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EOT test

i just finished up 48 weeks of tx Dec 28th. my Dr. office said to get checked within 6 mos. what do you think the minimum would be to get the VL tested? BTW- i did UND between week 12 & 15 and stayed that way throughout tx. thanks.
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Avatar universal
ah,  yes,  something we agree on :)

but thanks for the discussion!
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Avatar universal
Again, we will have to agree to disagree on most of what you just stated. I'll take a well-respected and published liver specialist who is willing to push the treatment envelope (double-dosing, for example when indicated) or the treatment protocols (monthly VL tests) over a "by-the-book" doc who relies on med inserts or very basic reports like you posted.

-- Jim
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Avatar universal
access to that review is free. You can get it via the pubmed link or here:
http://jama.ama-assn.org/cgi/content/full/297/7/724
since you routinely post vl test recommendations it might be worth reading.

There's definitely nothing dramatic there, but that's my whole point: there's a difference in the reliability of tx recommendations based on mature evidence and those based on preliminary or no evidence (but informed guesses). I'm not objecting to the latter, only to a failure to distinguish between the two. For example, definitive interpretation of the week 4 VL test remains unclear (can you safely shorten tx duration for RVR g2/3s to 12-16? See the recent PMID 18171217 vs the discussion in that review).

In the absence of any fundamental understanding of what makes tx work/fail access to Drs willing to experiment with unsubstantiated dosage adjustments or duration isn't necessarily better treatment. IMHO a healthy respect for evidence (and for assuming neutral or worse until proven otherwise)  is warranted in this field. Results like those obtained for HALT-C or DITTO - where eminently reasonable approaches yielded no benefit are recent cautions.
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Avatar universal
Does appear the Australian study used a less sensitive test, but the data is still useful -- at least for geotype 3's. 93 per cent positive predicitive if <615 at week 2 with a NPV for SVR of 43 per cent. Hard to say what a more sensitive test might have yielded. BTW with the standard used here, I also would have been UND at week 2.
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Avatar universal
Jim, that "ultra" RVR - they used <615 ??
They've got to be kidding. In that case I was UND at week 2 - maybe even week one cause they missed taking that one. I can see using that test on me NOW cause I am not txing and I know my vl was 7 million plus last time I checked, but I don't understand why they would use that test for a study and not a more sensitive or I should say why wouldn't they use the MOST sensitive to see EXACTLY what the VL is.

Its late so I'll read the rest tomorrow. Gonna hit the sack.

nighty-night.
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Avatar universal
Willing: if you're going to dismiss the standard of care in a current JAMA-published review as not delivering optimal care I guess there's not much to talk about....:)
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I only have access to the abstract of that article, but based on the abstract, it seems more of a very basic treatment guide as opposed to optimum or even current care, as for example some of the teaching modules on the Clinical Care Options Web site, taught by some of the leading clinicians in the field.  

I have never suggested something is proven, unless backed by study data. On the other hand, if you don't believe that individualizing treatment, as per my example in raising the ribavirin dose in a slower responder has merit, then I guess we really don't have any more to discuss :)

"Optimum" treatment to me, is just that, optimum. It not only relies on a standard of care that is in part dictated by older studies, committees,  and insurance considerations --  but it also relies on the judgment of experienced clinicians who will take the study data and from it extrapolate reasonable protocols and conclusions to integrate into their practice.

It is only quite recent that the TMA sensitivity and the week 4 viral load test have been *legitmized/validated" by papers like you just cited as "standard of care".

On the other hand, my treatment doc, as well as two of my consults, were using both of these concepts as their standard of care over two and a half years ago, when I started treating. I call that "optimum care", at least for that point in time.

Thanks for the discussion.

-- Jim
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Avatar universal
mo: Hi -  as a g2,  having achieved RVR and then relapsed after 24weeks *is*  unusual but  I'm not sure you'll find anyone that can make sense of whether a VL of 96 at week 3 was or was not out of line with the VL curves of other g2 RVRs who went on to SVR. It's a good example of an uninformative test - what can you compare it to for interpretation?

