Aa
Any theories about hiding viral particles
I have asked two gastro's what their opinion was in regards to patients going through treatment non detected then relapsing once finished. I have asked them is it just simply a matter of one microscopic virion hiding somewhere in the body all through treatment evading the killer drugs. They have no solid answers. I also wonder why extented treatment( 72 weeks which I currently am doing) takes so long to hunt down that one or two little virions and for that matter why is it that when people clear at 8-16 weeks it should take the fiull 48 weeks SOC for our bodies in conjunction with the drugs to force the virions out of hiding and destroy them. I also wonder if peoiple who do acheive SVR still may have a few virions left in the body but their own immune systems are simply keeping them in check where as people who relapse simply didn't have the natural immune fire power to keep the virus from multiplying. Tell me your theories friends.
Interesting observations concerning sinus/nose/ear/throat issues both pre and post tx. I've had an ongoing problem with sinus congestion (but no sinus infections, knock on phlegm), apparently caused by allergies throughout most of my adult life (infected at 17). I've also had on/off chronic irritation of the eyes and throat (less frequently though). I'm currently 7 weeks post tx, and I'd have to say in the last 6+ months or so (UND since last August), I've had much less sinus congestion than I normally have. And I've been sleeping deeper and more soundly than ever before as a consequence of it. The congestion and my deviated septum caused me to experience sleep anea quite a bit prior to treatment. But I seem to be less congested overall and am able to breathe through my nose better now and as a consequence sleep better at night; which makes me feel a whole lot better the next day. I don't know if I'm going to get my SVR yet, for all I know the virus has already rebounded and my old symptoms will come right back. But for many months now (all the while being UND), I'd have to say I've seen a distinct improvement in the sinus congestion department (and I'm very happy about it!). You really might be on to something there, thanks for sharing your experiences.
Once again a great, thouight-full post. I am sometimes amazed by you and Jim and those of your ilk. You think through problems logically, apply professional medical level studies and data and do it thoroughly and willingly. Bravo.
I appreciate your thoughts re: "just forum members" but you have also had many experiences...way too many...that some of us newbies do not.
I was a directed ECMO donor and received lots of specialized testing...as a matter of fact, my last donor card even had the note "CMV negative" on it.
I will keep you posted.
Deb
I appreciate your thoughts re: "just forum members" but you have also had many experiences...way too many...that some of us newbies do not.
I was a directed ECMO donor and received lots of specialized testing...as a matter of fact, my last donor card even had the note "CMV negative" on it.
I will keep you posted.
Deb
Wow -- What an interesting thought.
Hmmm - My asthma, sinus issues do seem to be better. But the way I look at it - is the liver processes EVERYTHING - cleans it and sends it back out.
If it isn't working properly - or doing double duty --- LOL - then it really can't clean out all the things that may cause allergic reactions - or keep you healthy - because it's using all of your immunities to help itself.
So I don't know if it is because of one thing that causes another --- or if it's just related... Or maybe like a lot of the symptoms - DNA predisposition towards it affected by the HCV and or the TX for HCV.
Most people, I have noticed seem to have the basic 4... Fatigue, Aches, Pains, Mental Impairment.
But there are a tons others... and they seem to be on a roulette wheel that spins -- and today's the day you get this side effect....
Like it changes.
But I haven't had a sinus infection since I ended TX... and it IS allergy season...
Having a bit of Asthma - allergy feeling -- but not sniffles or running nose - or uncomfortable pressure behind my eyes... Interesting that you noticed that.
Hmmm - My asthma, sinus issues do seem to be better. But the way I look at it - is the liver processes EVERYTHING - cleans it and sends it back out.
If it isn't working properly - or doing double duty --- LOL - then it really can't clean out all the things that may cause allergic reactions - or keep you healthy - because it's using all of your immunities to help itself.
So I don't know if it is because of one thing that causes another --- or if it's just related... Or maybe like a lot of the symptoms - DNA predisposition towards it affected by the HCV and or the TX for HCV.
