GENO 1A-Cleared @4wks--doc now says I have to treat for 72 wks

I need some HELP!! what do I do now??!! A couple of months ago my hep doctor threw it out there that I should treat for 72 wks--since I'm 1A..ok..I said I would talk about it later... I'm at my 40th week now and getting excited about being done... Yesterday had my monthly appt w/ doctor and addressed the issue again...Said I HAVE to treat for 72 wks --BECAUSE...their studies now show---that 1A's who start w/ HIGH viral loads..mine was 16,000,000 are having high rate of relapsing before 6 month SVR..(my doctor is a hepatologist--who even does liver transplants --@LIFELINK)
she said if I WANT to stop @48 wks--they would do monthly viral load and if I relapse they would start treatment again right away but then it WOULD be for 72 wks!  NOW what kind of option is it for me!  That's kind of like "russian roulet"  I don't know--all I did was cry all the way home--this treatment has been hell on me...
Can anyone help me with this???
Help??
Thanks... Dorsey

[Trinity4]

Dorsey,
My new hep doc told me that he usually advises at least 36 wks of treatment for slow responders after they become UND. Since we don't know exactly when I became UND after 12 wks - I have to go the 72 wks even if we err on the side of caution.  This is only for those that are not UND by 12 wks.  He is a top hep guy and I trust him completely. You cleared in 4 wks.  Why would he want to subject you to more toxins than needed?  It makes no sense to me and we would have heard about this approach if it were being practiced.  The only time VL makes a difference is when it is low, otherwise, you have the same chance of SVR with a VL of 1 mil as you do with 16 mil.
Don't do it Dorsey, unless there is some reason I'm not aware of but the high VL doesn't cut it.
Trinity

[meNtoby]

A geno 1 clearing at 4 weeks is GOLD.  What's up with that doctor??

[portann]

Can your doctor show you her studies for recommending this based on your viral load and apparently nothing else? This point of view seems out of left field, doesn't it? I would run to another hepatologist for a second opinion, except you're almost certain to hear, as Trin and meNToby mentioned, that 48 weeks is the standard.

The puzzle remains, though, as to why she'd push this. At best, it may only be experimental on her part and at your expense.

[pKinCA]

Here's something you might want to read...  Looks very good for you!  

I think this statement is very important:

"However, once a person had achieved RVR, no baseline factors significantly predicted SVR."

Good luck to you!!  pK


(http://hivandhepatitis.com/hep_c/news/2008/101408_b.html)

24 Weeks of Pegylated Interferon plus Ribavirin May Be Sufficient for Selected Genotype 1/4 Chronic Hepatitis C Patients with Rapid Response

By Liz Highleyman

Given the side effects and cost of interferon-based therapy for chronic hepatitis C virus (HCV) infection, researchers continue to explore shorter treatment durations, especially for individuals who respond rapidly after starting therapy.

The current standard of care is 24 weeks of pegylated interferon plus ribavirin for chronic hepatitis C patients with HCV genotypes 2 or 3, while those with hard-to-treat genotypes 1 or 4 are treated for 48 weeks. Many experts recommend longer therapy for individuals with HIV-HCV coinfection.

In a study described in the August 2008 issue of Gastroenterology, Peter Ferenci and colleagues from Austria aimed to determine whether 24 weeks might be adequate for patients with HCV genotype 1 or 4 who achieve rapid virological response (RVR), or undetectable after 4 weeks of therapy.

The study initially included 516 genotype 1 or 4 patients treated with 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 1000-1200 mg/day weight-based ribavirin. Participants who did not achieve RVR (HCV RNA < 50 copies/mL) at week 4 were randomly assigned to receive 48 or 72 weeks of treatment (this part of the study was ongoing at the time of the report).

Among those who did achieve RVR, the investigators analyzed rates of sustained virological response (SVR), or continued undetectable HCV viral load 24 weeks after completion of therapy.

Results

• 150 of the 516 patients (26%) achieved RVR.

• 143 of the 150 completed 24 weeks of treatment.

• The overall SVR rate in this subgroup was 80.4%:

• 78.8% for genotype 1;
• 86.7% for genotype 4.

• The following factors were predictive of RVR:

• younger age;
• lower body fat;
• low baseline HCV RNA (< 400,000 IU/mL);
• HCV genotype 4 rather than 1.