That RVR has got to bode well for your next tx - you clearly responded quickly. I've always been puzzled by the fact that the recommendation to shorten g2/3 tx to 24 was based on data indicating the same SVR rate as for 48 - yet  most relapsed g2/g3 who re-tx with 48 do fine. Anyway, best of luck!

jim: well if you're going to dismiss the standard of care in a current JAMA-published review as not delivering optimal care I guess there's not much to talk about....:)

I believe the point we agreed on was that the days of low-sensitivity tests were numbered as more large-scale studies switch to sensitivities of 50 and less. Where we don't seem to agree is on the difference between opinion/guessing and evidence-based  practice. The recommendations in that JAMA review are based on  evidence, usually accepted, large-scale studies. On the other hand, if "the clinician might decide to intervene with a dose adjustment"  at week X because there was not a drop of Y there  is little or evidence in support of his actions. This may help,  or not (could well be the patient is already saturated with ifn and failure is simply due to viral resistance to its effects).

The state of knowledge re HCV is so poor that acting on opinions/guesses may well  be the best strategy. But IMHO they should be recognized as such  and distinguished from the little that is known with some certainty.  Referring to the VL testing schedule in that Fig 1 may be a useful counterpoint in that regard.
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Avatar universal
You make some very good points and one main underlying one is that early and frequent viral load tests are only as good as what you do with them -- the caveat being that even wasted opportunities may bring fruit with a future treatment -- either with a new doctor, or same doctor, if/when new studies come out.

Still, doctors like yours, in spite of the limitations you mention, are probably delivering the top 1% treatment in this country. To go beyond that, you really have to take a proactive role in your own treatment, which at the end of the day often means making your own tx decisions and then presenting them to your doctor. Especially if way off SOC and the reasons range from what you call "common sense" but what I might call lack of imagination -- my general take on most clinicians btw -- to reasons of time constraints and also liability.

I remember seeing one rock-star doc consultant early on in treatment and presented him with the Swedish high dose riba study. Surprisingly, it wasn't at all difficult to talk him into emulating it, and indeed he seemed quite excited to have me as a guinea pig in a study that apparently interested him. I doubt if he would have suggested that protocol to me for liablity reasons, but by presenting it to him, he was off the hook to a certain extent. That discussion ended up being academic as I ended up staying with my current doc and couldn't handle half of those high riba doses anyway.

I'm sure if you put together a well thought out plan, with studies to back it up, that you could find a good doc to help you implement it. Thing is, when you go this route, you're bringing a lot of responsibility on yourself, because a lot of this is uncharted territory.

Asking for weekly viral loads -- like I believe your current doc offers -- is not unreasonable -- nor is it unreasonable to ask for med adjustments if the response isn't what you want. As to early RVRs for geno 2's, they are already suggesting 48 weeks, so what would be YOUR plan if not UND by week 2 or 3? Treat longer than 48 weeks? Not sure I'd go that way, given your liver histology. Perhaps pre-dosing riba with a couple of weeks of double-dosing might make sense. And you might even want to set up your own stop rule, i.e. if not UND by week ____, then stop treatment and wait for better drugs. Personally, I'd wish you'd wait a little anyway, but I understand you want the virus to be gone now.

But moving ahead, what I find works best is not to get into philosphical discussions with docs about treatment procotols as you seem to have done. Just outline what you feel is a reasonable treatment approach, and present it succinctly. You might just get it, for better or worse.

-- Jim
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Avatar universal
You mentioned that your unnamed, but well-known liver specialist, tests for viral load weeekly (starting at week 1) until UND, and then monthly after that. This is the Standard of Care that would be ideal for everyone. Not only does it give the clinician more information to tweak meds, but even if study data isn't available now to match things up, the historical viral load data of a previous treatment, might come in useful in terms of future treatments if and when newer studies on viral kinetics come into play. Say, for example, that a study comes out tomorrow that says geno 2's really need to be UND by week 2. That suggests just not just extended treatment, but possibly a more agressive treatment the second time around. Just making up this example, but you see the point.
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I just lost my post,,,

Jim as far as these well known liver specialists -,,,,,, I am finding that they ALL lack common sense. Yeah they may test every week, BUT WHEN I MENTIONED MY NOT LIKING THE LEFT OVER VIRONS,,,,MEANT NOTHING TO THEM!  I knew there would be a problem - felt it in my bones.

