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How long to wait to re-treat? Post TX PCR.
Feeling very positive finishing my 2nd week without Peg and my first without riba -- but being the pro-active soul I am, a couple of questions:
(1) Some of you like Calio, have jumped right back on the treatment bandwagon within days/weeks of relapse. Goofy, I believe has indicated he'd do the same thing in case of relapse.
Others, have indicated their doctors wanted them to rest/heal like 6-months or so before re-treating, as mine once suggested.
First, for all those who re-treated, how long did you treat and how long did you wait before re-treating, and what logic if any did your doctor give you?
And related, did any of your doctors discuss in detail the why's or why nots of re-treating sooner or later. I ask this second part because one way of looking at it is to hit it hard again before the virus has time to get strong. Another way, is to take a rest and let the immune system get strong before re-treating.
(2) So when exactly is the 4-week post-tx PCR/TMA?
When we count our treating weeks, we start with the Peg shot. So our treating week 4 PCR would be the day before our 5th shot. I'm assuming it works similar post treatment, except the difference is post tx we already start with drugs in our system. So do you start counting from the day of your last shot. Or, do you start counting from the day of your last riba?
Here's my example. Last shot Wed March 8th. Last Riba Wed March 15th. I therefore think my week 4 PCR/TMA should be Tuesday April 4th. But counting from last riba would make it April 11th. Any input welcome.
Thanks.
-- Jim
(1) Some of you like Calio, have jumped right back on the treatment bandwagon within days/weeks of relapse. Goofy, I believe has indicated he'd do the same thing in case of relapse.
Others, have indicated their doctors wanted them to rest/heal like 6-months or so before re-treating, as mine once suggested.
First, for all those who re-treated, how long did you treat and how long did you wait before re-treating, and what logic if any did your doctor give you?
And related, did any of your doctors discuss in detail the why's or why nots of re-treating sooner or later. I ask this second part because one way of looking at it is to hit it hard again before the virus has time to get strong. Another way, is to take a rest and let the immune system get strong before re-treating.
(2) So when exactly is the 4-week post-tx PCR/TMA?
When we count our treating weeks, we start with the Peg shot. So our treating week 4 PCR would be the day before our 5th shot. I'm assuming it works similar post treatment, except the difference is post tx we already start with drugs in our system. So do you start counting from the day of your last shot. Or, do you start counting from the day of your last riba?
Here's my example. Last shot Wed March 8th. Last Riba Wed March 15th. I therefore think my week 4 PCR/TMA should be Tuesday April 4th. But counting from last riba would make it April 11th. Any input welcome.
Thanks.
-- Jim
Jim, By my reasoning, the post tx calendar started for me when I stopped the riba - 6 days after last peg shot. Up until that day I was doing the same thing I had for 6 months - on treatment.
Anyone one care to speculate as to when the majority of relapses could first be detected? I'll probably test around the 3-4 week mark, but I'm trying to pin it down some. Also, I would guess that a TMA would be overkill, a Qual. PCR should be sensitive enough. Of course I'll continue testing at 3, 6, 12 mos.
I just realized I went into post tx without switching my toothbrush - oh the horor! The drug store was out of my sonicare replacement heads on a couple visits, so it seems I was using the same one through a number of months of Un-D - and into post tx. Is reinfection through personal toothbrush a real possibility?
Anyone one care to speculate as to when the majority of relapses could first be detected? I'll probably test around the 3-4 week mark, but I'm trying to pin it down some. Also, I would guess that a TMA would be overkill, a Qual. PCR should be sensitive enough. Of course I'll continue testing at 3, 6, 12 mos.
I just realized I went into post tx without switching my toothbrush - oh the horor! The drug store was out of my sonicare replacement heads on a couple visits, so it seems I was using the same one through a number of months of Un-D - and into post tx. Is reinfection through personal toothbrush a real possibility?
If you have a callendar handy -- so you're suggesting (see my first post) then that my 4-week PCR/TMA would be on April 11th or the 7th?
I'll speculate that most relapses happen pretty fast -- like within two weeks. Makes sense since the 4-week test is supposedly 90% accurate. My doc wants me to have a two-week post tx- PCR/TMA which is like tomorrow (or is it next week) eeks. LOL.
Regarding the type of test, it can get confusing differentiating between qualitative/tma/PCR when tests like Heptimax, for example, are combinations.
Conceptually, what you want post-tx is the most sensitve test available. Traditionally that used to be a qualitative (you're either positive or negative) -- but now, with Heptimax, you can get similar <5 IU/ml sensitivity and also get a number should you be positive. I believe Dr. Gish has written on this in Projects in Knowledge.
