I need everyones advice

I received my 21 week VRL test today and it is at 76 copies down from 37 million.  I'm 1A and last month I was at 516 VRL.  My doctor agreed to 72 weeks if necessary but I'm not sure its worth cotinuing because my strain seems so virulent and won't leave my system.  Should I push on or give up guys?  Also, anyone in here approved for 72 weeks and if so how hard was it to get approval for it through your insurance company?

[BJ1fish]

I am tx for 72 weeks and had no problems with insurance.

[KAMO]

I'm currently watching a relative die of liver cancer so I wouldn't give up.  I would do whatever I could to try and beat this virus.  It's got to be better than what she's and us, her family is going through.

[KAMO]

I'm currently watching a relative die of liver cancer so I wouldn't give up.  I would do whatever I could to try and beat this virus.  It's got to be better than what she's and us, her family is going through.

[DoubleDose]

ABSOLUTELY!!!!!

You have come a long way as far as VL reduction, and by older tests you would be considered undetected right now!!!

You need to be undetected by week 24, to be a good candidate for the extended tx.....so make completely sure you are doing the FULL interferon dose each time (or more, if there is additional left in the syringe!), and also doing the maximum ribavirin your body can handle.  If your red blood count (RBC) is not down near 10.0, you might be an under-assimilator of Ribavirin, and may in fact need a higher dosage to get the intended effect.  (discuss this recent concept, and strategy with your doctor!)

I also got undetected late, and did the 72 week course, and am SVR for almost three years now!  DO NOT QUIT at this point.  If you can indeed get undetected at the 24 week point, then you have pretty good odds that if you go to 72 weeks....AT FULL DOSAGES, of course, that you will become SVR.  

This is serious business, and getting cured is never easy, but you really do have a good shot at it.  Do not take it lightly, or back away because it is difficult...you will really regret it if you do.

Go for the 'brass ring' when it is presented to you, and give it your very best effort.  There are many adjunct medications your doctor can prescribe for the ongoing issues....anti-depressants, red cell boosters, white cell boosters, sleeping aids, pain relief medications, etc. etc.  You just have to work through the tx, one week at a time.

Again, the very most important priority right now is getting FULLY undetected in three weeks.  You are just a tiny 'hair' away from that status!  Keep the meds UP as high as you can, and get it done.

One more question:  What was your viral load at week #12 ?

This will also shed some light on your situation.

Good Luck!  Stay Strong!!!

DoubleDose

[Kalio1]

I vote for you to keep going too. You just about got to UND now. You have a lot invested already, I hope your insurance cooperates. Your doctor can help you and pressure them to let you keep going. If they wont maybe you could get ommitment to Care to help out? Worth a call anyway, here is their #
800 521 7157. Hang in there, you just about got rid of them now, wow down from 37 mil that's great.

[tulsatime]

I agree with double dose. Keep going, you are almost there!! Good luck, kick that dragon's butt!  Debi

[Bill1954]

Have you had a biopsy and if so, what is your stage of fibrosis?

[goldyn]

As long as your handeling the meds ok , i would say go for it you have knocked out a whopper full it wont be long before your unde.....

[mycoldfeet]

I'm on 72 wk afer relapsing after 48wks and if your insurance co, gives you trouble, contact Pegasys and your
Dr. They gave me problems saying 48wks is the fda standard, sorry, but give Pegasys and your Dr. the denial letter from your insurance co. From that point on it's between them, but in 4 days I was approved by Pegasys for free meds if my insurance doesn't pay the number is on the site. Good luck I'm on shot 4 of 72. long way to go, but glad to do it.

[Mister beagle bailey]

YES,go the 72 weeks, their are many here doing just that.  Even being a 1A you can be cured, others have done it.  Keep the faith and remember were here for you.

Beagle

[Alady1620]

I would wait until 24 weeks before I made a decision.

One week at a time, my friend.  If you stop and then start over, you'll have lost all the time you already spent.

[Bill1954]

Boy, these decisions are difficult sometimes. In terms of log drop you're doing really well; a 3.42 log drop @ 12 weeks, followed by a 1.88 drop @ 21 weeks. In the big picture, 76 IU is insignificant; except that it's still there now instead of up front where you wanted it.

I would put a lot of weight into how you've been tolerating the meds so far; 21 weeks should be long enough to give you a glimpse into the remaining 51 weeks, should you decide to go that route.

Consider your current liver histology. At stage 3 or 4, there can be two viable endpoints to treatment; SVR is obvious, but improvement in liver architecture might also be considered an acceptable trade-off. Keep in mind that this is still being studied (HALT-C trials, for one), but some patients do seem to achieve a decent histological response.