But anyhow when I told the rock star that I can NOT understand how you and all these other liver specialists consider g2 RVR at week 4 when geno 1 is also considered RVR at week 4????? He said well, studies blah blah and you fell into the 20%. And I said No I think that would be 10% cause I read you guys combine g2 and g3.

So I said, Dr X, let me give you this analogy,,,,,, Lets pretend I am 100lbs 6 ft tall female and a marothon runner. I run a 25 mile marathon and break the record,,,,BUT ALSO THERE IS A 400 LB 5 FT TALL WOMAN who ties the race with me...... Yes she and I both broke the record,,,BUT DON'T YOU THINK I SHOULD HAVE BEAT HER??????

Well Dr. X, I guess you see that I am trying to say that Geno 2 is the skinny 6 ft lady and geno 1 is the heavy lady....YES WE DID AN INCREDIBLE JOB AT BREAKING THE RECORD, BUT I SHOULD HAVE BEAT HER!!!!!!!!!  

I said Please Dr. I am losing it. I really am. Don't you doctors see that you are leaving geno 2's out. No on cares about us.

The story goes on and he lightened up the mood by making me laugh, and jokingly said I should be an advocate for geno 2's.

I walked out of the office very discouraged and still am at times cause now I will be moving on to another big name who is involved in these studies and I asked him when will you first test me after baseline lab and he said - 4th week - thats the info we need. I politely disagreed and said what I wanted - weekly VL tests,,,but Jim, I am so disgusted that these doctors just don't get it sometimes - no common sense. It troubles me. I do not have the brain power that you and the rest of the "heavy hitters" on forum have, but I have a bit of sense, sometimes can grasp a little of the science, but so much of this is plain ole logic and it bothers me so much I can't even put it into words how much it bothers me. If I lived in California I would ask HR to please get me thru this next tx. He really is the only doctor I have confidence in - total confidence.
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Avatar universal
Here, they discuss ultra RVR -- a week 2 RVR -- as a good predictor of SVR in geno 2's.
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JIm, do you remember I just said that not to long ago to you??? I said how can they say RVR for geno 1 is week 4 and RVR for week 2 be the same SINCE GENO 1 IS SUPPOSED TO BE THE RESISTANT GENO I SHOULD BE RVR AT WEEK 2!!!!


I didn't read the study YET, but I will and ALSO WILL BRING IT where I treated cause I just had this discussion with him a month or 2 ago!!

But here is THE MISTAKE I SEE WITHOUT EVEN READING IT and only going by what you have posted.....ULTRA???? That's not ultra!! Its plain ole RVR - what it should be,,,,but to cover their own rear -ends 'ULTRA' makes it sound like a NEW FIND,,,, instead of seeing it SHOULD HAVE BEEN LOOKED AT THIS WAY ALL THE LONG ,,,WELL ESPECIALLY for people like me geno 2 HIGH VL.
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Avatar universal
You mentioned that your unnamed, but well-known liver specialist, tests for viral load weeekly (starting at week 1) until UND, and then monthly after that. This is the Standard of Care that would be ideal for everyone. Not only does it give the clinician more information to tweak meds, but even if study data isn't available now to match things up, the historical viral load data of a previous treatment, might come in useful in terms of future treatments if and when newer studies on viral kinetics come into play. Say, for example, that a study comes out tomorrow that says geno 2's really need to be UND by week 2. That suggests just not just extended treatment, but possibly a more agressive treatment the second time around. Just making up this example, but you see the point.

-- Jim
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Avatar universal
MO: Hi to you too, Only said hi to Willing.
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That's OK. Women have been ignoring me lately, so getting used to it.