• However, once a person had achieved RVR, no baseline factors significantly predicted SVR.

• Treatment was well tolerated overall.

Based on these findings, the investigators concluded, "This prospective study confirms that a 24-week regimen of peginterferon alfa-2a plus ribavirin 1000-1200 mg/day is appropriate in genotype 1 and 4 patients with a low baseline HCV RNA level who achieve an RVR by week 4 of therapy."

Medical University, Vienna, Austria; Kaiser-Franz-Josef-Spital, Vienna, Austria; Wilhelminenspital, Vienna, Austria; Elisabethinen Hospital, Linz, Austria; Hospital Hietzing, Vienna, Austria; Medical University, Graz, Austria; Rudolfshospital, Vienna, Austria; LKH Hörgas-Enzenbach, Gratwein, Austria; Krankenhaus, Oberndorf, Austria; Roche Austria, Vienna, Austria.

10/14/08

Reference
P Ferenci, H Laferl, TM Scherzer, and others. Peginterferon alfa-2a and ribavirin for 24 weeks in hepatitis C type 1 and 4 patients with rapid virological response. Gastroenterology 135(2): 451-458. August 2008. (Abstract).

[moahunter]

This surprises me, but I am no expert. You would think though, with a 4 week RVR, followed by 47 weeks of treatment clear of virus, the odds are good. But if there are studies to the contrary... whatever is decided, you have done so well to get through treatment - good luck, and best wishes on an SVR.

[FlGuy]

Did the doc say anymore, like other adverse predictors?  Like advanced liver damage, high BMI, older than dirt, wants to get back at you for something?  The prospects of doing 48 is pretty tempting especially when you are in 40.  The prospects of 48, plus another 72 is scary.  Is there room for logical arrival at a middle ground?  Had the do steered you wrong yet?  Are you tolerating tx ok?  Is your life significantly 'dented' by tx (work and personal)?  A lot to consider.  Good luck.

[zazza]

I know of people in Canada and even in the States whose doctors told them to go 72 weeks when they were not UND by week 4. But not of anyone who was UND by week 4 like you.

I agree with FlGuy though. Every additional week is extra insurance. We cannot trust this virus to be gone until we have the SVR in our hand.

[dorsey15]

Here's the scoop..I'm not older than dirt...but treatment sure has made me feel that way!!
I still work..but had to cut hours down to around 35 a week..Rest of my life *****!! Have no life... Fatigued, depressed, insomnia, nauseated, neupogen, yada yada yada,! etc, etc, etc, !
I'm stage 2, grade 2..that's it!
So I just don't know what else to say...

You guys are the BEST !! I don't know what I would have done all these weeks without you here...I have wanted to quit so many times-- but being on this forum and having you here has kept me going..
What a blessing!!
You have NO IDEA!!
Love to ALL!
Dorsey

[FlGuy]

just to make sure of your 4-week undetectable.  Do you have the lab report copy to re-validate for yourself, matching the date of the VL to the actual start of tx and the number of weeks gone by for that PCR.  And was it a fairly sensitive PCR and were the results obvious and unambiguous to you?

[Trinity4]

Let's say your 4 wk PCR was UND with a low sensitivity.  48 wks + 4 wks would be the tops any hep doc would recommend.  Max 52 wks.  Honestly Dorsey, there aren't any guarantees with 72 wks either.  These drugs are extremely difficult on our bodies, and I wish your doctor had provided some other reason other than high viral load.  Your liver damage isn't bad, and you've had a very difficult time with tx.  I think a second opinion is in order here.  

[dorsey15]

That's exactly my thoughts! Max 52 wks !
I'm going to ask the doctor next month when I go --where's the DATA!

I'm barely making it as it is going to work every day both physically and emotionally !
There aren't any more antidepressants I can take and certainly nothing that can help with this fatigued we get from these meds and I get horrible bouts of insomnia too..I take enought **** for that too.... I do the best I can to get by....but I want to be SVR!!!!!!

Thanks Trinity-- you are one of my HERO'S .. you need to know that!! you help me each and every day!! :)

Love ya,  Dorsey

[portann]

At what other points were you tested for viral load between your fourth and fortieth weeks? Do you know the results?

[dorsey15]

I have those results at home... but several times and all were undedected...

