Geno type 1A treatment time

[rockportbill]

Trying to find out the latest information on treatment time , being  geno type 1a  ,starting with a low viral load  (257,000) and obtaining RVR at week two?   is 48 weeks still the norm?

Thanks in advance ,  I know you people will have some answers

[WriteItDown]

"however, among patients with an RVR, no baseline factor predicted SVR."

If this is the case, why would they only be recommending 24 week treatment for patients with viral load >400,000?  Why wouldn't it be a wait-and-see recommendation, only for patients who achieve RVR?  This does not make sense.

[Bill1954]

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

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

and


“Background & Aims: This analysis reports the rate of sustained virological response (SVR) in patients infected with hepatitis C virus (HCV) genotype 1 or 4 who were assigned to 24 weeks of treatment with pegylated interferon (peginterferon) alfa-2a 180 μg/wk plus ribavirin 1000/1200 mg/day after achieving a rapid virological response (RVR; HCV RNA level <50 IU/mL) at week 4 in a prospective trial investigating response-guided therapy. Methods: Non-RVR patients with an early virological response were randomized to 48 or 72 weeks of therapy (this is a still-ongoing trial). Results: A total of 150 of 516 patients (29%) had an RVR, 143 of whom completed 24 weeks of treatment. Younger patients, leaner patients, and those with an HCV RNA level ≤400,000 IU/mL and HCV genotype 4 infection were more likely to achieve an RVR; however, among patients with an RVR, no baseline factor predicted SVR. The SVR rate was 80.4% (115/143; 95% confidence interval [CI], 72.9–86.6) in patients who completed 24 weeks of treatment. The SVR rate was 86.7% (26/30; 95% CI, 69.3%–96.2%) in patients infected with genotype 4 and 78.8% in those infected with genotype 1 (89/113; 95% CI, 70.1%–85.9%; intent to treat: 89/120; 74.2%; 65.4–81.7%). Treatment was well tolerated. Conclusions: 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.”

http://www.gastrojournal.org/article/S0016-5085(08)00656-2/abstract

Be sure to discuss all your options throughly with your treating physician--

Bill

[Bill1954]

Hey, you finally got started, huh? Good or you.

Boy, I believe you’ll still be doing 48 weeks of treatment. However, you might want to speak with your doctor, given your stats.

If you were treating in the E.U., I think their protocol would only require 24 weeks Tx; this changed in 2007, I think. We haven’t adopted this in the states yet.

I don’t have the supporting study handy; perhaps one of our European members will step up and offer something for you, or you can play with Google and locate it yourself.

Best of luck; let us know how things go,

Bill

[copyman]

I'm sure there will be mixed feelings on this but you fit the criteria of someone that could stop at 24 weeks. If you remain undetectable throughout tx you could stop at 24 weeks. Studies have shown that stopping at 24 weeks has almost the same chance as someone treating 48 weeks. With only a 2% difference in SVR according to one study that I read. Less time for these harsh drugs to damage the body.

I personally would treat for 24 weeks then taper off the meds for 4 more weeks ending at 28 weeks. Of course I would do PCR's more frequent, 4,8,12,16 & 24 weeks.

If by some chance I relapsed then I would treat again when the new drugs come out.

Good luck with whatever you decide to do.