How long to wait to re-treat? Post TX PCR.

[jmjm530]

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

[can-do-man]

HCA said....I don't know why you are planning to retreat,as previously discussed there is a fine chance of SVR-give yourself a break!!
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Just can't stand the thought of no more riba can ya jim? :)

[mikesimon]

You don't need to worry about re-treating Jim. But I treated within a month after relapse. My surgeon was cool with it - he didn't advise me one way or the other. I really don't think it matters much Jim because when I relapsed 3 weeks after stopping TX my VL was 6.8 million and 1 month later my VL was 3.5 million so it varries a good deal after relapse, or so it would seem. I think if you test 3 weeks after your last riba you'll probably see it if things are bad. The virus replicates so rapidly or at least it did in my case. I have to always keep in mind that as a transplant recipient things aren't the same for me as they are for others. But I know a lot of people whose relapse showed up real fast. Still Jim, I think you're gonna be okay and I'm rooting for you pretty damn hard. I wish you the very best outcome - SVR!! Mike

[HCA]

I can help you here,having treated four times.
1)Hitting the virus again quickly whilst it's low did not work for me.
I had a PCR between treatments which curiously showed just 40,000 copies.
I hit again to take advantage and got a partial response only.
This time round the baseline was 1.3m, and it was the only time I became PCR neg.It was two years since last treatment.
Rules don't apply-everyone is a maverick.
The problem with research data is that it is all a smoothed out average.
As individuals we do not emerge at the apex of the data,but somewhere within the wide sweep of results.
I don't know why you are planning to retreat,as previously discussed there is a fine chance of SVR-give yourself a break!!
You've only just finished!!
2)Timing.PEG has a half life of 72 hours,so I would suggest the precise end of the treatment is 4 days after the final shot.
The last Riba is not relevant as plasma will persist long after IFN has left system.The T-Cell attack on the virus will subside as the IFN subsides.
Rgs
Laurence