Most people, I have noticed seem to have the basic 4... Fatigue, Aches, Pains, Mental Impairment.
But there are a tons others... and they seem to be on a roulette wheel that spins -- and today's the day you get this side effect....
Like it changes.
But I haven't had a sinus infection since I ended TX... and it IS allergy season...
Having a bit of Asthma - allergy feeling -- but not sniffles or running nose - or uncomfortable pressure behind my eyes... Interesting that you noticed that.
I will kind of reverse course here, and in light of your follow up post, indicating that you were HCV negative for years, by blood test, until recently....then it appears you may well be an 'acute ' HCV case with a pretty high probability. My only reasoning for going 48 weeks was the possibility you could have been a somewhat asymptomatic, undiscovered chronic case for years. It appears that this is not the case, and I do tend to agree with Willing. If we are dealing with a definite case of acute HCV, then everything I have ever read suggests 24 weeks of tx being more than adequate.
Still I would fully engage with Dr. Gish regarding his reasoning, and why also he would even suspect you could have been a chronic HCV case, in light of your comments above regarding regular blood donation, and I would assume concurrent HCV testing. I always tend to lean toward 'over-doing' things when it comes to eradicating HCV, but in your specific case, it would seem reasonable that 24 weeks would be as effective as 48 weeks for acute HCV.
Thanks for your follow up reply, because it makes your situation more clear, and allows for a more specific response from forum members. Also, remember we are just that, forum members....we are not your doctor, and should not make decisions for members. We can provide data and opinions, as well as articles, with which you can arm yourself in further discussions with your doctor. I think that debating, questioning, and 'pushing back' with HCV doctors is very healthy, and ultimately leads to better overall decisions being made.
Good luck to you. Please keep us informed of your progress, and outcome.
DoubleDose
Still I would fully engage with Dr. Gish regarding his reasoning, and why also he would even suspect you could have been a chronic HCV case, in light of your comments above regarding regular blood donation, and I would assume concurrent HCV testing. I always tend to lean toward 'over-doing' things when it comes to eradicating HCV, but in your specific case, it would seem reasonable that 24 weeks would be as effective as 48 weeks for acute HCV.
Thanks for your follow up reply, because it makes your situation more clear, and allows for a more specific response from forum members. Also, remember we are just that, forum members....we are not your doctor, and should not make decisions for members. We can provide data and opinions, as well as articles, with which you can arm yourself in further discussions with your doctor. I think that debating, questioning, and 'pushing back' with HCV doctors is very healthy, and ultimately leads to better overall decisions being made.
Good luck to you. Please keep us informed of your progress, and outcome.
DoubleDose
deb: you may want to take a look at a recent AMA review on hcv treatment
Molecular diagnostics of hepatitis C virus infection: a systematic review.
JAMA. 2007 Feb 21;297(7):724-32. Review.
PMID: 17312292 [PubMed - indexed for MEDLINE]
they review current "best-practices" and re acute and some recent studies summarize with:
"Several controversial issues were resolved, including (1) optimal time after infection to initiate therapy (8-12 weeks); (2) optimal treatment duration(24 weeks); and (3) the important point that ribavirin is apparently not required for optimal responses during acute infection, thus reducing the riskof major adverse effects (anemia)."
48 weeks for acute is way off the beaten path - at a minimum you should understand why he thinks this is the way to go
st.george: overall there's no mechanistic basis for determining effetive tx time (there's this much virus and it dies off at this rate) so ALL tx-length decisions are based on clinical data (this is what we did to the lab rats and this is what happened) and statistical extrapolations from that data, like Drusano, which like all forecasting, is sometimes right..
It's important to remember that what we can measure (the amount of virus in a blood draw) is only a very small and indirect measure of the amount, type and location of virus throughout the body.. See for example the fourth diagram in the following report
http://www.natap.org/2007/DDW/DDW_36.htm
Molecular diagnostics of hepatitis C virus infection: a systematic review.
