Breakthrough?

hello,

i wonder if i am a breakthrough case?
in my past therapy my vl was 300@week 24 but 5000@week48.
i know that usually i had to stopp at week 24 because i was still detectable,but my doc said we can continue if you want and see what happens at week 48.

is this a breakthrough,or is this just a case of nonresponse ,cause i thought a breakthrough is when you are undecteable and then the virus break through at some point.

do breakthroughs poeple have a resistent virus?can they retreat wth soc?

[jusjames]

yes iam afraid you have breakthrough, i doubt that there is ant point in continuing aunless you get a different interferon and extend your tx, your doctor should be advising you of this, maybe you need a new doctor

[rexx73]

i stopped my therapy at week 48 anyway.
so i dont think my doc was wrong,cause my vl gone down from 350 000 to 10 000 by week 4,to 1000 by week 12, and 300 by week 24.
i wanted to continue cause there was still hope to get undectable at week 48.
and then at week 48 my vl was at 5000 and i stopped.
this was this summer.

right now im looking forward to go in the debio or roche trial,so for me it makes no difference, cause i have to try again anyway.

so i think all poeple wo dont clear by week 24 would have a higher vl at week 48 anyway if they would continue with therapy.

even i had a sort of breakthrough i think thats no big diffrence to a nonresponder.

[Trish77]

You were looking at the TMC435 trial - are you still considering that?

[rexx73]

my prof said i can choose between the debio, or the roche R7128  trial

@trish,

do you think poeple with breakthrough in standart treatment with pegintron/riba can became ressistent again interferon/riba?
i never heard of poeple have ressistent virus from pegintron/riba treatment,just from the protease inhibitors.

[Trish77]

I haven't heard of resistance to INF or riba BECAUSE of treatment, more that there are other factors that make INF/riba treatment less effective than it could be.

[newleaf09]

I have read theories that breakthrough is caused by anti-interferon antibodies that the systems of some patients make over the course of TX.  I would think, if that were the case, that adding a polymerase or protease inhibitor and knocking the virus out early in the TX period, would be the best plan for SVR for breakthrough cases.  

[Trish77]

http://www.scielo.br/pdf/bjid/v8n1/a02v08n1.pdf

"There was no correlation between the presence of anti-interferon antibodies and demographic variables and laboratory data of the patients. Similarly, these variables did not influence the virological response 24 weeks after the end of treatment. Multivariate analysis by logistic regression did not show any significant
correlation between the clinical pathologic parameters and virological response to treatment. In conclusion, our analysis of biochemical, virological and clinical pathologic responses did not show any correlation between the presence of anti-interferon antibody and response to treatment."

I'm thinking the presence of anti-interferon antibodies has a minimal to none effect.

[volvic]

as far as I am aware breakthrough occurs when on therapy non dectable occurs and then vl is later during therapy dectected.
The quantity  of  vl at breakthrough is very important in determining whether therapy should be extended to 72 weeks and if very low-marginal should be continued,especially in HV-HIV co-infected like myself.

[nygirl7]

Maybe I am wrong but considering you never got to UND I think that makes you non-response not breakthrough?

Either way though it's semantics - hopefully adding the extra drug will make all the difference for you as it has helped others like Andiamo and Rocker.  People complain that they aren't doing enough for hep patients like us, but remembering just a few years ago how the trials really weren't panning out but now they are having such great success - it really gives one hope for the future.

[Marcia2202]

I would also call it non-response. As Deb said, a break through is if you reach UND on treatment and then test positive again. Kind like a relapse, but while on treatment.

I wish you all the best. There are several non-responders who had positive outcomes with the trials. I sincerely hope you will be one of them.

[rexx73]

thanks to all,

well ,next year i will go for the debio or the roche trial and i hope one of them will knock this virus out.

but right now i have to enjoy my life,the trial in april will be hard enough.

[child24angel]

Good luck to you as you move forward in the trials...
Since you never became UND....it is not breakthrough
you did respond however, still considered a non-responder.

All my very best to you
Hugs
Elaine