Aa
GT3 , RVR and relapse rates
Hi members,
I am presently undergoing peg, riba treatment for GT 3. I am currently 20 days into treatment.
I will have my week 4 VL test in about a week's time.
If it is UND should I go for the standard six months or should I insist that the treatment be for 36 weeks instead.
I am asking this because I have read a couple of cases of GT 3, on this forum itself who had RVR but relapsed soon after treatment.
I am 30 about to be 31 in a month and looking to get married.
I want to get rid of this beast once and for all. I do not want to enter into marriage before slaying this beast.
f at all I do attain RVR, should I still insist on a longer duration of treatment. Would that be of any help in attaining SVR ?
I am presently undergoing peg, riba treatment for GT 3. I am currently 20 days into treatment.
I will have my week 4 VL test in about a week's time.
If it is UND should I go for the standard six months or should I insist that the treatment be for 36 weeks instead.
I am asking this because I have read a couple of cases of GT 3, on this forum itself who had RVR but relapsed soon after treatment.
I am 30 about to be 31 in a month and looking to get married.
I want to get rid of this beast once and for all. I do not want to enter into marriage before slaying this beast.
f at all I do attain RVR, should I still insist on a longer duration of treatment. Would that be of any help in attaining SVR ?
As far as I can tell, if you are a RVR you have up to an 88% chance of attaining SVR.
"HCV RNA Responses During Therapy
Rapid Virologic Response (RVR): The week 4 quantitative HCV RNA provides the earliest indication that treatment may be successful. A rapid virologic response, or RVR, is defined as an undetectable HCV RNA at week 4 (Figure 1) and remains one of the strongest predictors of SVR in patients on peginterferon and ribavirin, with up to 88% of those with RVR going on to SVR (for HCV genotypes 1, 2, 3, and 4)[2,3]. An HCV RNA level obtained 4 weeks after starting the protease inhibitor (as part of triple therapy) remains an important positive predictor for SVR[4]. Many of the same clinical factors that predict SVR also correlate with RVR, such as low pre-treatment HCV viral level and IL28B CC genotype[3,5]. The presence of an RVR can trump other well-known poor prognostic factors. For example, while African-American patients are overall less likely than Caucasian patients to achieve an SVR for a given week 4 decrease in HCV RNA level, the few patients who do achieve an RVR can attain SVR rates of 80 to 90%, which is comparable to rates observed in Caucasians who achieve RVR[3,6]. "
Let's see what happens with these test results, then go from there.
"HCV RNA Responses During Therapy
Rapid Virologic Response (RVR): The week 4 quantitative HCV RNA provides the earliest indication that treatment may be successful. A rapid virologic response, or RVR, is defined as an undetectable HCV RNA at week 4 (Figure 1) and remains one of the strongest predictors of SVR in patients on peginterferon and ribavirin, with up to 88% of those with RVR going on to SVR (for HCV genotypes 1, 2, 3, and 4)[2,3]. An HCV RNA level obtained 4 weeks after starting the protease inhibitor (as part of triple therapy) remains an important positive predictor for SVR[4]. Many of the same clinical factors that predict SVR also correlate with RVR, such as low pre-treatment HCV viral level and IL28B CC genotype[3,5]. The presence of an RVR can trump other well-known poor prognostic factors. For example, while African-American patients are overall less likely than Caucasian patients to achieve an SVR for a given week 4 decrease in HCV RNA level, the few patients who do achieve an RVR can attain SVR rates of 80 to 90%, which is comparable to rates observed in Caucasians who achieve RVR[3,6]. "
Let's see what happens with these test results, then go from there.
I included the part about Ribavirin doasge. The part about the SVR rates and length of treatment is after the part about Ribavirin dosage.