Thanks Dorsey

[nygirl7]

You don't know what the sensitivity of the test was - did I miss that (just got my eyes dilated at the eye docs and can't see anything)!

I've never heard of anybody insisting someone und at 4 go for 72.  UND at 4 doesn't that give you like 90% odds of SVR?  Perhaps they have it a little mixed up........I ONLY did the 72 because, like Trin, was not UND until after 12 and before 24 somewhere.

All of the top docs agree there are really only two numbers supported for a geno 1 (I was a 1a and 1b and Dr. Jacobson said it didn't matter one bit) 48 weeks of 72.  One or the other (I wanted 60).  Adding 'extra' weeks he said is just a moot point because no data suggests it does anything (except make us feel better about having extra 'insurance').

One thing you are going to have to find out is - since you are not of the criteria supported by the studies will the insurance company even PAY the extra $$$?  I was definitely in the group that needs to extend (but the studies had only recently come out) and I was deemed that it was "experimental" and Aetna refused to pay for it. Of course I just went to Commit to Care and they helped but - if your insurance won't pay you could be up the creek since you tehcnically aren't a 72 weeker.

I'd find that out - it might be a great reason to throw back at the doc if you dont' want the extra meds floating around for another six full months!

Good luck Dorsey!

[Deb_c430]

i went UND at 12 weeks, but from the begining he kept talking 72 weeks, slow responder and relapser,      

[CockSparrow]

Your Doctor is probably right in that G1 HVL do have high relapse rates.
However your Doc is ignoring the incredible predictive power of RVR regardless of any other baseline factors.

Below comes from an Article by Mitchell L. Shiffman Optimizing the Current Therapy for Chronic Hepatitis C Virus: Peginterferon and Ribavirin Dosing and the Utility of Growth Factors in Clinics of Liver Disease 2008

Defining the time when the patient first becomes HCV RNA undetectable is critically important in the management of HCV treatment because this is directly related to the likelihood of an SVR [10]. Patients who become HCV RNA undetectable within 4 weeks of initiating treatment are referred to as having a rapid virologic response (RVR). As illustrated in Fig. 2, approximately 15% of patients who have genotype 1 and 66% of patients who have genotypes 2 and 3 achieve an RVR [4,10]. These patients are exquisitely sensitive to treatment; they have an SVR rate of 90% regardless of their genotype and the type of therapy they receive [4,10]. In a retrospective analysis of a large clinical trial database, patients who had genotype 1 and an RVR had an SVR of 90% whether they were treated with peginterferon and full-dose ribavirin, a lower dose of ribavirin, standard interferon and ribavirin, or even peginterferon monotherapy [10,15].

Shortening the duration of therapy from 48 to only 24 weeks also seemed to be effective in achieving high rates of SVR in genotype 1–infected patients with an RVR [15]. These observations have significant implications for dosing peginterferon and ribavirin. Because patients with an RVR are so responsive to treatment, the primary response to adverse events in these patients should be to reduce the dose of peginterferon or ribavirin and not to add growth factors or other adjuvant therapies.

Continued
CS

[CockSparrow]

The excepts below com from an Article “Tailored Treatment for Hepatitis C”
by Thomas Berg in Clinics of Liver Disease 2008

Viral kinetic studies have further expanded our knowledge of the mechanisms of IFNa action and have shown that the likelihood of achieving a sustained virologic response (SVR) clearly depends on the speed of the response [8–10]. It is well established that the rate of SVR is inversely correlated with the time on treatment that is necessary to clear HCV RNA from serum. Individual prognosis with respect to the long-term treatment outcome can therefore be best predicted by early viral kinetics, because all baseline factors finally alter the speed of response (Fig. 1). Indeed, if one includes viral kinetic parameters in multivariate models to predict SVR, most of the baseline factors lose their predictive power.

The rational background of any individualized therapy is based on the concept that rapid responders need less therapy as compared with those patients who are slow responders.