As mentioned above, I think I would go cautiously forward, look at the 24 week data, and regroup at that point. If your doctor will write the orders, get a very accurate viral assay (<5-10 IU/mL every 28 days after that; if it sneaks back up, I'd consider it a breakthrough, and get away from it.

Anything you can do to hit it hard over the next few weeks would be a bonus as well; ask your doctor if he can get creative with either the Peg or the riba. I myself missed the 2-log drop at 12 weeks by 706 IU; my doctor responded by increasing the riba from the assigned 1200 mg/day to 1800 mg/day, and extended my Tx to 56 weeks. I became undetectable at 20 weeks, and stayed that way for the duration. Although I relapsed within 30 days post-treatment, I know I gave it all I had at the time, and don't regret the effort.

Work with your doctor-- hopefully he has some wisdom to share with you; and after all that's been said above, the *statistical* chances of achieving SVR look rather dismal for you right now-- but statistics are what they are, and your mileage may vary, as they say.

It's a tough decision, and I wish you the best,

Bill

[Bill1954]

I should have said that your statistical chances look dismal for SVR with Standard of Care treatment; once you change out of conventional Tx, the stats can change significantly.

Bill

[DoubleDose]

Your 12 week viral load of 14,000 is well over a 3-Log reduction from your original baseline viral load!!!

I am sure you are aware that just a 2-log viral load reduction at 12 weeks is the milestone that doctors look for to indicate that the therapy has good odds of success.  Your response, being over 3-logs at 12 weeks, means you are a very strong candidate for SVR!  You have surpassed the guideline very handily, and your viral decline curve is pretty steep.  This is a very GOOD sign!

Just remember the 'no dose reduction' rule for at least the next thirty weeks or so.  Sometimes doctors will allow a slight dose reduction (if absolutely necessary) during the last few months of a 72 week course.  The ideal is to keep it at maximum dosage until the very end.

Also, if you do have leeway to 'squeeze out' a little more interferon, it won't hurt anything, and may well push things along.  The ribavirin is also very important to getting the final SVR, and can also be important to the process of getting fully undetected.  Make absolutely sure you are doing the very maximum dose allowed for your weight, and then also check your red blood cell counts.  If they have not decreased into the 10 to 11 range (or lower) you MIGHT just be under-assimilating the riba into your blood, and the new studies are showing that this could be a situation where you would need to use MORE than the standard dose, in order to get the full effect of the drug. Discuss with your doctor.  Google the studies, for support with your doc.

Keep hanging in there, and I really believe you will be CURED.  Go the full 72 weeks, and your odds should be way up there. (if you can get undetected on the 24 week PCR, AND stay undetected until the 72 week stopping point).

We will all be pulling for you!!!  The studies clearly demonstrate that the SVR's are happening frequently for the late responder who goes 72 weeks.  Let us all know how the 24 week goes.  Good Luck!

DoubleDose

[DoubleDose]

Please note Bill's correction:  The standard care of 52 weeks would give you lousy odds of SVR...but, the extended therapy to 72 weeks is a different story, and increase your odds of success tremendously.  Plus the fact that YOU have a pretty steep viral decline curve (you started out with a very high viral load) means you have even better odds!!!  Many late responders have a 'flatter' decline curve, and end up having a harder time completely eradicating the last remnants of the virus.  You obviously clear the virus very effectively....you just had a lot more per ml. to clear.  THAT...is a good sign, in my opinion.

Like Bill said, you can also get a little bit creative with your doctor, and see if you can 'eke out' a 'little bit' more in the dosages.
Preferably with the interferon, which is the viral load reduction 'workhorse', but possibly ALSO with the Ribavirin, IF your red counts are higher than would be expected.  High dosing ribavirin is another strategy that in some studies seems to be increasing the SVR rate.  Just be careful to monitor the hemoglobin regularly, and to intervene with Procrit if necessary.  

The length of extension is the real kicker in late responder cases, and the 72 weeks really makes a huge difference.  You just need that additional time to get all the constantly replicating low-level virus copies...completely.

DD

[Bill1954]

Well put, D-squared!

[St. George]

Thanks for your inspiration. At 12 weeks I was at 14,000.

[NYgirl]

I'm doing 72.  As long as you are clear by 24 go for it! :)

If you aren't clear by 24 the odds go drastically down that you will achieve SVR at any point I believe.

Ask a doctor about this, the odds are very well known.  Both my docs said if I hadn't cleared by 24 they would have taken me off this protocol and started me on another.

If it's not working - perhaps it's not working but there ARE other courses you can try that might knock it out for good!

Don't quit before you get another test ata 24 though cause that is such a low number you can do it!

I didn't clear the 400 stragglers until somewhere BETWEEN 12 and 24 - you can do it too!

[St. George]

Thank You everyone for your support and well wishes