But back to your post, you may be sorta correct. This isn't for geno 2's, but here's yet another study showing why more frequent VL testing than the cookbook week 12, 24, 48 makes sense.

Here, they discuss ultra RVR -- a week 2 RVR -- as a good predictor of SVR in geno 2's. Since so many geno 2's get traditional RVR, no doubt even earlier testing -- like you got -- makes sense and earlier RVRs may be more predicive than the week 4.

http://www.hivandhepatitis.com/2007icr/aasld/docs/110907_d.html
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Avatar universal
Hi to you too, Only said hi to Willing.
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Avatar universal
willing
"The only vl tests that guide widely-recognized clinical decisions for 1s currently are week 12 (evr?,  extend? ) and week 24 (stop?)."
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Hi Willing, I'm a geno 2b (relapser), so the week 4 as you know is the one they look at, but someone as myself who had a high VL and was still detectible at week 3 with 96iu, that never sat right with me. I was RVR by week 4, but I just didn't like the way week 3 looked.
My medical team looked at it as "contamination" yet in cases when small amounts linger with a geno 1 at week 12, doctors seem to view it differently.

Jim's post from a study
"Thus our study clearly indicates that patients even with a minimal amount of HCV RNA detected at week 12 can suffer from relapse rates greater than 50%. These patients may indeed benefit when their treatment duration is adapted to their individual needs."

So what would be considered MY WEEK TWELVE as a geno 2b or my week that should be used to guide my treatment decision?  I know they view 4 as VERY-VERY important, so should week 3 NOT count at all? Minimal virons are hanging on in my own case RIGHT BEFORE A VERY IMPORTANT week - week 4.

Maybe its just my way of looking at it and I might be not seeing it that clearly. You guys are way over my head in most of this stuff and I can only grasp bits and pieces here and there, so maybe I am only making sense to myself. But I think non geno 1's need to be studied a little more. I searched on forum a bit and have found 11 geno 2's that had relapsed. Maybe there are more, but I just wanted to try to find info for myself in trying to see anything we had in common.

Not to scare anyone that is a geno 2,cause chances are good for you to SVR, but some on forum knew I was curious and that is what I found. I haven't found how their second tx worked out except I did find Rochammer SVR'd 2nd time. I hope the others cleared and chances are they did otherwise they probably would still be on forum posting.







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Avatar universal
And just to follow-up the previous example -- if the week 4 test suggests a treatment change, then testing weekly after week 4 is the best way to monitor if treatment changes are working, not to mention being able to pinpoint the date of UND more accurately. Also, if you read my entire exchange with "Antman" you will see that my opinion was not stressing him, in fact, given the fact that he had an UND very close to EOT, I stated that he could probably skip the EOT test. Still, if one has a choice in the matter -- not after the fact -- why not take the EOT test at the end of treatment?
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Avatar universal
Willing:  Doctors are not giving sub-optimal care because they don't want to order week 6 or or 8 or 20 or 48 tests
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I guess we will have to agree to disagree on this, although I was convinced that you conceded my point on most of this sometime in December. I will have to check back on some of those threads.

Besides the Berg study quoted before, and another recent study that suggested monthly sensitive TMAs were predictive of relapse -- besides these two studies, there is the well-embraced principle that individualized treatment is better treatment. And the more information we have, the more treatment is able to be tailored to the indivdual.

I bring up the same example, once again -- and there are dozens of similar --

What about the patient who has less than a one-log drop at week 4? Without the week 4 test, by the time the clinician reviews the week 12 test, it may be too late. However, with the week 4 test, the clinician might decide to intervene with a dose adjustment.

The week 4 test has become almost standard with liver specialists now. The studies all back them up. Are you saying that if you treated now, you would forgo the week 4 test and just get tested at week 12?