Importance of the sensitivity of the hepatitis C virus RNA test
Undetectable hepatitis C viremia on treatment, even when evaluated by standard qualitative HCV RNA tests (detection limit of 50 IU/mL) does not, per se, indicate that the virus was completely eliminated from the serum.
There is now emerging evidence that by applying more sensitive assays (eg, transcription-mediated amplification [TMA] or real-time polymerase chain reaction [PCR] assays with a detection limit!10 IU/mL), a significant proportion of patients who were shown to have undetectable HCV RNA levels by standard assay are still viremic.
This implies that many patients considered so far to have had a relapse might, in fact, have been nonresponders with a minimal replication level (minimal residual viremia)


Experiences with shortening treatment duration in hepatitis C virus type 1 infection
Treatment guidelines recommend that patients infected with HCV genotype 1 should be treated for 48 weeks with the combination of peg-IFN plus ribavirin [13,14]. The recommendation of this fixed treatment duration is based on the outcome of a large randomized international trial published in 2004 by Hadziyannis and colleagues [6], in which patients were randomized to treatment for 24 or 48 weeks with peg-IFNa-2a plus ribavirin at a dosage of 800 or 1000/1200 mg/d. SVR rates ranged from 29% to 52% across the four treatment groups, and the highest SVR rates were achieved with a 48-week treatment regimen plus ribavirin at a dosage of 1000/1200 mg/d.

Extension of treatment duration up to 48 weeks increased the SVR rate, especially in patients who had high baseline viremia (R800,000 IU/mL) from 26% to 47%, whereas increasing treatment duration from 24 to 48 weeks in patients who had low viremia (!800,000 IU/mL) yielded only a moderate effect on SVR rates (52% versus 65%). These data indicate that a subgroup of patients defined by pretreatment HCV RNA levels of less than 800,000 IU/mL can achieve long-term response rates up to 52% even after a treatment period of 24 weeks.

Based on these findings, Zeuzem and colleagues [15] performed a study to examine whether patients who have HCV genotype 1 and low baseline HCV RNA levels (defined as!600,000 IU/mL) may require just 24 weeks of treatment with peg-IFNa plus ribavirin. Two hundred thirty-five treatment-naïve patients infected with HCV genotype 1 were treated for 24 weeks with peg- IFNa-2b at a dosage of 1.5 mg/kg/wk and weight-based ribavirin (800–1400  mg/d).Acomparable group of patients who had type 1 infection and low baseline viremia who had been treated for 48 weeks within the Manns’ trial [3] served as a historical control. The end-of-treatment virologic response rates were comparable between both studies (ie, 80% versus 74%).
SVR rates were significantly different (50% versus 71%), however, because of higher relapse rates observed in patients treated for only 24 weeks (37% versus 4%).

Thus, baseline factors alone, like HCV RNA levels, do not really help to get sound information concerning tailoring of treatment duration.

These investigators then re-evaluated their findings and found that a subgroup of patients expressing a rapid virologic response (RVR) already at week 4 (defined as HCV RNA levels !29 IU/mL by real-time PCR) had an 89% chance to achieve an SVR even after only 24 weeks of combination therapy, which was comparable to the SVR rates observed in patients with an RVR treated for 48 weeks (85% in historical control group with RVRs).

Jensen and colleagues [16] aimed to explore the prognostic factors for an RVR (HCV RNA !50 IU/mL at week 4) and an SVR in type 1–infected patients treated in the study by Hadziyannis and colleagues [6] for 24 weeks with peg-IFNa-2a at a dose of 180 mg plus ribavirin at a dosage of 800 or 1000 to 1200 mg/d by stepwise multiple logistic regression analysis. Their findings confirmed that RVR was the single best predictor of SVR.
Thus, 89% with an RVR versus 19% without an RVR had an SVR (Table 2) when treated for only 24 weeks. A multiple regression model demonstrates that HCV RNA level was the only independent predictor of RVR.

These findings could also be confirmed in a prospective study by Ferenci and colleagues [17], in which type 1–infected patients and a small proportion of type 4–infected patients with an RVR (50 IU/mL at week 4) were treated for only 24 weeks with peg-IFNa-2a plus weight-based ribavirin.
Overall SVR rates were 87%. Patients with a high viral load at baseline (defined as Greater than 600,000 IU/mL) achieved SVR rates lower as compared with those with a low viral load of less than 600,000 IU/mL (74% versus 93%).
Stage of fibrosis also influenced SVR rates in patients defined as ‘‘super-responders’’ (SVR rates were 90% with stage F0–F2 versus 79% with stage F3–F4). Also of interest are these investigators’ observations that frequency of relapse rates could be determined according to the assays applied to determine HCV RNA. In the case of a negative real-time PCR HCV RNA at week 4, the relapse rate was 10% as compared with relapse rates of 30% in patients still positive with the sensitive assay at week 4.