JAMA. 2007 Feb 21;297(7):724-32. Review.
PMID: 17312292 [PubMed - indexed for MEDLINE]
they review current "best-practices" and re acute and some recent studies summarize with:
"Several controversial issues were resolved, including (1) optimal time after infection to initiate therapy (8-12 weeks); (2) optimal treatment duration(24 weeks); and (3) the important point that ribavirin is apparently not required for optimal responses during acute infection, thus reducing the riskof major adverse effects (anemia)."
48 weeks for acute is way off the beaten path - at a minimum you should understand why he thinks this is the way to go
st.george: overall there's no mechanistic basis for determining effetive tx time (there's this much virus and it dies off at this rate) so ALL tx-length decisions are based on clinical data (this is what we did to the lab rats and this is what happened) and statistical extrapolations from that data, like Drusano, which like all forecasting, is sometimes right..
It's important to remember that what we can measure (the amount of virus in a blood draw) is only a very small and indirect measure of the amount, type and location of virus throughout the body.. See for example the fourth diagram in the following report
http://www.natap.org/2007/DDW/DDW_36.htm
That was a thought provoking post.
It did make me think that I have to have an ANA on my next labs.
I've had allergies/sinus all my life; also at the same time I was a regular blood donator (post 92...I donated for ten years after the HCV testing was applied to donations). So i'm less concerned about a lifeline HCV infection than one might normally be.
But again I think I need to start looking at an autoimmune component here. All those types of tests were done prior to treatment and were negative but who knows what the HCV tx has done to me.
I will go to 24 and re evaluate to see if i can get to 36 and re evaluate again.....that seems like the best position.
Deb
It did make me think that I have to have an ANA on my next labs.
I've had allergies/sinus all my life; also at the same time I was a regular blood donator (post 92...I donated for ten years after the HCV testing was applied to donations). So i'm less concerned about a lifeline HCV infection than one might normally be.
But again I think I need to start looking at an autoimmune component here. All those types of tests were done prior to treatment and were negative but who knows what the HCV tx has done to me.
I will go to 24 and re evaluate to see if i can get to 36 and re evaluate again.....that seems like the best position.
Deb
Do either of you see any connection between your sinus infection issues, and HCV? The reason that I ask is that I had chronic sinus problems, and frequent sinus infections over the years when I was HCV positive. Most of my sinus problems have resolved totally over the past four years since obtaining SVR after tx.
I also know an individual who has had HCV for decades, and has also had the ongoing sinus infections over the years. Remember that HCV is also strongly associated with a Sjogren's Syndrome-like syndrome, which causes all sorts of problems in the salivary system, and related glands. Often the nose, eyes, and mouth of these people are very symptomatic, and irritated chronically.
I have often wondered over the years if the HCV actually infects the sinus tissues, thus triggering infections, or if the immune response provoked by HCV causes the sinus tissue symptoms. Maybe there is a connection.
How does the history of your sinus problems relate to the history of your HCV infections? Was there a period of time when the sinus issues clearly began?
I would also like to hear from any other board members who have also suffered from chronic sinus issues. Have any of you considered a possible HCV connection?
Deb: I also agree with Dr. Gish on your 48 week protocol, since there is no way of being sure that your HCV infection is really acute, or was chronic, and just flared-up after your surgery. To be safe, you would want to really take your best shot on the first tx. I know you are also an early responder, and might be cured with 24 weeks, but there are some risks there. If you can possibly handle the 48 weeks, I think it is a good idea.
DoubleDose
I also know an individual who has had HCV for decades, and has also had the ongoing sinus infections over the years. Remember that HCV is also strongly associated with a Sjogren's Syndrome-like syndrome, which causes all sorts of problems in the salivary system, and related glands. Often the nose, eyes, and mouth of these people are very symptomatic, and irritated chronically.