From University of Washington: Hepatitis C
"Ribavirin Dosing Readdressed: Weight Based versus Fixed Dose
The ACCELERATE trial used a lower, fixed-dose of ribavirin (800 mg/day), whereas previous studies had utilized weight-based ribavirin dosing (1000 to 1200 mg/day), yielding conflicting results and raising the question whether the lower, fixed-dose of ribavirin could be associated with lower SVR rates and/or higher rates of relapse. One study demonstrated that in patients with genotype 2 and 3 treated with the standard, fixed-dose ribavirin (800 mg/day), SVR rates were greater in the patients who were exposed to the higher mean dose of ribavirin, based on body weight [20]. Similarly, other studies have found an association between higher average doses of ribavirin per kilogram of body weight and higher SVR rates[10,11]. In contrast, in a large multicenter trial that involved 1,831 patients with genotype 2 or 3 infection, investigators found similar overall SVR rates with weight-based versus fixed ribavirin dosing (67.7% and 65.0% respectively) as part of a 24-week treatment course[21]. Of note, within the weight-based ribavirin group, SVR rates were consistent across all weight categories, whereas SVR significantly decreased with increasing weight in the fixed-dose group (Figure 5). Weight-based ribavirin dosing could be considered for those patients that may be more difficult to treat due to underlying host characteristics such as obesity or advanced fibrosis.
Extended Treatment for Patients who do not Achieve RVR
Patients with genotype 2 or 3 who do not achieve a rapid virological response have low SVR rates, ranging from 26 to 41% (Figure 6)[16,22]. Although current guidelines recommend treating all patients with genotype 2 or 3 infection for 24 weeks, the benefit of longer therapy for these non-RVR patients continues to be debated. Weight-based ribavirin may also benefit this subset of patients with genotypes 2 or 3 infection who do not achieve a RVR. One retrospective analysis of genotype 2 or 3 patients who did not achieve an RVR found a trend toward higher SVR rates among those who received 48 weeks of weight-based ribavirin compared with those in other treatment categories (24 weeks of weight-based ribavirin, 24 weeks of fixed-dose ribavirin, or 48 weeks of fixed-dose ribavirin)[23]. Another study found that treatment up to 36 weeks resulted in a small but statistically insignificant increase in SVR compared with the standard 24 weeks among genotype 3 patients who did not achieve an RVR (62% versus 52%, P=0.25)[24]. There are currently insufficient data to make clear recommendations supporting the strategy of intensifying treatment for this patient group.
Differential Treatment Responses with Genotype 2 and 3
Genotypes 2 and 3 have historically been grouped together as easy-to-treat and comparable in response, but studies suggest that patients with genotype 3 may have lower SVR rates and higher relapse rates than those with genotype 2[25]. In a meta-analysis of 12 clinical trials comparing outcomes between genotype 2 and 3 patients after 24 weeks of therapy, the SVR rates were 74% in genotype 2 patients and 68% in genotype 3 patients (pooled odds ratio 1.49, 95% CI 1.23-1.80)[16]. This difference, however, was more striking in the subset of patients with high baseline HCV viral levels (greater than 400,000 to 600,000 IU/mL); for those patients with a high baseline HCV RNA level, the SVR rates were 75% in genotype 2 and 58% in genotype 3 patients, which compared with SVR rates of 79% and 75% respectively among those with low baseline viral levels. Among those that attained a rapid virologic response, SVR rates were similar (83 to 86%) between genotype 2 and 3 patients, regardless of duration of therapy (12 to 16 weeks or 24 weeks) or baseline HCV RNA levels. For those patients who did not achieve RVR and received treatment for 24 weeks, the SVR rates were much higher for genotype 2 than 3 (62% versus 46%, respectively). These data suggest that patient with genotype 3 may benefit from a longer duration of therapy, particularly if other poor prognostic factors, such as high baseline viral level and lack of RVR, exist. Nevertheless, further studies are needed before this approach can be routinely recommended."