Between February 2001 and November 2003, the Dynamically Individualized Treatment of Hepatitis C Infection and Correlates of Viral/Host dynamics (DITTO-HCV) study group evaluated a dynamically individualized treatment schedule according to the early virologic response (compared with a standard-of-care peg-IFNa plus ribavirin combination therapy for 48 weeks) [18]. Patients categorized as having an RVR (definition: total log10 decline of HCV RNA during the first 4 weeks R2 and a second phase decline R0.09 per day) were randomized to 24 or 48 weeks of treatment. SVR rates in HCV type 1–infected patients with an RVR who were treated for only 24 weeks were substantial (65%) but were lower than in those treated for 48 weeks (83%). No significant difference, however, was observed when patients with a low viral load (ie, !800,000 IU/mL) were considered, in whom SVR rates were nearly identical regardless of whether they were treated for 24 or 48 weeks (82% versus 83%) [18].

Would it be possible to shorten treatment duration further?
In a prospective, multicenter, randomized controlled study fromGermany,HCVtype 1–infected patients received an individualized treatment duration from18 to 48 weeks tailored according to early viral kinetics. Patients with a low viral load (800,000 IU/mL and RVR defined as 5.3 IU/mL by means of TMA assay) achieved an SVR of 95% after the 18-week treatment duration, and these findings were similar to the comparable control group treated for 48 weeks (94% SVR rate) [19].

Cont.

[pKinCA]

You might want to show your doctor the article I posted up above.  

It has some pretty significant findings -- high SVR rate for Genos 1 and 4 who go UND by week 4 (or RVR) who only did 24 WEEKS of tx!!  

This article just came out on Tuesday... New studies and findings...

pK

[CockSparrow]

Experiences with extending treatment duration in hepatitis C virus type 1
Extension of treatment with peg-IFNa plus ribavirin from 24 to 48 weeks has significantly increased the SVR rate in patients who have HCV genotype 1. Thus, the standard duration of therapy for patients who have chronic HCV is 48 weeks.
The ability to achieve an SVR depends on the time at which HCV RNA becomes undetectable, however, and patients who have a slow virologic response have an increased risk for relapse after treatment has been discontinued, even when HCV RNA was undetectable at the end of the 48-week treatment period [8]. Obviously, the HCV RNA-negative interval was too short to clear HCV from the host tissue permanently. Extension of treatment duration may be one possibility for improving SVR rates by reducing relapse rates in these patients [23]. This concept is, however, confronted with some limitations, considering the troublesome side effects associated with this combination therapy, which, as a consequence, may be responsible for an increasing number of dropouts when treatment duration is extended. In this situation, the intention-to-treat analysis may not be optimal to demonstrate the potential benefit of extending treatment duration, because the higher withdrawal rates (when extending treatment duration) and higher relapse rates (when shortening treatment duration) may neutralize each other.

Summary of the current concepts of tailoring treatment duration in patients who have hepatitis C virus type 1
Patients who have an RVR and low baseline viremia may be potential candidates for shortening treatment duration from 48 to 24 weeks. Around 10% to 15% of all HCV type 1–infected patients reach these criteria. The optimal cutoff to define low viremia (400,000, 600,000, or 800,000 IU/mL) in this setting is still unclear. As long as HCV RNA is undetectable by sensitive real-time PCR assays or TMA tests at week 4, however, levels of less than 600,000 IU/mL seem to be appropriate (more conservative physicians may even choose 400,000 IU/mL). Because hepatitis C viremia may fluctuate in the natural course of the disease, however, it is desirable to have at least two measurements of HCV RNA before starting therapy to confirm low-level replication over time. To exclude to the best possible level the presence of minimal residual viremia at week 4, which clearly increases the likelihood of experiencing a relapse, the most sensitive HCV RNA assays should be used when shortening treatment duration is considered.

Furthermore, patients who have advanced fibrosis or established cirrhosis, or those who need a marked dose reduction within the first 24 weeks of treatment, should at present be excluded from abbreviated treatment regimens because of insufficient data for those cohorts.