I have often wondered over the years if the HCV actually infects the sinus tissues, thus triggering infections, or if the immune response provoked by HCV causes the sinus tissue symptoms. Maybe there is a connection.
How does the history of your sinus problems relate to the history of your HCV infections? Was there a period of time when the sinus issues clearly began?
I would also like to hear from any other board members who have also suffered from chronic sinus issues. Have any of you considered a possible HCV connection?
Deb: I also agree with Dr. Gish on your 48 week protocol, since there is no way of being sure that your HCV infection is really acute, or was chronic, and just flared-up after your surgery. To be safe, you would want to really take your best shot on the first tx. I know you are also an early responder, and might be cured with 24 weeks, but there are some risks there. If you can possibly handle the 48 weeks, I think it is a good idea.
DoubleDose
I commend you on your advenures all the way from the UK to California Pacific Medical Center!
Having seen Gish and another Hepo in his practice - I took the impression that G is a little more agressive that some of the docs there. As Jim points out about the NP - these are folks who practice together, share access to the same data, and debate their opinions regularly. Yet they apparently have quite different reads on different cases. Go figure.
One thing that should not go without being said is that late infections like yours, especially those acquired through surgery, can apparently progress much more quickly than the routine.
Still - an extra-early-RVR sure bodes well for SVR. Couple that with a high physical cost of treating in your case and well..... it's a difficult decision, I'm sure.
Good luck and best wishes.
One thing that should not go without being said is that late infections like yours, especially those acquired through surgery, can apparently progress much more quickly than the routine.
Still - an extra-early-RVR sure bodes well for SVR. Couple that with a high physical cost of treating in your case and well..... it's a difficult decision, I'm sure.
Good luck and best wishes.
Deb,
As so many of these decisions are, it's a tough one with no clear cut or "correct" answer, at least how I see it. Gish says "A", but his own NP says "B".
The "BMI" thing, however, sticks out a bit, as my understanding is that while high BMI is a pre-tx negative -- your RVR would trump that. But even so, it seems Gish's position is to treat an acute like a chronic just in case they are really not acute. But then again, he writes that you are a "classic" acute.
Well, he certainly has a logic, but where is the risk/reward equation? Is Gish assigning any risk at all to treating 24 weeks longer (48 instead of 24)? Not to pick on Gish, but a lot of these doctors don't seem to assign a lot to that, continually citing that your chances are better with longer treatment, but never discussing the cost.
Sorry, don't know of any CA doctors at his level, but if you want to hope on a plane, I'd suggest Afdahl in Boston, Eugene Schiff in Miami, and Douglas Dieterich and Ira Jacobsen in New York City. Short of seeing them in person, you may find that one (or more) will accept your case via phone consult.
Good luck.
-- Jim
As so many of these decisions are, it's a tough one with no clear cut or "correct" answer, at least how I see it. Gish says "A", but his own NP says "B".
The "BMI" thing, however, sticks out a bit, as my understanding is that while high BMI is a pre-tx negative -- your RVR would trump that. But even so, it seems Gish's position is to treat an acute like a chronic just in case they are really not acute. But then again, he writes that you are a "classic" acute.
Well, he certainly has a logic, but where is the risk/reward equation? Is Gish assigning any risk at all to treating 24 weeks longer (48 instead of 24)? Not to pick on Gish, but a lot of these doctors don't seem to assign a lot to that, continually citing that your chances are better with longer treatment, but never discussing the cost.
Sorry, don't know of any CA doctors at his level, but if you want to hope on a plane, I'd suggest Afdahl in Boston, Eugene Schiff in Miami, and Douglas Dieterich and Ira Jacobsen in New York City. Short of seeing them in person, you may find that one (or more) will accept your case via phone consult.
Good luck.
-- Jim
Hi Jim good to see you.