Lastly, you mentioned earlier you would re-treat in event of relapse. Did you discuss with your doctor how long you would wait from relapse to re-treatment? For me, it's not so much wanting to get it over with quickly in the event of a relapse, but the question of whether or not it's better for future SVR. Calio's doctor apparently thinks so.
Hope you're starting to feel better. My own fighting/proactive self is starting to emerge again, and that's why all these questions. I think the more you learn about/plot the future, the less scary it becomes. I'm sure you understand what I mean about thinking ahead, because I remember your post a couple of months ago on mainteance for fibrosis, SVR or not
-- Jim
I'll speculate that most relapses happen pretty fast -- like within two weeks. Makes sense since the 4-week test is supposedly 90% accurate. My doc wants me to have a two-week post tx- PCR/TMA which is like tomorrow (or is it next week) eeks. LOL.
Regarding the type of test, it can get confusing differentiating between qualitative/tma/PCR when tests like Heptimax, for example, are combinations.
Conceptually, what you want post-tx is the most sensitve test available. Traditionally that used to be a qualitative (you're either positive or negative) -- but now, with Heptimax, you can get similar <5 IU/ml sensitivity and also get a number should you be positive. I believe Dr. Gish has written on this in Projects in Knowledge.
Lastly, you mentioned earlier you would re-treat in event of relapse. Did you discuss with your doctor how long you would wait from relapse to re-treatment? For me, it's not so much wanting to get it over with quickly in the event of a relapse, but the question of whether or not it's better for future SVR. Calio's doctor apparently thinks so.
Hope you're starting to feel better. My own fighting/proactive self is starting to emerge again, and that's why all these questions. I think the more you learn about/plot the future, the less scary it becomes. I'm sure you understand what I mean about thinking ahead, because I remember your post a couple of months ago on mainteance for fibrosis, SVR or not
-- Jim
If you want to pinpoint the date at which the meds cease to cause viral suppression,I would suggest that they wind down rapidly i.e 72 hours after the last shot.
Riba will persist in the system but as a mono-therapy it has no direct effect on viral replication.As you know it is believed to corrupt the normal mutational activity .
Riba is more important in the initial weeks,and less so after 'clearance'.
All the above is just my opinion of course,it's not gospel.
I took last Riba with last shot,and did not do another week.
Mind you with hgb at 8.5 I had had enough!
When I re-treated at 40,000 it was my call,and the doctor said he could understand why I wanted to.
If you do have a worst case scenario,I would see if if there had been histological improvement before rushing back onto the combo.
Remember Vertex 950 is only 4 years away-in fact it's always 3-4 years away ,and always will be!!!!!!!!!(just kidding I hope)
I finished 48 weeks a week ago,yet still feel compelled to check out the forum and all things HVC.
If either of us had any sense we would abstain from all of it until PCR time comes around.
I haven't had a drink for four years,until last night when,with medical approval I had two small beers-strangely disappointing!
Riba will persist in the system but as a mono-therapy it has no direct effect on viral replication.As you know it is believed to corrupt the normal mutational activity .
Riba is more important in the initial weeks,and less so after 'clearance'.
All the above is just my opinion of course,it's not gospel.
I took last Riba with last shot,and did not do another week.
Mind you with hgb at 8.5 I had had enough!
When I re-treated at 40,000 it was my call,and the doctor said he could understand why I wanted to.
If you do have a worst case scenario,I would see if if there had been histological improvement before rushing back onto the combo.
Remember Vertex 950 is only 4 years away-in fact it's always 3-4 years away ,and always will be!!!!!!!!!(just kidding I hope)
I finished 48 weeks a week ago,yet still feel compelled to check out the forum and all things HVC.
If either of us had any sense we would abstain from all of it until PCR time comes around.
I haven't had a drink for four years,until last night when,with medical approval I had two small beers-strangely disappointing!
HCA: Remember Vertex 950 is only 4 years away-in fact it's always 3-4 years away...
LOL. Funniest thing I've heard in a long time. Not sure though as a stage 3 (biopsy 3 years ago) if I have 3-4 years to wait. Hopefully Vertex will start trials soon for non-responders.
HCA:I haven't had a drink for four years,until last night when,with medical approval I had two small beers-strangely disappointing!
Early in tx, I used to think about a Bud Light. However, my taste buds are so shot now, don't even want one. BTW my doc today said something about exercise and red wine to boost my HDL cholesterol after SVR. I took a double-take. But apparently he doesn't have a problem with moderate drinking after SVR.
I also asked him if he believed SVR meant the virus (replicating part anyway) was totally gone or that the immune system simply has been trained to repress the virus. He said, no, SVR means the replicating virus is gone. In other words, something like drinking -- while in excess it might hurt the liver -- theoretically can't bring back on the virus cause in his opinion it no longer exists. I found that comforting because who wants to rely on our failing immune systems. LOL.