-- Jim
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Avatar universal
my concern is that the distinction between interesting but largely useless vs clinically -critical information seems to get blurred.  Doctors are not giving sub-optimal care because they don't want to order week 6 or or 8 or 20 or 48 tests and I sure hope ant  is not getting stressed about missing a test " six days after your last injection".  Use of VL tests in the current standard of care for hcv is well summarized in a recent, freely accessible, JAMA review by Scott and Gretch.:

http://www.ncbi.nlm.nih.gov/pubmed/17312292?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Note from the tx algorithm summarized in  Figure1 that there is no mention of EOT or breakthough tests and that the week 4 test merely gives background information about SVR odds. Once tx has started the only two tests on which a decision hinges are at weeks 12 and 24.

Additional information is certainly nice to have, but I think it's important to remember  that it may do nothing to guide therapy. For example, re TMA-detected breakthrough we have "Approximately 10% of patients with a single positive TMA result at the end of treatment still achieved SVR."[ PMID 16871570]  and "A positive TMA on two or more occasions in patients who have become PCR-negative on therapy indicates a high likelihood of treatment failure." [PMID 17406826] vs "Among the 57 IVR patients, we detected transient or persistent reappearance of low levels of HCV RNA in 10 of the 23 (43%) patients with eventual breakthrough or relapse; but in none of the 34 SVR patients." [PMID  17591033].  Only in the last study was any TMA-detected breakthough observed to be completely incompatible with SVR. On the basis of  such data it's hard to see a Dr. responsibly advising a patient to discontinue tx because of a TMA-detected breakthrough.

Likewise abbreviating/extending tx   based on week 4 results remains a research topic "In contrast, RVR may be used as an indicator for both shortened and extended  treatment durations among patients with HCV G1 infection. HCV G1-infected  patients with low baseline viral load who attain RVR may be effectively treated for 24 weeks, whereas patients who do not attain RVR may be candidates for an extended 72-week regimen." [eg PMID  18171217]

Don't get me wrong,  I'm somewhat obsessed by data and given the option would like to get hourly VL tests for the first 72 hours, daily for the first 10 days and weekly thereafter from both blood and PBMCs + full sequencing of all clones from those samples, plus ifn-gamma concentrations, plus CD4+ and CD8+ response.  Even though you can't always get what you want, it seems important to be able to distinguish that from not getting what you *need* (eg a timely, high-sensitivity week 12 test).
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Avatar universal
Without getting into the Labcorp vs Quest thing, the following is HR's take on the use of senstive VL tests near the end of treatment which addresses your 48 vs 52 week question in a different manner. Also, HR has been on record numerous times, suggesting that frequent and very senstive viral load tests are very important.

Personally, I don't like the idea of extending treatment if found positive via TMA at week 48, but there may be other scenarios -- shorter tx scenarios -- where this might be useful. Anyway -- here's HR's take.
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HR:

The test to use if extreme sensitive UND status is desired, is the Labcorp test called HCV NGI ultraqual LC#140609. It has the same >2 iU cutoff, but is only a qual test. pos or neg. But that is really all you need at this point.It is of course cheaper than the NGI quantasure. This test is identical with the NGI ultraqual, it is just started with a NGI HCV Superquant and continued with Ultraqual, if below 40 IU, the limit of the NGI Superquant. You can trust me on these issues, since i am actually the inventor of all these NGI tests. But to be clear there is absolutely NFI of mine in these tests.


And Jim, if you are close to or at EOT, and you hand an even more sensitive test (than this above), and it would show you that you are not really UND with this, but UND with the less sensitive tests,
THEN
you could start thinking  of killing the remaining virions by extending UNTIL you finally are much more UND.
Remember your stance GONE, NONE, NADA, DEAD, NISCHTA ,KAPUTT implies that if you still have some real virus circulating, that your chance to become a relapser are actually HIGH.
All this sensitivity issues were nicely detailed in the Berg abstract that you recently posted, I was actually there and heard him.