I did have a talk with Gish. His feedback was this:
He says their SOC is probably more traiditional than individualized. He says he's done a lot of transplants on HCV folks. He says that I have probably one of the best chances to cure that he has seen lately. He says that 48 weeks is the SOC for 1 and 4. He says that he believes I am acute but on the off chance that I'm not (which I don't get..... I was a blood donor until two years prior to surgery), and ALSO with my higher BMI than most (now hi 20s) is the reason for the 48 weeks. Those are his justifications for the 48. The NP thinks 24 is enough as has told me she'll fight for this but he'll probably overrule. He treats NO ONE like they are acute even though it is in writing in his latest note - probable acute. A previous note called it "Classic acute hep c".
I have had so many infections. If I hadn't been fired three weeks ago I'm pretty sure this last one would have been the straw. I also have a still open wound from my surgery....this was still in the process of healing when I started treatment and I've had to have weekly appointments for wound care to get it to close....a very slow process. Sorry if that's gross...it is to me too. Plus I need surgery on the whole incisional area because of the poor healing in general and that has to wait until after I'm off interferon. It involves some pain as well.
I know I sound like I am whining .....sorry if that's true...but i now spend most of my time literally in bed, on so many medications in addition to treatment to take every day to keep noninfected with either bacterial or viral infections, to sleep and to not have too much pain that the quality of my life has decreased considerably. I don't go out unless i must and it's usually for docs appts. My counts aren't bad ....still in low normal range, so it's not that.
I want to cure but I want a life back...effectively since having surgery, having acute hepatitis and starting treatment, I've been "ill" for eight months and I'm looking at finishing up....if i go 48 ...for another 32 weeks. 16 months of significant illness. Those are MY justifications. I don't know who to see for a second....Gish is in CA .....are other Gish-level heps in CA?
Anyway, that's my latest info on this...
Thanks for ringing in on this again, Jim, I have a great deal of respect for your knowledge and opinion, as well as all of the others on the forum.
Deb
I did have a talk with Gish. His feedback was this:
He says their SOC is probably more traiditional than individualized. He says he's done a lot of transplants on HCV folks. He says that I have probably one of the best chances to cure that he has seen lately. He says that 48 weeks is the SOC for 1 and 4. He says that he believes I am acute but on the off chance that I'm not (which I don't get..... I was a blood donor until two years prior to surgery), and ALSO with my higher BMI than most (now hi 20s) is the reason for the 48 weeks. Those are his justifications for the 48. The NP thinks 24 is enough as has told me she'll fight for this but he'll probably overrule. He treats NO ONE like they are acute even though it is in writing in his latest note - probable acute. A previous note called it "Classic acute hep c".
I have had so many infections. If I hadn't been fired three weeks ago I'm pretty sure this last one would have been the straw. I also have a still open wound from my surgery....this was still in the process of healing when I started treatment and I've had to have weekly appointments for wound care to get it to close....a very slow process. Sorry if that's gross...it is to me too. Plus I need surgery on the whole incisional area because of the poor healing in general and that has to wait until after I'm off interferon. It involves some pain as well.
I know I sound like I am whining .....sorry if that's true...but i now spend most of my time literally in bed, on so many medications in addition to treatment to take every day to keep noninfected with either bacterial or viral infections, to sleep and to not have too much pain that the quality of my life has decreased considerably. I don't go out unless i must and it's usually for docs appts. My counts aren't bad ....still in low normal range, so it's not that.
I want to cure but I want a life back...effectively since having surgery, having acute hepatitis and starting treatment, I've been "ill" for eight months and I'm looking at finishing up....if i go 48 ...for another 32 weeks. 16 months of significant illness. Those are MY justifications. I don't know who to see for a second....Gish is in CA .....are other Gish-level heps in CA?
Anyway, that's my latest info on this...
Thanks for ringing in on this again, Jim, I have a great deal of respect for your knowledge and opinion, as well as all of the others on the forum.
Deb
Here is the thread I had remembered:
http://www.medhelp.org/forums/hepatitis/messages/46846.html
In it, Sonic makes a case for treating 48 weeks based on a more recent article by "Wiegand", but my reading of the same article came to a different conclusion -- see thread.