In contrast, there is now emerging evidence that patients who have a slow virologic response not reaching an undetectable HCV RNA level before week 24 who are exposed to a 48-week standard treatment period run a high risk for relapse (reaching up to 70%). Extension of the treatment period up to 72 weeks can help to reduce relapse rates in these patients. In this context, it should be pointed out that the thus far generally accepted stopping rule for patients with a less than 2-log10 decline of HCV RNA within the initial 12 weeks of therapy should be reconsidered, because the high negative predictive value of this stopping rule of 98% to 100% has so far only been established for the 48-week treatment duration. Therefore, this cutoff may not be relevant when patients are treated for 72 weeks

CS

[portann]

Hi Deb,

How do you figure that he thought that way? That makes me do a double take. Were there other factors or was it just his unconventional approach?

[dorsey15]

You have NO IDEA how you have helped me today!! Thank you SO MUCH!!

That answers my question!  No more than 48 weeks for me !!

Thank you!

Dorsey

P.S.  I will print this info and take it to my doctor !!

[portann]

Thanks for those studies. I'm going to open the links and print them out, to take to my doc. I'm sure he won't read them but I'll wave them around in his face and at least negotiate a script for an out-of-town more sensitve test in future. The study mentions the relevance of sensitive testing in a very persuasive way.

Very reassuring to read that Dorsey's situation seems so promising and that doing 72 may be (is?) a misread (a blunder?) on the part of her doctor.

Hope all is well down under, CockSparrow. Thank you for sharing your research.

[nygirl7]

I'll tell you one thing - I wouldn't cut the length of treatment in half - no fricking way....maybe just me but easier isn't always the better version and is just risky.

[CoWriter]

Good job!

[meNtoby]

I'm going to pipe in one thing regarding the less sensitive test of <50.  And yes, I'm geno 2b, but see if my reasoning is somewhat sound.  

As a geno 2, with two high VL's pre treatment (17 million in May, 30m in late August) that if I am RVR, or Und <50 at week 4, <50 at week 12, and again at week 24, that it's a safe bet that $ucker isn't hiding out for 20 more weeks at a sneaky 10 copies, or 4.
As a matter of fact, unless they change tests. I will be betting my life on it.

But assuming it is the cost of the more sensitive tests, then consider this option that would shorten the expense by 8 weeks of chemo:

If I were going to shorten my length of treatment,(and they've twice suggested I do, if I am "clear" at week 4), I think I'd want the most sensitive test they make to be done at like, week 2. If I were UND <5 at week 2, I believe I would feel safer stopping at week 16.  So why is it that they just don't order the more sensitive testing, and do it sooner???

Wouldn't the insurance company rather throw in a couple of more expensive lab tests, EARLIER, if it meant that a geno 2, or any genotype really, could reach EOT earlier, and still have decent odds of SVR?  Or do they believe that the potential for RVR at week 2 or 3 is so low that they just seldom do it?

Are there any studies done on SVR rates which include sensitive testing at weeks 1 or 2?  I swear I saw one article that said the VL takes the biggest hit during the FIRST 24 HOURS!  And no, I can't name the article, and I'm so tired and buggy right now, I'm not sure if what I'm asking is even stated logically. (but gee, it makes so much sense in my HEAD, that I hope so~)

I think there was a question in there!  I'm exhausted and foggy, so I'll let this chum soak for awhile and come back hopefully without the pea soup.  Somebody here has to be able to understand my question, even if I no longer do. Eh, eh?

~:-)  <that's a chemo head, one hair.

[CockSparrow]

As a geno 2, with two high VL's pre treatment (17 million in May, 30m in late August) that if I am RVR, or Und <50 at week 4, <50 at week 12, and again at week 24, that it's a safe bet that $ucker isn't hiding out for 20 more weeks at a sneaky 10 copies, or 4.

If I understand this correctly, No a test of <50IU does not guarantee that the virus isn’t hanging around at low levels. So yes the more sensitive the test the more likely you are truly UND. <10 is be about as high as I would want but preferably even lower. HR’s <2 IU test (no idea what the LabCorp # is) would be my preferred test for this time point if shortening Tx was in the decision mix. <5IUs would be good also.


Are there any studies done on SVR rates which include sensitive testing at weeks 1 or 2?  
Yes and no.
They say it makes no difference to SVR rates than the 4 week test.
At least one recently, stated that being <600 at 2weeks was predictive of SVR but this was for G3 HVL.

