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HCV RNA below 15 IU/ml
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HCV RNA below 15 IU/ml

I'm a 52 yr old female recently diagnosed  with genotype 3.  My viral load before tx was 1,130,000.  At week 4 of interferon and RBV, my tests came back detected, but too low to calculate.  I am very relieved that tx seems to be effective.  But was just wondering if anyone has similar results and gone on to clear it.
My blood work is low and had to reduce my RNV, but still on a high dose1200mg, and added Eprex to fix blood counts, there're all out of wack but after 3 wks improving slightly and energy coming back.  
I've lost 10 lbs in 6 weeks,  I weigh now 140, I'm 5'5 so I don't want to loose much more.
I can't help but worry, so would appreciate any support.  It's all new to me and the Internet has become my friend.

Thank you in advance to this forum, glad I found you!
28 Comments Post a Comment
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5720485_tn?1373566655
Sorry typo,  "RNV". Should be RBV, Ribavirin
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1840891_tn?1383280315
Hi Shyrl, and welcome to the forum! I'm not very knowledgeable about genotype 3, but someone who is will probably come along soon. In the meantime I think the answer might be fairly generic. Lots of us had similar treatment results (DET, too low to count) at 4 weeks and went on to achieve SVR. I was higher at week 4: DET, 40, and I went on to become UND at week 8 and stayed that way throughout treatment. I'm now SVR. You will get there too!
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5720485_tn?1373566655
Thank you,  I needed to hear that!  I know it's important to stay positive and I'm trying. I glad I found this forum as I don't have anyone that I know with experience except drs and specialists.   Still waiting for results from Fobroscan and expecting the worst, but hoping. . .
I'm with an excellent hep clinic in Canada, however newer treatments will not be available here as  in U S.  so I opted to just go ahead and start tx.  
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4113881_tn?1401895587
Hello and welcome. I am a genotype 3 as well  who finished 28 weeks of treatment on April 7th 2013.

"At week 4 of interferon and RBV, my tests came back detected, but too low to calculate. "

Do you know what IL28B genotype you are? The reason I ask is because it can be a significant indicator to how you will respond to treatment. If you have not had the test yet I would advise you to ask your treating doctor for it. Its called the Interleukin 28B Genotype test. This test is important for a genotype 3 who did not have an RVR (undetectable at 4 weeks) Although there's not much clinical data on treating genotype 3 patients longer than 24 weeks, many doctors are now doing that if there patients do not have an RVR and have unfavorable IL28B genotypes TT or CT. I am a CT and did not have an RVR so my doctor tried to treat me for 36 weeks however insurance only went for 28. There are other genotype 3's on this forum that are treating longer than the 24 weeks because of this scenario.

"Genotype 3 is a common type of HCV infection, and standard therapy using pegylated interferon (PEG-IFN) and ribavirin (RBV) is quite effective in these patients. While a short course of 16 weeks may result in comparable end of therapy responses, relapse rates are often high. A 24-week course is therefore preferable, and is expected to result in sustained virological response (SVR) rates of more than 70%. The 24-week course is especially recommended in the presence of steatosis (often associated with Genotype 3 infection), fibrosis stage two or more, high BMI and high viral load. In patients who do not achieve a rapid viral response (RVR) with combination therapy, an extended course up to 48 weeks should be considered. While not as definite as for genotype 1 patients, the presence of the CC variant of IL28b could help in the initial prognosis and the need for additional treatment, if an RVR is not achieved. The role of directly acting antiviral agents (DAA) has not been fully evaluated in treatment naïve, non-responders and relapsers in genotype 3 patients. Initial results with the cyclophilin inhibitor Debio-025 are quite encouraging. There is an urgent need for large clinical trials using DAA and host modulators in patients with G3 infection."

