Is viral breakthrough during treatment unusual?

[prettydamscared]

Does anyone know the answer to this?  I'd like to know if there are any studies on this and/or anyone's perception of how often this happens. I've read of it happening to a few posters on this board but, for the most part, don't know a lot about it.  

Thanks in advance for any info or ideas anyone can provide.

[sfbaygirl]

Thanks HR! I never would have guessed that Intent to treat would mean people that stopped tx. Good to have someone around that knows the lingo.

[APKhaos]

In the VX case, the pathway gets the VX molecule locked onto the viron during replication. Virus with the VX inhibitor cannot replicate [or so the theory goes]. VX is a finely pointed spear.

If/when mutations lead to virons that are resistant to the VX molecule, the Inf and Riba are there to sweep them up. Seems that the current expectation is that VX will need to be given in a combo with Inf and maybe Riba to provide the broad sweep up of mutations.

The Prove 2 trial is without Riba. If that shows strong results, then maybe a combo VX & Inf is possible. Its conjecture until the data is available, but a combo without Riba would be a life changer for many treaters.

[sfbaygirl]

Does anyone see my post above? I posted a while ago and I see my name, but not the post. Weird?

I guess I will say it again...My understanding is that if you have an UND at say 12 weeks, and 24 weeks and then a positive VL at 36 weeks you have had a viral breakthough. When you never have an UND you are a non responder.

[chcnme]

Thanks APK.  Yeah that's it!  In a nutshell, or at least how I've understood it (just couldn't remember how to say all of that :)  And on the polymerase end (the poly inhibitors like HCV 796), I think I'm understanding it's doing somewhat the same thing as the protease inhibitors (VX) except it's interfering with the polyermase ...something or another...with the replication, and ... (I'll leave it at that since beyond that point it's too easy to tell I flunked molecular science.)  But yeah, that's it!  Thanks for the explanation.  

I'd read where there is no riba being given in the study (or in some arms) but I've not understood all the arms or the SOC.  I hope you're fortunate enough to be taking no riba at this point! I knew they were projecting the possible exclusion of Riba, which would be fantastic indeed since it's the riba that seems to be so bad for some.

lol sfbgirl. You aren't dreaming or hallucinating, or - if you are - I am too.  I see notes, and then I don't, or I don't see them and suddenly I do. I think it might have something to do with cookies, but I flunked computer too.  I think we should just eat chocolate chip cookies. Yeah :)  

But what you said about UND and no response, yeah - that's what I understand about it, too.

[sfbaygirl]

My understanding is someone who does not get to UND at any point in tx is a non responder or slow responder. Someone who has had an UND at 12 and 24 and then has a VL then has a viral breakthrough.

[sfbaygirl]

What's interesting in this study by Perlman, is that they used difficult to treat geno 1's, African Americans, High fibrosis, etc. They all were given weight based Ribavarin, unlike Berg (800). But it is a small study and needs to have a larger group. Quite a big difference in SVR rates with extending to 72 weeks.