Is shorter treatment possible in geno 1's

[mom4two]

I have a question that I haven't heard anybody comment on.  Has any geno 1's that have gone undetected at week 4 stop tx early and remained undetectable.  I'm considering tx and the thought of 48 weeks of tx just doesn't seem possible.  I read this article

http://www.hivandhepatitis.com/2005icr/aasld/docs/111405_h.html

It suggust that if you're a "super-responder" you may only need to tx for 24 weeks.  Now I don't know if I will be a "super-responder" but it appears that 20% of the patients were.  I think I would try it for the 4 weeks to determine weather I was in that catigory,  I don't know what makes somebody a super-responder, but I am female,low vl, and not a heavy drinker so I figure I have as much of a chance as anybody. I do see that the pcr that was used wasn't the most sensitive( which of course I would request)but I would like anybody else's insight on the topic

[GoofyDad]

My understandng is the TMA requires extra mixing and the processing lab out here waits for the next earthquake to shake things up before processing the sample. As you say - that can take up to a week.

Didn't expect to find you up!

[jmjm530]

Not "up"...just got up. LOL. Hopefully, I'll be back to sleep soon.

-- Jim

[GoofyDad]

We pass like heppers in the night....

Have a look at the 'Short Term Treatment.....' paper posted in the <a href="http://www.medhelp.org/perl6/hepatitis/messages/39713.html">News Sstories and Other Posts</a> thread.

Here are a couple mildly disturbing nuggets:

<i>
In conclusion, the authors write, "In HCV-2 or -3, the HCV RNA status after 4 weeks of therapy may guide treatment duration. Short treatment duration is effective in both HCV-2 and -3 patients with RVR, <b>but those with severe fibrosis are less likely to experience both RVR and SVR, and more frequently relapse off therapy.</b>"

Virologic relapse was observed in 29/274 RVR patients (10.6%), and was more frequently observed among those with low ALT levels (14% vs 5%), high viremia (14% vs 6%), and severe fibrosis (18% vs 8%).
</i>

[jmjm530]

Gooof quorted: In conclusion, the authors write, "In HCV-2 or -3, the HCV RNA status after 4 weeks of therapy may guide treatment duration. Short treatment duration is effective in both HCV-2 and -3 patients with RVR, but those with severe fibrosis are less likely to experience both RVR and SVR, and more frequently relapse off therapy."
----------------------

As often happens with the medical papers -- especially the abstracts -- the writing is confusing -- so really don't know what to make of it.

Do they mean that those with severe fibrosis are less likely to experience both RVR and SVR and have more frequent relapses -- because certainly that makes sense as severe fibrosis is a negative pre-tx predictor of SVR. Or, do they mean that those with severe fibrosis *who experience RVR* are less likely to experience SVR, etc. BIG difference.

Guess you gotta go fork over ten bucks or so, read the complete study, or go buy a case of beer instead. Oopps. forget the beer for now.

-- Jim

[GoofyDad]

Sat night & I just knocked out my first case, better not drive till tomorrow. Who am I kidding - I had a spicy fish taco last night & would not order a bottle of non-alcoholic beer. I was like - how pathetic is this???

Looks like RVRs w/o severe fibrosis had 8% replaspe vs. 18% for those w/ severe fibrosis. I don't think the sample is big enough to read much into that - a couple extra relapsers is all it would take.

Looks to me though like RVR removes maybe half the stigma of adv. fibrosis - which ain't all that bad.  A big black mark pales to a muted shade of grey.

[jmjm530]

Good point on "muted shade of grey" or as we liked to say in the 60's to use the words of Procal Harum "A lighter shade of Pale" :)

Still, after re-reading the abstract, I can't tell for sure if the fibrosis was a pre-tx predictor or included with the RVR group. BTW , they also list "low ALT" as a neg predictor. I've seen this before but on its face doesn't seem to make sense?

-- Jim