http://depts.washington.edu/hepstudy/hepC/mgmt/gt23/discussion.html
From University of Washington: Hepatitis C
"Ribavirin Dosing Readdressed: Weight Based versus Fixed Dose
The ACCELERATE trial used a lower, fixed-dose of ribavirin (800 mg/day), whereas previous studies had utilized weight-based ribavirin dosing (1000 to 1200 mg/day), yielding conflicting results and raising the question whether the lower, fixed-dose of ribavirin could be associated with lower SVR rates and/or higher rates of relapse. One study demonstrated that in patients with genotype 2 and 3 treated with the standard, fixed-dose ribavirin (800 mg/day), SVR rates were greater in the patients who were exposed to the higher mean dose of ribavirin, based on body weight [20]. Similarly, other studies have found an association between higher average doses of ribavirin per kilogram of body weight and higher SVR rates[10,11]. In contrast, in a large multicenter trial that involved 1,831 patients with genotype 2 or 3 infection, investigators found similar overall SVR rates with weight-based versus fixed ribavirin dosing (67.7% and 65.0% respectively) as part of a 24-week treatment course[21]. Of note, within the weight-based ribavirin group, SVR rates were consistent across all weight categories, whereas SVR significantly decreased with increasing weight in the fixed-dose group (Figure 5). Weight-based ribavirin dosing could be considered for those patients that may be more difficult to treat due to underlying host characteristics such as obesity or advanced fibrosis.
Extended Treatment for Patients who do not Achieve RVR
Patients with genotype 2 or 3 who do not achieve a rapid virological response have low SVR rates, ranging from 26 to 41% (Figure 6)[16,22]. Although current guidelines recommend treating all patients with genotype 2 or 3 infection for 24 weeks, the benefit of longer therapy for these non-RVR patients continues to be debated. Weight-based ribavirin may also benefit this subset of patients with genotypes 2 or 3 infection who do not achieve a RVR. One retrospective analysis of genotype 2 or 3 patients who did not achieve an RVR found a trend toward higher SVR rates among those who received 48 weeks of weight-based ribavirin compared with those in other treatment categories (24 weeks of weight-based ribavirin, 24 weeks of fixed-dose ribavirin, or 48 weeks of fixed-dose ribavirin)[23]. Another study found that treatment up to 36 weeks resulted in a small but statistically insignificant increase in SVR compared with the standard 24 weeks among genotype 3 patients who did not achieve an RVR (62% versus 52%, P=0.25)[24]. There are currently insufficient data to make clear recommendations supporting the strategy of intensifying treatment for this patient group.
Differential Treatment Responses with Genotype 2 and 3
Genotypes 2 and 3 have historically been grouped together as easy-to-treat and comparable in response, but studies suggest that patients with genotype 3 may have lower SVR rates and higher relapse rates than those with genotype 2[25]. In a meta-analysis of 12 clinical trials comparing outcomes between genotype 2 and 3 patients after 24 weeks of therapy, the SVR rates were 74% in genotype 2 patients and 68% in genotype 3 patients (pooled odds ratio 1.49, 95% CI 1.23-1.80)[16]. This difference, however, was more striking in the subset of patients with high baseline HCV viral levels (greater than 400,000 to 600,000 IU/mL); for those patients with a high baseline HCV RNA level, the SVR rates were 75% in genotype 2 and 58% in genotype 3 patients, which compared with SVR rates of 79% and 75% respectively among those with low baseline viral levels. Among those that attained a rapid virologic response, SVR rates were similar (83 to 86%) between genotype 2 and 3 patients, regardless of duration of therapy (12 to 16 weeks or 24 weeks) or baseline HCV RNA levels. For those patients who did not achieve RVR and received treatment for 24 weeks, the SVR rates were much higher for genotype 2 than 3 (62% versus 46%, respectively). These data suggest that patient with genotype 3 may benefit from a longer duration of therapy, particularly if other poor prognostic factors, such as high baseline viral level and lack of RVR, exist. Nevertheless, further studies are needed before this approach can be routinely recommended."
http://depts.washington.edu/hepstudy/hepC/mgmt/gt23/discussion.html
Thank you all for taking the time out to answer.