If it were me, I'd print out the full-text article cited, study it some more, and perhaps bring it to your appointment tomorrow.
Deb, these are difficult decisions, and often no clear guidance is offered, even by the experts.
I wish you the very best and hope you feel better soon.
-- Jim
http://www.medhelp.org/forums/hepatitis/messages/46846.html
In it, Sonic makes a case for treating 48 weeks based on a more recent article by "Wiegand", but my reading of the same article came to a different conclusion -- see thread.
If it were me, I'd print out the full-text article cited, study it some more, and perhaps bring it to your appointment tomorrow.
Deb, these are difficult decisions, and often no clear guidance is offered, even by the experts.
I wish you the very best and hope you feel better soon.
-- Jim
Deb,
In general, I am all for the shorter 24-week course for geno 1's with little or no liver damage if study prerequisites are met such as low pre-tx viral load and being non-detectible by week 4. There are also formula's like 'Drusano', that suggest treatment duration correlates to some degree with RVR and you were very RVR being non-detectible at week 2. And I believe there's a good article ('Berg' I believe) recently posted by 'Drofi' or 'Zazza' that also summarizes the relationship of tx length to RVR, although unfortunately I believe it's in German but maybe one of them can help translate some of the salient points.
That said, your case is different since I believe your diagnosis is/was "acute" as compared to "chronic" while the people in the shorter course studies were probably mostly (or all) chronic.
As stated before, I don't know much about treating acutes other than a few studies (mostly older) that suggested they only needed what I remember to be 24-weeks of treatment or even less.
Because of this, and because there seems to be a dearth of recent literature in treating acutes, my recommendation to you was to ask Dr. G. exactly why he wants to treat you for 48-weeks instead of 24-weeks, including citations of any pertinent recent studies. Then to evaluate his response, or add to it with an outside consult with someone at his level, even if it means some travel. My recommendation hasn't changed.
As to "Sonic", I somewhat remember that thread and vaguely remember that something he said (or perhaps a newer study he posted) supported Dr. G's position. Maybe you can post a link to that thread if you saved it.
Good luck with your NP appointment tomorrow. It may be a good time to ask for a face-to-face with Dr. G. so you can update him in person on your side effects and find out what the logic is in treating the 48 weeks, and what difference in odds would he expect in SVR if you stopped earlier.
All the best,
-- Jim
In general, I am all for the shorter 24-week course for geno 1's with little or no liver damage if study prerequisites are met such as low pre-tx viral load and being non-detectible by week 4. There are also formula's like 'Drusano', that suggest treatment duration correlates to some degree with RVR and you were very RVR being non-detectible at week 2. And I believe there's a good article ('Berg' I believe) recently posted by 'Drofi' or 'Zazza' that also summarizes the relationship of tx length to RVR, although unfortunately I believe it's in German but maybe one of them can help translate some of the salient points.
That said, your case is different since I believe your diagnosis is/was "acute" as compared to "chronic" while the people in the shorter course studies were probably mostly (or all) chronic.
As stated before, I don't know much about treating acutes other than a few studies (mostly older) that suggested they only needed what I remember to be 24-weeks of treatment or even less.
Because of this, and because there seems to be a dearth of recent literature in treating acutes, my recommendation to you was to ask Dr. G. exactly why he wants to treat you for 48-weeks instead of 24-weeks, including citations of any pertinent recent studies. Then to evaluate his response, or add to it with an outside consult with someone at his level, even if it means some travel. My recommendation hasn't changed.
As to "Sonic", I somewhat remember that thread and vaguely remember that something he said (or perhaps a newer study he posted) supported Dr. G's position. Maybe you can post a link to that thread if you saved it.
Good luck with your NP appointment tomorrow. It may be a good time to ask for a face-to-face with Dr. G. so you can update him in person on your side effects and find out what the logic is in treating the 48 weeks, and what difference in odds would he expect in SVR if you stopped earlier.