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02715.x/full

_________________________________________________________

An IL28B Polymorphism Determines Treatment Response of Hepatitis C Virus Genotype 2 or 3 Patients Who Do Not Achieve a Rapid Virologic Response

Results

The frequencies of the IL-28B genotypes were as follows: CC, 37%; CT, 48%; and TT, 15%; 82% of patients with the CC genotype achieved a sustained virologic response (SVR), compared with 75% with the CT and 58% with the TT genotypes (P = .0046). 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 (>70% for all IL-28B genotypes). In a multivariable logistic regression model, IL-28B genotype predicted SVR (odds ratio, 1.76; 95% confidence interval, 1.16–2.7).
Conclusions

An IL-28B polymorphism was associated with an SVR in patients infected with genotype 2/3 HCV who did not achieve a RVR. Analysis of IL-28B genotype might be used to guide treatment for these patients.

http://www.gastrojournal.org/article/S0016-5085%2810%2900841-3/abstract
_______________________________________________________

Impact of IL28B-Related Single Nucleotide Polymorphisms on Liver Histopathology in Chronic Hepatitis C Genotype 2 and 3

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029370
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4113881_tn?1401895587
Treatment of patients with genotype 3 chronic hepatitis C- current and future therapies

"In patients who received 24 weeks of antiviral treatment, the probability of achieving an SVR in those who did not achieve an RVR, was higher in those with the CC allele (74%) than with the CT (59%) or TT alleles (29%). Mangia et al. [21] reported that IL28B influenced treatment outcome in patients who did not achieve an RVR, with SVR rates of 29%, 67% and 87% in patients carrying the TT, CT or CC alleles at rs12979860 respectively. "

http://hepatitiscresearchandnewsupdates.blogspot.ca/2012/01/treatment-of-patients-with-genotype-3.html#.UdcYTG0gvFK
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Avatar_m_tn
I find your posts interesting........

Will
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4113881_tn?1401895587
"But was just wondering if anyone has similar results and gone on to clear it. "

There are some G3's on the forum who were not RVR and still went on to SVR. (Hopefully I will be one of them)


"My blood work is low and had to reduce my RNV, but still on a high dose1200mg"..."I weigh now 140, I'm 5'5 "

If Im correct, 140lbs is 63.5 kg  and for G3's 61 to 65 kg, the dose of Ribavirin is 400 mg orally twice a day based on that weight. If you weigh 189.6 to 231.49 lbs (86 to 105 kg) you would be taking Ribavirin 600 mg orally twice a day. So I wouldn't worry about your doc reducing the dose.
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4705307_tn?1408435812
Again welcome to the forum, I too am a G3. Currently I am at the end of week 31 of a 48 tx plan. I did not achieve an RVR, My VL was 130 or log 2.114 at week 4 and UND at week 12. ActingBrandNew has lead you to a lot of good information, if your anything like me it'll take a while to make sense, not to worry you'll be alright.
I have been very fortunate, so far my blood work has been pretty solid, although I have dropped 40lbs in 31 weeks, not that I wanted to but what the heck, now I weight as much as I did in H.S. 37 years ago. Seems there aren't many of us here on this forum. Not sure why but that's not important.
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5720485_tn?1373566655
Thank you ActingbrandNew,
for the info, wow I will have to find out what IL28b genotype  that I am.  I did not realize that this also pertained to genotype3.  And thanks for deciphering the results for me.  I read the study, however I was going to read it again to be sure I'm interpreting it correctly. CC being the more favorable type.  But I will just deal with whatever I have to.  
I've probably had this for 25 yrs, and what reading I have done and my hep nurse tells me my genotype is more difficult to treat than G2, at this point, hence the high dose RBV.  Thank goodness for that!  
Now I'm set for 24 weeks, and I guess that could be adjusted to longer tx if my dr feels nescesarry.  