So a very big decison  (to extend SOC, maybe to add Alinia, Vertex, etc) could be made at a critical time, when it might matter most  ( the virus is already very very low, but just not DEAD YET) and paid the most dividends to do so - to push a real UND.

http://www.medhelp.org/posts/show/383166


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Avatar universal
Willing: The only vl tests that guide widely-recognized clinical decisions for 1s currently are week 12 (evr?,  extend? ) and week 24 (stop?).
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To clarify, that was the Berg study quoted above. Here is summary of same study with the charts in better format. Note that the week 4 TMA is being touted here as important for clinical decisions. In fact, the week 4 test for some time has become standard in the office of better clinicians. I assume they do this for a reason.

http://www.hivandhepatitis.com/2007icr/aasld/docs/110907_a.html

Willing: ut  if you can find a dr. that can meaningfully interpret the difference between a week 48 breakthrough and a week 52 relapse you should probably be looking for another dr..
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The difference is that the week 48 breakthrough was on the treatment drugs and a week 52 relapse was off the drugs.

This may give the clinician valuable information in a re-treatment scenario.

If relapse, then extended treatment makes the most sense, because the current dosage and type of Peg appears to have worked up to the point when the drugs were withdrawn.

However, if breakthrough, then extension would not make a difference because the first treatment wasn't strong enough to keep the virus down even while on the drugs -- and studies tell us TMA positives during treatment (or EOT) will translate into  VL positive results post treatment, i.e. no SVR.

Therefore, in a breakthrough scenario, retreatment might focus on higher doses, or a differerent Peg -- or perhaps making a decision to wait for newer drugs.
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Avatar universal
From AASLD 2007
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".....here is clear evidence for a high relapse rate in patients with a positive TMA within the first 12 weeks of therapy being more pronounced when treatment duration shortened in the individualized treatment group. In contrast patients shown to respond as early as week 4 evidenced by a negative TMA test had relapse rates below 10% irrespectively from treatment group. Conclusion The application of the highly sensitive HCV RNA tests must be considered to be now mandatory because this new test helps to evaluate in a much more refined way treatment response as well as relapse rates and provides better clues for an individualized tailored treatment strategy. Thus our study clearly indicates that patients even with a minimal amount of HCV RNA detected at week 12 can suffer from relapse rates greater than 50%. These patients may indeed benefit when their treatment duration is adapted to their individual needs..."
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Complete:

The exact estimation of early virologic response rates in the course of antiviral therapy is an important goal in order to improve individualized therapeutic strategies in HCV infection. The sensitive TMA test could provide better advantage to distinguish at early stages sustained from non-sustained responders. We evaluated HCV type 1 patients who took part in a prospective study asking whether the application of TMA in bDNA-negative patients may be a better indicator to predict long-term outcome of the HCV infection. Methods 433 patients were randomized to receive either 1.5ug/kg PEG-INFa-2b plus 800-1400 mg RBV for 48 weeks (n=225, group A) or an individualized tailored treatment duration (n=208, group B). In the latter group treatment duration was calculated by the time required to become for the first time HCV RNA negative as defined by bDNA assay (detection limit 615 IU/mL) multiplied by the factor 6. HCV RNA levels were quantified weekly until week 8, at week 12 and 24. For all those patients who were bDNA negative the more sensitive TMA test (detection limit 5.3 IU/mL) was also prospectively assessed. The different response groups were classified according to the HCV RNA levels at week 4 and 12 (Table). Results Table shows the relevant data and refers to the relative relapse rates in group A and B at week 4 and 12 in relation to the treatment schedule. There is clear evidence for a high relapse rate in patients with a positive TMA within the first 12 weeks of therapy being more pronounced when treatment duration shortened in the individualized treatment group. In contrast patients shown to respond as early as week 4 evidenced by a negative TMA test had relapse rates below 10% irrespectively from treatment group. Conclusion The application of the highly sensitive HCV RNA tests must be considered to be now mandatory because this new test helps to evaluate in a much more refined way treatment response as well as relapse rates and provides better clues for an individualized tailored treatment strategy. Thus our study clearly indicates that patients even with a minimal amount of HCV RNA detected at week 12 can suffer from relapse rates greater than 50%. These patients may indeed benefit when their treatment duration is adapted to their individual needs.


