Good news?

[applebook]

My initial viral load genotype 4 is 2280 IU/mL ( no treatment yet).
Is having such a low initial viral load good news or bad news?


should i start the 6 month treatment course now or wait and do another test after a couple of months?

[applebook]

Most likely i had it for years( 20 years or more) however i just found out about it accidentally when i did a regular blood test.

[Bill1954]

A viral load of 2280 IU/mL is quite low; it doesn’t sound as if the virus is well established. Is there any possibility that this is an acute case? Have you been diagnosed with Chronic HCV? Just wondering—

Bill

[jmjm530]

If you've decided to treat already then I'd jump on it right away assuming your viral load is really that low. Anything under 400,000 IU/ml is considered low and studies suggest a better chance of successful treatment along with the option to only treat for six months assuming you are UND by week 4. At least for  genotype 1's but you could check this out for geno 4's as well. On the other hand if you're basing treatment on how much liver damage you have then you should biopsy first. Ordinarily I'd recommend a biopsy in either case but a viral load that low seems almost a gift for someone who already made up their mind to treat. Of course run this all by a good liver specialist.

-- Jim

[zazza]

Here is another abstract with a somewhat different result:

http://www.kenes.com/easl2009/Posters/Abstract512.htm

INSULIN RESISTANCE AND GEOGRAPHICAL ORIGIN ARE MAJOR PREDICTORS OF LIVER FIBROSIS AND RESPONSE TO PEGYLATED INTERFERON AND RIBAVIRIN IN GENOTYPE 4 CHRONIC HEPATITIS C PATIENTS

"SVR was achieved in 54 patients (55%), and was more frequent in Egyptians (62%) than in Caucasians (50%) or Africans (45%). By univariate analysis, SVR was associated with HOMA < 2, serum HCV RNA level < 600 000 IU/mL, and non severe fibrosis. By logistic regression, HOMA < 2 (p=0.007, OR=4.7, CI=1.5-14.7), Serum HCV-RNA level < 600 000 IU/mL (p=0.044, OR=2.9, CI=1.0-8.4) and non severe fibrosis (p=0.042, OR=3.2, CI=1.0-10.2) were independently associated with SVR.
Conclusion: Insulin resistance and geographical origin are major predictors of liver fibrosis and response to Pegylated Interferon and Ribavirin in HCV-4 patients."

[nygirl7]

No but that is very very interesting reading - I still believe in taking every single odd on my side that I can...since numbers are fluid and really dont mean squat when it comes down to person to person and you being the one who succeeds vs. the one who does not. I still think it's all about that RVR personally and not the baseline VL at all - although there sure are no guarantees.  a 13% decrease is a big deal if you are starting out talking only 50% of people do get SVR.

No I have no idea what it could mean at all - type 2 error but that info is very interesting.

[zazza]

Here is an interesting abstract about geno 4:

IMPACT OF ETHNICITY ON VIRAL KINETICS AND SUSTAINED VIROLOGICAL RESPONSE RATES OF GENOTYPE 4, CHRONIC HEPATITIS C PATIENTS TREATED WITH PEG-INTERFERON-A2A PLUS RIBAVIRIN

http://www.kenes.com/easl2009/Posters/Abstract487.htm

"Overall, 43.5% of patients exhibited SVR, 42.6% were non-responders and 13.9% were relapsers. EVR was observed in 40.74% and LVR in 59.25% of them."

The SVR rate is similar to geno 1s, but the non-responder group is larger. I would say this is why geno 4s treat like geno 1s.

[zazza]

http://www.kenes.com/easl2009/Posters/Abstract477.htm

This is the link to the abstract I talked about above, "SHORTENED COURSE OF THERAPY FOR CHRONIC HEPATITIS C GENOTYPE 1 (G1) PATIENTS DEVELOPING RAPID VIROLOGICAL RESPONSE (RVR): META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS (RCTS)".

"Conclusion: In G1 patients who develop RVR, a shortened course of PEG-IFN plus RBV therapy of 24 weeks is associated with a 13% significant decrease in SVR compared to 48 weeks. When restricted to patients with low baseline viral load, the rate of SVR was no longer significant despite a 5% increase in SVR in patients treated for 48 weeks, probably because of a type 2 error. Those results suggest maintaining a 48-week course of treatment in genotype 1 patients with RVR, even with low baseline viral load to maximize the probability of SVR."

Hmm, what is a "type 2 error"? Does anyone know?

[nygirl7]

Ditto to everything my friend Zazza said above.

A geno 4 is similar to a geno 1 - therefore I'd get the biopsy and see where I stood.  

[zazza]

Have you had a biopsy done? The result from a biopsy would likely influence your decision whether to treat now or wait for the new drugs coming, hopefully in 2011. Having said that, with such a low baseline viral load I would be very tempted to treat right away and see if I hit that RVR.

[zazza]

You must have missed my answer to you in your other thread. I will repeat it here:

"Is this your pre-treatment viral load? Having a low baseline viral load increases your chance of SVR (sustained viral response). You also have a much greater chance of becoming RVR (rapid viral response), ie undetectable by week 4.

You can read more about low baseline viral load here:

http://www.natap.org/2007/EASL/EASL_41.htm"

2280 IU/mL is an incredibly good baseline viral load. It should give you a very good chance of clearing.

I am wondering a bit though why you are talking about a 6 month treatment and not a 48 week treatment. Genotype 4 usually treats for 48 weeks just like geno 1s, if I am not mistaken.

I do know that geno 1 rapid viral responders (UND by week 4) with a low baseline viral load are in some countries offered to do only 24 weeks. However, I read a study abstract from EASL (European Association for the Study of the Liver) 2009 which said that 48 weeks for these patients does give a couple of percentages higher SVR rate. When I treated with a low baseline viral load I was only going to treat for 24 weeks if I became RVR. I don't think I would risk that today, but then your baseline viral load is much lower than mine was.