All the best,
-- Jim
deb - just FYI - I got sick a lot with my TX.
It's like my immune system dumped and everyone around me was Typhoid Mary...
If they had a cough --- I got a cough --- if they had the stomach flu - I got the stomach flu.
Got to the point we posted "PLEASE WASH YOUR HANDS" everywhere...
And I'm prone to sinus/upper respiratory issues anyway - so everything turns into that once it runs it's havoc on me. LOL!
But --- Take Airborne or EmergenC --- Keep yourself healthy--- like as if you were the boy in the plastic bubble.
Stay on top of allergy meds --- etc. Cause it's weird - but a case of hay fever turned nasty on me in my sinuses.
I just wanted to clue you in on that...
Oh and there's another one... Uhm once you get sick that helped me --- uhmmm Zycam or Zicam or something like that.
A friend at school passed those on to me... She called the school system a petri dish of diseases... LOL!
Meki
It's like my immune system dumped and everyone around me was Typhoid Mary...
If they had a cough --- I got a cough --- if they had the stomach flu - I got the stomach flu.
Got to the point we posted "PLEASE WASH YOUR HANDS" everywhere...
And I'm prone to sinus/upper respiratory issues anyway - so everything turns into that once it runs it's havoc on me. LOL!
But --- Take Airborne or EmergenC --- Keep yourself healthy--- like as if you were the boy in the plastic bubble.
Stay on top of allergy meds --- etc. Cause it's weird - but a case of hay fever turned nasty on me in my sinuses.
I just wanted to clue you in on that...
Oh and there's another one... Uhm once you get sick that helped me --- uhmmm Zycam or Zicam or something like that.
A friend at school passed those on to me... She called the school system a petri dish of diseases... LOL!
Meki
Wonderful discussion and very educational for me.....
This brings up a few questions in my mind.....of course, it's about MY personal situation.....
I am thought to be an acute from exposure last nov. at surgery. Initial VL in Feb. was 43,000, three weeks later down to 192 and a couple weeks after that up to 4200.
On the Friday morning prior to second shot, i was UND <50. I didn't have another VL until week 11, while very sick with sinus/ear/etc viral infection and that, by TMA was <5. So Dr. Gish calls me an RVR. I'm a geno 4, wild type.
Even though I am acute and UND at week 2 (1?), he wants me to do 48 weeks.
I've discussed this on the board before and kind of resigned myself to 48 weeks but going through yet ANOTHER antibiotic requiring infection of my sinuses (4 courses total, and two courses for a skin infection)...in other words I'm sick again on top of treating, I'm giving serious thought to asking for a shortened course. 24 weeks or at worst 36
Jim was pushing back on the 48 week as I recall as well (correct me if I am wrong Jim).
I see my NP tomorrow for labs. THoughts? Sonic BandAid disagreed with wanting to shorten ......but I have a lot of pain and problems with these continual infections.
Deb
This brings up a few questions in my mind.....of course, it's about MY personal situation.....
I am thought to be an acute from exposure last nov. at surgery. Initial VL in Feb. was 43,000, three weeks later down to 192 and a couple weeks after that up to 4200.
On the Friday morning prior to second shot, i was UND <50. I didn't have another VL until week 11, while very sick with sinus/ear/etc viral infection and that, by TMA was <5. So Dr. Gish calls me an RVR. I'm a geno 4, wild type.
Even though I am acute and UND at week 2 (1?), he wants me to do 48 weeks.
I've discussed this on the board before and kind of resigned myself to 48 weeks but going through yet ANOTHER antibiotic requiring infection of my sinuses (4 courses total, and two courses for a skin infection)...in other words I'm sick again on top of treating, I'm giving serious thought to asking for a shortened course. 24 weeks or at worst 36
Jim was pushing back on the 48 week as I recall as well (correct me if I am wrong Jim).