I don't know if my results mean that I have had a rapid response RVR.  Or if RVR only applies only to undetected.  
I'm so glad I found this forum and thank you for the info.  
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5720485_tn?1373566655
And best wishes for SVR, I'm sure even the extra 4 weeks makes a difference.  As well I'm unsure if I'll be covered for extended treatment. Lol oh man.   I have to 1,000 per quarter as is, before my drugs are covered, so it's draining financially.
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5720485_tn?1373566655
Thank you also Timothy 141 for your support, it brings tears to my eyes as I was feeling so alone and now I feel like I can also provide some small support for others like myself.  
Wow oh man I thought 24 weeks was going to be a long time, but I'm really hoping that your treatment plan is successfully.  I'm almost to my high school weight now too,  lol . Never thought that would happen!
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4113881_tn?1401895587
Its my understand that RVR is defined as undetectable HCV RNA at 4 weeks

I started with a VL of 12 million and was undetectable at week 5 and therefore classified as an EVR since I didn't completely clear by week 4. It seems that the IL28B is only relevant to those of us that are G3's who did not achieve and RVR and are either TT or CT. From what Ive read, your right in that the CC would be the more favorable either way...RVR or not.

My treating doctor told me the IL28B only applied to genotype 1 until I showed him some of the literature. Being as my doc was very easy to deal with, he felt since I was a CT and had Hepatic Steatosis, I maybe would benefit from longer treatment duration. I had a REALLY hard time treating...it was rough and I wanted to stop at week 24 but in the event I relapse...Id always wonder if the extra weeks would have helped.

Im currently waited for my 12 week EOT lab results. They are in however my doc has to sign off on them before I can see them online. Hopefully Im still UND.



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4113881_tn?1401895587
Here is another link that has charts and bar graphs....you have to get passed the HIV/HCV co-infection stuff...I believe it starts on page 5, 6

http://health.usf.edu/NR/rdonlyres/19465342-EE78-4A02-912E-2B19D795691A/0/UpdateontheClinicalCorrelatesofIL28BGenotype.pdf
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5720485_tn?1373566655
Thank you for the links, I can refer them to my doc as well.  And please I'd be interested in hearing your wk 12 results.  
Best wishes,
S
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4705307_tn?1408435812
"My treating doctor told me the IL28B only applied to genotype 1 until I showed him some of the literature."
I know this is nuts, but when I bring that question to the table, whats my IL28B. His only response is, "at this point it is irrelevant." He states to me it really has no bearing on my Tx at this point. I wonder is that because I am going the full 48 weeks? He has acknowledged the validity of the test, for some but not me.
Confused in Las Vegas.
Tim    
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5720485_tn?1373566655
Hi Timothy141,
I am going to request the test and if necessary i'll put it in writing.  I'm in Canada, so testing is usually covered, but doc are suppose to make sure they are not testing unnecessarily, and wasting tax dollars.  So we'll see what happens.  
What would happen if you requested a test, just to be aware?
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Avatar_m_tn
HI,

i am a Gen 3a also.  Before TX my VL was 7 million plus.  At 4 weeks my VL was @ 1.7 million.  But, @ 12 weeks my VL was undetected.  My Doctor was set on 48 weeks from the beginning because of my stage 2/3 liver, my weight and being 59 years old.  

There is no other tx available yet, so it was easy to decide to except his 48 week call.  Only on week 23 now of 48 weeks.  

I just wanted you to know, that I did not even come close to clearing @ 4 weeks but did clear by week 12.  

The odds are in our favor for SVR.  Please stay in touch.  We will all be pulling for you.

nuhepper

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4113881_tn?1401895587
"I know this is nuts, but when I bring that question to the table, whats my IL28B. His only response is, "at this point it is irrelevant." He states to me it really has no bearing on my Tx at this point. I wonder is that because I am going the full 48 weeks?"

I think it would be safe to assume that. Even if you were CT or TT I dont believe your doctor would go any longer than 48 weeks especially since your treatment naive. The studies Ive read show that the IL28B does directly effect G3's who do not have an RVR. Although they recognize the impact of the IL28B and a G3, theres not much clinical data supporting the idea that longer treatment duration is warranted. The longer treatment duration for a G3 up to this point has usually been based on...

"steatosis (often associated with Genotype 3 infection), fibrosis stage two or more, high BMI and high viral load. In patients who do not achieve a rapid viral response (RVR) with combination therapy, an extended course up to 48 weeks should be considered."

