tests the nations blood supply. This is FDA approval and is done by LAB CORP.

Beagle