I see my NP tomorrow for labs. THoughts? Sonic BandAid disagreed with wanting to shorten ......but I have a lot of pain and problems with these continual infections.
Deb
As to why it takes 48 weeks to 72 weeks to 'hunt down those last few virions' as you state, here are a few thoughts:
First, there is never a 'static' number of virions in your body at any time during tx. The virions are constantly multiplying at a rapid and very high rate. So as millions are being killed off, a little less than those same millions are being produced! This is why slow responders, non-responders, and fast responders show the patterns that they do. Different rates of viral clearance, and reproduction, within different individuals, fueled by differing doses of Inf. and Riba, all add up to an individual's unique 'response' to the drugs.
So, when you are at week 15 in tx, and show a viral load of 9,000 virions for example, you are clearing, but just a little more slowly than standard protocol, and the amount of virus being 'killed off' by the interferon each week, is 'almost' being kept up with by the replication of the HCV still alive in your system.
Also, the viral load at any given test point, is only the amount of virions in a given volume of blood. Multiply that number by the number of ml's of blood, total in your body, and you come up with a vastly higher number of 'total virions' at large and REPRODUCING' all day long in your system.
ALSO, there may be difficult to reach virions hidden away in the hepatocytes, which may have a longer clearance cycle than those in the blood, or may just be harder to kill off.
Consider all these issues when you picture the tx at work. It is not as simplistic or linear as it sounds when the doctors use viral load numbers, reduction curves, etc. It's a little like cleaning the cloudiness from an aquarium with a filter....you get to a point where the water starts to 'seem' clear in a period of time, but you quickly realize that there is a very slowly depleting amount of algae, dirt, and particles that are almost invisible to the naked eye...and they may take weeks to fully filter out. Its what you don't see, and are not able to measure during tx that is the real 'bear' in achieving SVR.
Many things are continuing to take place with the virus while you are trying to kill it off, and it takes far longer to achieve than logic would initially indicate.
Hence 72 weeks to finally outrun all those slow to clear virions at large and reproducing within the 'slow responder'.
Just my thoughts! I hope they are helpful.
DoubleDose
First, there is never a 'static' number of virions in your body at any time during tx. The virions are constantly multiplying at a rapid and very high rate. So as millions are being killed off, a little less than those same millions are being produced! This is why slow responders, non-responders, and fast responders show the patterns that they do. Different rates of viral clearance, and reproduction, within different individuals, fueled by differing doses of Inf. and Riba, all add up to an individual's unique 'response' to the drugs.
So, when you are at week 15 in tx, and show a viral load of 9,000 virions for example, you are clearing, but just a little more slowly than standard protocol, and the amount of virus being 'killed off' by the interferon each week, is 'almost' being kept up with by the replication of the HCV still alive in your system.
Also, the viral load at any given test point, is only the amount of virions in a given volume of blood. Multiply that number by the number of ml's of blood, total in your body, and you come up with a vastly higher number of 'total virions' at large and REPRODUCING' all day long in your system.
ALSO, there may be difficult to reach virions hidden away in the hepatocytes, which may have a longer clearance cycle than those in the blood, or may just be harder to kill off.
Consider all these issues when you picture the tx at work. It is not as simplistic or linear as it sounds when the doctors use viral load numbers, reduction curves, etc. It's a little like cleaning the cloudiness from an aquarium with a filter....you get to a point where the water starts to 'seem' clear in a period of time, but you quickly realize that there is a very slowly depleting amount of algae, dirt, and particles that are almost invisible to the naked eye...and they may take weeks to fully filter out. Its what you don't see, and are not able to measure during tx that is the real 'bear' in achieving SVR.
Many things are continuing to take place with the virus while you are trying to kill it off, and it takes far longer to achieve than logic would initially indicate.
Hence 72 weeks to finally outrun all those slow to clear virions at large and reproducing within the 'slow responder'.
Just my thoughts! I hope they are helpful.
DoubleDose
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