If UND @ <5 at week 2 then 16 weeks seems reasonable to me. But with your HVL don’t expect it to happen. With G2s HVL doesn’t have the same impact in reducing SVR as it does with G1s or G3s for that matter, but I still wouldn’t like to shorten Tx as the relapse rate will be higher.

In your case I would do 24 weeks especially if you have any negs other than HVL.

All the Best
CS

[CockSparrow]

I'll tell you one thing - I wouldn't cut the length of treatment in half - no fricking way.

So 18 weeks is out of the question then. -lol
even with these SVR rates
G1 Patients with a low viral load (<800,000 IU/mL and RVR defined as <5.3 IU/mL by means of TMA assay) achieved an SVR of 95% after the 18-week treatment duration, and these findings were similar to the comparable control group treated for 48 weeks (94% SVR rate)

CS

[dorsey15]

I definately wouldn't have considered cutting my treatment to 24 wks--whatever the statistics.. but I don't know about my doctor saying I should do a full 72 wks either...

CS-- you have some great information for me to print and really study here...Thank you soooo much for your time....
A lot to consider..

When I took my 4 wk viral load test I had not even taken my 4th shot...hum?? and I was undetected < 10...log drop of 6.93...  16,000,000 viral load drop....
I don't understand their reasoning to go 72 weeks total either...

Thanks for everyone's input...

Dorsey

[portann]

Wow, Dorsey, with numbers like that, you're one of those 'exquisitely sensitive' people who respond to treatment, as mentioned in the study. I'd love to borrow some of whatever it is you've luckily been endowed with. Keep posting with news of this 72 week seeming fiasco, proposed by your doctor. How could she possibly make sense?

[dorsey15]

Hi Portann-- "exquisitely sensitive" yeah...I was reading that too..hadn't heard that statement before... ! I'd LOVE to give that to EVERYONE on treatment!!!!!!!

Wondered too if that meant why I'm so sick too--- hee hee-- but if that means that this is why it worked so quick-- then that's I guess worth it...

I wonder if the doctors are in cha hoots with the pharmaceutical companies and the insurance companies ?!! hee hee...

Thank you too for all your great information and taking the time to help me...

Dorsey

[meNtoby]

Dorsey- Wow!  You really do have impressive numbers there!  I thought going 30 mill to below 50 was da bomb, but If you gave blood before your 4th shot, it sounds like you only had 3 weeks worth of tx too, before testing <10.  Your doctor shoulda' done back flips for a geno 1 like you!  Congratulations!!!!

CS, thank you for your post on my situation, and for putting the study results in here for dorsey and geno 1's. And pK and nygirl, trin, portann, ca,  ALL you guys that take the time to help us better deal with our doctors with stats and information... As well as your personal experiences. When you answer one, you help dozens!  :-)

cat

[dorsey15]

AMEN TO THAT!
Everyone has NO IDEA how much they help all of us with sharing their information!!
Taking the time out of their busy days to give us STATS like they do and sharing their personal stories and information.... It has helped me emensly (sp) I can't spell today--got brain fog  :)
My doctors haven't given me as much information as everyone here has !!!!

Thanks again to all!
Love ya,
Dorsey in Florida

[jmjm530]

First, your doctor is wrong based on what I've heard from other liver specialists and researched. That said, ask for a *full-text* copy of the supporting study, read it, and feel free to post it here for group comments. You may have mentioned it already, but how much liver damage do you have. If you're stage 4, I might see some logic.

Also, one doc -- whoever he or she is -- does not a consensus make. For that reason you might start looking around for a second consult although it does appear your doc has given you the alternative to stop at week 48. Still, always ideal to have all medical records in front of another doc in case something is missed.

-- Jim

[pKinCA]

You're very welcome!

It was a big coincidence that I'd just finished reading the article I posted then looked at MedHelp and saw your thread :-)

If I had been Geno 1 and had RVR, I would be very happy reading the great SVR rates from that study.  I'm excited for new patients too... and imagine that in a short while length of tx will be tailored quite differently than it is now.  It's turning out that RVR is very important piece of the tx puzzle...

As a Geno 2b, I'm glad someone did studies a few years ago that showed good SVR success after only 24 weeks, versus the old standard of 48 weeks for all genos... Now 24 weeks is standard for 2s and 3s -- this is how "medicine" unfolds...

Please let us know how it goes (went) with your doctor!!

pK