response groups  relative relapse rate (%)  
      
week 4
response  >= log decline,
bDNA positive  36%
(all patients)  19%
(group A) 63%
(group B)
bDNA negative,
TMA positive  38%
(all patients)  22%
(group A) 49%
(group B)
bDNA negative,
TMA negative  4%
(all patients)  0%
(group A) 8%
(group B)
week 12
response  >= 2log decline,
bDNA positive  77%
(all patients) 78%
(group A) 75%
(group B)
bDNA negative,
TMA positive  64%
(all patients) 56%
(group A) 69%
(group B)
bDNA negative,
TMA negative  20%
(all patients) 9%
(group A) 32%
(group B)

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Avatar universal
I though we had agreed, per  newer studies that frequent and sensitive  VL tests do matter, including the 4 week test? In additiont to help prediciting SVR, they also offert the doctor the opportunity to tweak meds if response is not as fast as they would like. The latter may not be *studied* but certainly an advantage to the doctor and patient under an indivdualized treatment program. Example -- week 4 response less than one log with no drop in hemoglobin. Action: increase riba with the intent to get UND ASAP.
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jim: "The EOT test should be taken six days after your last injection"; to measure what ? breakthough during the last week? Why is that more significant than the previous week?
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The significance is that six-days after the last injection is by definition EOT. Ergo it is the last measurable day where similar drug levels are present compared to on treatment, assuming blood levels were measured during treatment the day before the injection.

In other words, you draw blood for EOT the day before the 49th injection that you never take, assuming a 48 week tx duration.  After that, of course,  you are *post* treatment as serum levels of both peg and riba start to decline as per during tx.

As to why not the previous week? The same question could be asked, why not the previous month? Or the month before that? The answer to all these questions is that neither of those tests are EOT but *during* treatment tests.

Of course, you can argue that if someone if someone is UND the week before stopping the meds, the chances are excellent that they will be UND six days after the last injection. And I have no quibble with that argument, but why not take the EOT test at EOT? Why not do it correctly when it's as easy to have blood drawn six days after the last njection as six days before the last injection?

It's like saying what is the signficance of taking the week 24 VL test on week 24 -- why not do it on week 23, chances are the results will be the same? The real question is why not do the week 24 VL test at week 24. And why not do the EOT test at EOT.

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Avatar universal
ant,mo: if you have the money and time by all means get all the sensitive tests you like but it might be helpful to bear in mind that these will contribute no information that guides a clinical decision (which is why many drs will balk at ordering them). The only vl tests that guide widely-recognized clinical decisions for 1s currently are week 12 (evr?,  extend? ) and week 24 (stop?). There's definitely data showing that breakthroughs are bad news, but  if you can find a dr. that can meaningfully interpret the difference between a week 48 breakthrough and a week 52 relapse you should probably be looking for another dr...and if you're going to relapse (and let's hope not!!) it'll happen regardless of when you test.  The main thing is to enjoy getting your life back! congratulations.

jim: "The EOT test should be taken six days after your last injection"; to measure what ? breakthough during the last week? Why is that more significant than the previous week?
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Avatar universal
Assuming the VL test you had a few weeks ago was a sensitive one, you could probably then skip the EOT test if your doc is going to limit your tests. In that case, personally I'd test at 12, 24 and 48 weeks post treatment.

-- Jim
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Avatar universal
thanks for the reponses , support & advice! actually the last test was a few weeks before i stopped. so, like Jim said it was not a true EOT test, i guess. but, yeah, that one was UND. so i had 3 UND tests during TX- 1st @ between 12-15, 2nd @ 24 and 3rd near the end. the reason i have to say between 12 & 15 weeks is because i had a VL of 55 @ 12 weeks, then was retested @ 15 weeks and was UND. it could have gone UND @ week 13 for all i know.i know it's not the most up to date testing protocol but it is what it is, and i'll take it (what choice do i have at this point)?  :-)
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Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
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Learn about this treatable virus.
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Getting tested for this viral infection.
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3 key steps to getting on treatment.
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4 steps to getting on therapy.
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What you need to know about Hep C drugs.
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How the drugs might affect you.
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These tips may up your chances of a cure.
Popular Resources
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.