-- Jim
LOL. Funniest thing I've heard in a long time. Not sure though as a stage 3 (biopsy 3 years ago) if I have 3-4 years to wait. Hopefully Vertex will start trials soon for non-responders.
HCA:I haven't had a drink for four years,until last night when,with medical approval I had two small beers-strangely disappointing!
Early in tx, I used to think about a Bud Light. However, my taste buds are so shot now, don't even want one. BTW my doc today said something about exercise and red wine to boost my HDL cholesterol after SVR. I took a double-take. But apparently he doesn't have a problem with moderate drinking after SVR.
I also asked him if he believed SVR meant the virus (replicating part anyway) was totally gone or that the immune system simply has been trained to repress the virus. He said, no, SVR means the replicating virus is gone. In other words, something like drinking -- while in excess it might hurt the liver -- theoretically can't bring back on the virus cause in his opinion it no longer exists. I found that comforting because who wants to rely on our failing immune systems. LOL.
-- Jim
You could always set up an ALT test for this Friday and see what that says. If the virus is still around, it would be making a big effort to reassert itself and your ALT would probbaly show it.
Maybe you should just go the pound this weekend and adopt a dog. That'll get your mind off the hep.
Everyone talks about the 50/50 chance for geno 1, but I would imagine that for every 100 geno 1's that start tx. . . .
-15 cannot stand the meds and quit tx.
-20 have a tough strain of the virus and just barely get a 2-log drop at 12 weeks.
- 10 get little benefit from the meds and are taken off.
- 10 are not compliant with their meds.
- 5 supplement their tx with bonded bourbon, or, in a pinch, fortified wine.
That in itself would cover the 50% who are not cured. Not scientific, but something to think about.
Now take the other extreme. You were clear at 6 weeks into tx. That is phenomenal for genotype 1. One could say that you were a super-responder. I do not know if you got a vl test prior to 6 weeks. if you didn;t, how do you know you were not clear at week 4? Or week 2? Remember that my 4 week PCR was undetectable. I don't think that virus disappeared on the morning of the blood draw. My feeling is that I had cleared it by the end of the first week.
Furthermore, you did 48 weeks of treatment after your UND. Do you really think that any virions could have hidden and survived that onslaught?
Just tell yourself that failure is unacceptable. I did that with the bar exam and with tx. Worked like a charm both times.
As for the dogs, I'd suggest a German Shepherd.
DJL
Maybe you should just go the pound this weekend and adopt a dog. That'll get your mind off the hep.
Everyone talks about the 50/50 chance for geno 1, but I would imagine that for every 100 geno 1's that start tx. . . .
-15 cannot stand the meds and quit tx.
-20 have a tough strain of the virus and just barely get a 2-log drop at 12 weeks.
- 10 get little benefit from the meds and are taken off.
- 10 are not compliant with their meds.
- 5 supplement their tx with bonded bourbon, or, in a pinch, fortified wine.
That in itself would cover the 50% who are not cured. Not scientific, but something to think about.
Now take the other extreme. You were clear at 6 weeks into tx. That is phenomenal for genotype 1. One could say that you were a super-responder. I do not know if you got a vl test prior to 6 weeks. if you didn;t, how do you know you were not clear at week 4? Or week 2? Remember that my 4 week PCR was undetectable. I don't think that virus disappeared on the morning of the blood draw. My feeling is that I had cleared it by the end of the first week.
Furthermore, you did 48 weeks of treatment after your UND. Do you really think that any virions could have hidden and survived that onslaught?
Just tell yourself that failure is unacceptable. I did that with the bar exam and with tx. Worked like a charm both times.
As for the dogs, I'd suggest a German Shepherd.
DJL
In order for you to have re-infected via your toothbrush you would
a) Have to secreted blood from your gums to the brush.
b) Mixed the infected traces back into your bloodstream,only possible if you have bleeding gums.RNA is not carried by a froth of saliva and toothpaste- just blood.Blood to blood is the only means of transmission.
c)The virus cannot replicate on a toothbrush,unless it's a special one with human or chimpanzee liver cells- it can survive tho'.I think it's a few days under lab conditions.
d)As you only used the brush head post n/d I feel safe in saying the chances of you having re-infected yourself are so remote as to be not even worth thinking about.
a) Have to secreted blood from your gums to the brush.
b) Mixed the infected traces back into your bloodstream,only possible if you have bleeding gums.RNA is not carried by a froth of saliva and toothpaste- just blood.Blood to blood is the only means of transmission.
c)The virus cannot replicate on a toothbrush,unless it's a special one with human or chimpanzee liver cells- it can survive tho'.I think it's a few days under lab conditions.
d)As you only used the brush head post n/d I feel safe in saying the chances of you having re-infected yourself are so remote as to be not even worth thinking about.
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