virus relapsed twice

[drkontham]

May 1988 : Tubectomy

Nov 2003 : Hysterectomy (removal of uterus due to fibroid problem) Ovaries not    
                    removed
Nov 2004 : To Know how she is recovering from post surgery we on our own undergone                      
                    Master Health Checkup at Apollo Hyderbad. Due to high SGPT & SGOT
                     Levels the Doctor advised her to undergo Anti HCV Test.
                    The HCV Quantitative RT-PCR TEST result indicated positive.
                     Undergone Genome test. Identified as Genotype 3A which indicates  
                     Probable 100% cure after treatment.
20.11.2004 Undergone liver biopsy before commencement of treatment.
Impression Chronic hepatitis in HCV + person. Activity3/18 Staging 1/6.

Dec 2004 – : 24 weeks anti HCV treatment undergone at Asian Institute of Gastro
May 2005 :    Enterolgy, Hyderbad .
                       Inerferon injections at weekly intervals for 24 weeks.

10.03.2005:   Mid term review of treatment . HCV Quantitative RT-PCR test report
                      Shown Virus less than detectable levels.

June 2005    HCV Quantitative RT-PCR test shown Virus less than detectable levels.

During the above treatment period CBP, LFT tests are conducted at periodical intervals and the results are within ranges. The doctor advised her to undergo HCV quantitative RT-PCR test at half yearly intervals as follow up process.
17.12.2008 : HCV Quantitative RT-PCR Test Virus count 1,78,800. Identified as
                      Virus relapsed.
Jan 2006-    :24 weeks treatment repeated at Asian Institute of Gastro Enterology (Hyd)
June 2006   : Peg Viraferon Inj once a week. Thymosin Alfa twice a week,
                      Rebettol 2tab per day.
30.08.2006 :   HCV Quantitative RT-PCR Test Virus count less than detectable levels.
During the above treatment period ie Jan to June 2006, CBP, LFT tests are conducted at periodical intervals and the results SGPT, SGOT etc are within ranges.

APR 2007 : HCV Quantitative RT-PCR Test Virus count 1,29,900.
Before leaving Hyderabd for Chennai we met the doctor on the following days  and the following tests are conducted.
25.02.2008 :  LFT SGPT 84u/l (range 0- 40), SGOT 59u/l (range upto40)
                       Direct Bilirubin 0.3 (range upto 0.2)
                      CBP POLYMORPHS 85 (range 40-75), Lymphocytes 10(range 20-45)
                      ULTRASONOGRAPHY OF ABDOMEN(real time screening)
                      Conclusion : FATTY INFILTRATION OF LIVER NO FOCAL LESION
24.04.2008   QUANTITATIVE Real Time PCR:HCV RNA.
                     Sample is positive for HCV RNA and showing 417252 IU/ml
The virus has relapsed . What is the future course of action. Whether any new medicine has been developed for effective treatment. If we do not go for further treatment how long it will take to worsen

[willing]

an important consideration here is "Activity3/18 Staging 1/6" in '04 -ie effectively no damage. Unless there's been significant progression many/most Drs would not advise re-treatment with current drugs. R7128 is estimated to be approved by mid 2013 and with that staging there's little reason not to wait for it. A follow up biopsy and/or a fibroscan exam would  confirm this.

[copyman]

Welcome to the forum. I just wanted to get some facts straight for you.
There is NO 100% cure for genotype 3 or any other genotype for that matter. It is true that it is easier to cure then some other GT's but not 100%.
Actually recent studies show it is not as cureable as once thought. Along with problems from fatty liver, etc.

Good luck

[epiphiny]

Correction: I achieved UND after 28 days of R7128 in combination with SOC.  I then completed a total of 48 weeks of of SOC and achieved SVR (considered a cure) 6 months after the end of treatment.

[epiphiny]

There is a new drug (R7128 or RO5024048 ) in current trials that has proved very succesful for Genotype 3A.  It is probably 3 - 5 years away from being available providing all the trials continue to be succesful.

I myself had Gen 3A and was unresponsive to SOC treatment of Peg Interferon and Ribavirin 5 years ago.  I was on a trial for the new drug and achieved UND after 28 days of the new drug and a total of 48 weeks of SOC.

There is no point in retreating again with SOC unless you do something radically different such as add a new drug to the mix, increase dosage and length of treatment.

You say she was taking only 2 tablets of Rebettol per day.  What strength were the tablets?  It could be that she was under-dosed - this drug is critical in preventing relapse.

Treatment protocols have changed greatly in recent years and Geno 3A is now treated in the same way Geno 1 is, with weightbased dosing.

Another variable factor is the type of tests used and their sensitivities limits.  Those tests have also changed greatly and if she was tested orignally using one of the older tests thats sensitivity only went to <615IU or <50IU and then a more sensitive test such as <15IU was used more recently then it possible she was never undetectable at all back in 2004.

Very confusing for you and noone can really get a  true picture of your past treatment history without all the information.

Can you supply any information regrading the sensitivity of the tests used and what the dosing regimes were?

Epi.