....and those that relapsed after 24 weeks of TX who decided to retreat. The recommendation to treat longer with unfavorable IL28B genotypes is based only on an "idea" that longer treatment duration would benefit the patient.

If I were in your shoes...Id feel comfortable with the 48 weeks of TX.

Its real simple and even a laymen HCV patient can read and understand it...I find it irritating when doctors dont recogni
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4113881_tn?1401895587
Its real simple and even a laymen HCV patient can read and understand it...I find it irritating when doctors dont recognize the fact that the IL28B doesn't only pertain to a G1

"In patients who received 24 weeks of antiviral treatment, the probability of achieving an SVR in those who did not achieve an RVR, was higher in those with the CC allele (74%) than with the CT (59%) or TT alleles (29%). Mangia et al. [21] reported that IL28B influenced treatment outcome in patients who did not achieve an RVR, with SVR rates of 29%, 67% and 87% in patients carrying the TT, CT or CC alleles at rs12979860 respectively. "

http://hepatitiscresearchandnewsupdates.blogspot.ca/2012/01/treatment-of-patients-with-genotype-3.html#.UdcYTG0gvFK
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Avatar_m_tn
I am not sure on this, but what I have found seems to indicate that the IL28B polymorphism predicts  spontaneous clearance of HCV infection and also response to Peg-INF/Riba treatment.

You have dropped 6 log in 4 weeks. I call that RVR.
If you RVR you are responding very well to treatment.

I would not worry too much about if you are CC CT or TT. The drugs are working.

There is always the question as to whether to treat now or wait for a more sure thing.  How sick is chronic HCV making you feel and how will your health decline if you do not treat but wait.

If for some reason you do not SVR, there are several DAA's around the corner that will cure.

If I were in your shoes I would continue on with the treatment and not worry too much about IL28B.

Best wishes.
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4113881_tn?1401895587
A rapid virologic response, or RVR, is defined as an undetectable HCV RNA at week 4

http://depts.washington.edu/hepstudy/hepC/mgmt/viroresponse/discussion.html
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Avatar_m_tn
I have to admit ActingBrandNew is correct.
The patient only dropped 5 Log, some virus was still detected but it was below the limit of quantification. What's that limit, about 15 IU/mL or so?

I think things still look pretty good.



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5720485_tn?1373566655
Yes Cheesegrater,
I was so happy when I found out that I was responding so well to treatment. I was so relieved, I cried.

I am on a high dose RBV, was 1400 for first three weeks, had to reduce to 1200.  I am confident in my hep dr and nurses experience, as they hit my virus with high dose because G3 is harder to treat, but I do want to investigate further the IL28B gene.   Knowledge is power. Maybe they are aware of studies already. . . However i now want to know.

And I cant thank ABN enough for bringing this to my attention.  

I want to do whatever I have to or can do this first time and hopefully only time.
Still waiting on liver results.
S
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5720485_tn?1373566655
Well I just found out that they don't test for IL28B in Canada.  Only used for research. Disappointing.
S
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148588_tn?1407125204
Cambridge isn't that far from Buffalo, NY. in fact, I used to drive that far every week while txing. and would have, if that kind of info had been available back in the day. Last I heard, the test was about $300 but may have gone down. It doesn't even need to be a blood draw. A swab of the inside of your cheek is all that's necessary.

You're correct: "Knowledge is power."
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5720485_tn?1373566655
thinking I will make some phone calls, find out if I need a US doc to order. . .
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Avatar_m_tn
IL28B has been shown only important when using interferon-Riba.

The more modern (last year or 2, maybe older) Direct Acting Antivirals have been shown be just as effective for all IL28B polymorphs, or in other words, it won't matter if you are CC/CT/TT on the newer drugs.

Let's hope you do not need to try again after this bout!

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5720485_tn?1373566655
As far as I can tell though the odds do not improve for genotype 3 unless DAA added to Intf & Ribba. Anyway I sit here in Canada waiting for approvals in US then more waiting for approvals by Health Canada. . . Slow. . . Oh man, hence my decision to procede now with treatment.  
Yes praying for good results for myself, and knowing that better tx on the horizon!
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