Does anyone have access to data about the percentage of GT 3s who go on to achieve SVR sfter attaining RVR?
Does anyone have access to data about the percentage of GT 3s who go on to achieve SVR sfter attaining RVR?
I was a genotype 3a who did not RVR but was UND at week 5. I had my IL28B test and was found I was a CT so my doc put in for 36 weeks of treatment but insurance approved only 28. I did the 28 and am now SVR. If you are a IL28B CT or TT and you do not RVR, you may want to discuss treating longer than 6 months with your doc.
Good luck
Good luck
Hi - I was also diagnosed GT 3a and I just finished INF/Riba treatment in Dec. I decided to treat for 48 weeks when I didn't test undetected until my 12 week PCR (viral load test). I also learned I am IL-28B genotype.
It was a long 48 weeks but I wanted to ensure that I did everything necessary to give it my best shot at clearing the virus. I had a number of side effects from the meds, the worst of which were fatigue and depression.
I haven't had my first viral load test and even if I'm undetected, I won't be considered clear of the virus (SVR) until I've remained so for another five months.
One thing I learned is that treating Hep C requires a lot of patience. You are only three weeks into treatment and there is no rush to make a decision today. I agree with desrt that you will be better able to decide once you consider the three factors he's mentioned above.
Best of luck and I hope you reach UND at four weeks.
Rebecca
It was a long 48 weeks but I wanted to ensure that I did everything necessary to give it my best shot at clearing the virus. I had a number of side effects from the meds, the worst of which were fatigue and depression.
I haven't had my first viral load test and even if I'm undetected, I won't be considered clear of the virus (SVR) until I've remained so for another five months.
One thing I learned is that treating Hep C requires a lot of patience. You are only three weeks into treatment and there is no rush to make a decision today. I agree with desrt that you will be better able to decide once you consider the three factors he's mentioned above.
Best of luck and I hope you reach UND at four weeks.
Rebecca
Hi I was Geno. 3 also and I did 24 weeks rib and Pegasys . My first blood draw was 4 weeks I was UND . I stayed UND all through treatment and stopped at 24 weeks. that was June 2011. I did blood work one month after stopping UD and then every 6 months there after . Last blood work in Dec 2013. all blood work was normal and last ultra sound in Dec was spleen normal it was enlarged before treatment . Liver also was enlarged and it is almost normal now. My ALT and AST shoot out the roof when I was treating but are normal range now. Best of luck to you and I thank God that I beat this awful virus.
Hang in there and some days are not so good but look at the end results.
bbj
Hang in there and some days are not so good but look at the end results.
bbj
I would base response guided tx for GT 3 Peg/riba on several factors.
Your response at 4 weeks.
Your IL28B test results.
And how well you tolerate tx.
This will help you decide whether to extend, stop, or stay the course for 24 weeks.
Good luck.
http://www.gastrojournal.org/article/S0016-5085(10)00841-3/abstract
"...Differences between IL-28B genotypes were greatest among patients who failed to attain RVR (VD24 SVR rates: CC, 87%; CT, 67%; and TT, 29%; P = .0002). Among patients with RVRs (61%), the IL-28B genotype was not associated with SVR..."
Your response at 4 weeks.
Your IL28B test results.
And how well you tolerate tx.
This will help you decide whether to extend, stop, or stay the course for 24 weeks.
Good luck.
http://www.gastrojournal.org/article/S0016-5085(10)00841-3/abstract
"...Differences between IL-28B genotypes were greatest among patients who failed to attain RVR (VD24 SVR rates: CC, 87%; CT, 67%; and TT, 29%; P = .0002). Among patients with RVRs (61%), the IL-28B genotype was not associated with SVR..."
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