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My HCV count is 44 after 4 weeks - is that good?
What does it mean? The doctor says that's low, very close to undetectable and there's an over 50% chance I'll have SVR after 24 weeks.
I had a viral load test in 2003 before starting rebetron (I was a partial responder) and it was 250,000 and about a year after I relapsed it was 2,400,000. They didn't test it before I started this 24 week Pegatron treatment.
I'm now starting my 7th week. The side effects are not too bad so far except for an annoying itchy rash and small reddish spots covering half my body, including almost my entire back and the back of my neck. When I was on rebetron in 2003, I had the same rash but it was over just a small area on my left buttock.
I had a viral load test in 2003 before starting rebetron (I was a partial responder) and it was 250,000 and about a year after I relapsed it was 2,400,000. They didn't test it before I started this 24 week Pegatron treatment.
I'm now starting my 7th week. The side effects are not too bad so far except for an annoying itchy rash and small reddish spots covering half my body, including almost my entire back and the back of my neck. When I was on rebetron in 2003, I had the same rash but it was over just a small area on my left buttock.
I'm guessing from your post your also on Incivek and geno 1? If so the proper treatment for someone who is not und at week 4 is 48 weeks. You also said they didn't test your viral load before starting this treatment also throws up red flags about your doctor........ Wishing you the best
I'm Genotype 3 and I'm on just the peg and ribavirin.
I'm age 56 and have stage 4 cirrhosis. I've been at stage 4 since my biopsy in 2004 and it hasn't seemed to become any worse (the numbers on the blood tests have been close to the same over the years). I was reluctant to take this treatment since my life is going very well despite the Hep C and cirrhosis (I believe a very careful diet is very important) but the doctor seems convinced it would be a good idea.
The side effects seemed worse on the rebetron back in 2003 (I was more tired all the time) except for the current itchy rash.
I'm age 56 and have stage 4 cirrhosis. I've been at stage 4 since my biopsy in 2004 and it hasn't seemed to become any worse (the numbers on the blood tests have been close to the same over the years). I was reluctant to take this treatment since my life is going very well despite the Hep C and cirrhosis (I believe a very careful diet is very important) but the doctor seems convinced it would be a good idea.
The side effects seemed worse on the rebetron back in 2003 (I was more tired all the time) except for the current itchy rash.
44 is pretty good at 4 weeks if you are on triple med treatment with Incivek. It would be better if you were undetectable, but you still have a good chance (I think 60%) with your 4 week results.
One has to be 999 or less at 4 weeks to continue treatment.
You might want to ask your doc to order another test soon. Usually the next test would be 12 weeks, but since you were detectable at 4 weeks, it might be good to know how soon you become undetectable. I was detectable at 4 weeks ( <43 ) and I was new to the game. My case manager ordered another test for 8 weeks, which was undetectable. Since then, some have said if detectable at 4 weeks, to do the tests maybe every week until you reach undetectable status. Now I wish I had had another test at 5 weeks.
As Can-do said, you will still have to do 48 weeks total (12 weeks Incivek and a total of 48 weeks Inf. and Riba).
(My post is based on the assumption you are on Incivek, Inf., and Riba. if you are on some different regimen, my post won't apply.)
I wish you the best.
One has to be 999 or less at 4 weeks to continue treatment.
You might want to ask your doc to order another test soon. Usually the next test would be 12 weeks, but since you were detectable at 4 weeks, it might be good to know how soon you become undetectable. I was detectable at 4 weeks ( <43 ) and I was new to the game. My case manager ordered another test for 8 weeks, which was undetectable. Since then, some have said if detectable at 4 weeks, to do the tests maybe every week until you reach undetectable status. Now I wish I had had another test at 5 weeks.
As Can-do said, you will still have to do 48 weeks total (12 weeks Incivek and a total of 48 weeks Inf. and Riba).
(My post is based on the assumption you are on Incivek, Inf., and Riba. if you are on some different regimen, my post won't apply.)
I wish you the best.
By the way, keep an eye on that rash. The rashes can get worse pretty fast if not controlled. You might want to get a prescription for a stronger ointment for it. (When my rash got worse the Hydrocort. cream and Benadryl did nothing. I needed Fluocinonide ointment and Hydroxyzine at bedtime and Zyrtec in the am.)
Hi Peter, I just posted and now I see your second post. Disregard my post since it contains data about Incivek and the Incivek guidelines. If you are Geno 3 and on SOC then those guidelines are different.
However, I still think 44 is pretty good unless I don't understand something. It is difficult to know how far you dropped if you have not had a recent VL.
However, I still think 44 is pretty good unless I don't understand something. It is difficult to know how far you dropped if you have not had a recent VL.
Hi ,,I see from your second post you are a Geno type3 doing the combo Peg/Riba.
You have had a good early response,however given the data I have linked below it would most likely be recommended you extend tx. to 48 weeks,given that you are still Det. at week 4 and are chirrotic
http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02715.x/full
In patients who do not achieve a rapid viral response (RVR) with combination therapy, an extended course up to 48 weeks should be considered. While not as definite as for genotype 1 patients, the presence
of the CC variant of IL28b could help in the initial prognosis and the need
for additional treatment, if an RVR is not achieved
Factors that predict response to treatment in hepatitis C genotype3
Age < 40 years
Female gender
White race
Body weight < 85 kgs
Absence of diabetes mellitus
Absence of steatosis on liver biopsy
Fibrosis on liver biopsy ≤ 2
IL 28B polymorphisms
rs12979860 (CC allele)
rs8099917 (TT allele)
Viral load 3 cups per day)
Best of luck ..
Will
You have had a good early response,however given the data I have linked below it would most likely be recommended you extend tx. to 48 weeks,given that you are still Det. at week 4 and are chirrotic
http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02715.x/full
In patients who do not achieve a rapid viral response (RVR) with combination therapy, an extended course up to 48 weeks should be considered. While not as definite as for genotype 1 patients, the presence
of the CC variant of IL28b could help in the initial prognosis and the need
for additional treatment, if an RVR is not achieved
Factors that predict response to treatment in hepatitis C genotype3
Age < 40 years
Female gender
White race
Body weight < 85 kgs
Absence of diabetes mellitus
Absence of steatosis on liver biopsy
Fibrosis on liver biopsy ≤ 2
IL 28B polymorphisms
rs12979860 (CC allele)
rs8099917 (TT allele)
Viral load 3 cups per day)
Best of luck ..
Will
sorry. The info on the last line of my post seems to say you should take 3 cups a day of your viral load??
It should have read.."having a low viral load 3 cups of coffee a day
Will
It should have read.."having a low viral load 3 cups of coffee a day
Will
still not right..
Having a low VL 3 cups of coffee per day
There......I think I have it.....
Having a low VL 3 cups of coffee per day
There......I think I have it.....
I'll have some of what Will is having, please -)). The 3 cups of coffee sound pretty good as well.
Age < 40 years : I'm 56
Female gender : male
White race : yes
Body weight < 85 kgs : I'm close to 95
Absence of diabetes mellitus : I have type II diabetes, but just over borderline, not serious yet
Absence of steatosis on liver biopsy - not sure - I have stage 4 cirrhosis
Fibrosis on liver biopsy ≤ 2 : yes
IL 28B polymorphisms : ?
rs12979860 (CC allele) : ?
rs8099917 (TT allele) : ?
Viral load : 250,000 in 2003, 2,400,000 in 2005
I think I have about a 50% chance of SVR, because the nearly undetectable viral load shows the drugs are working. From the studies I've seen on the internet, for older people with cirrhosis and genotypes 2 or 3, weeks 17 to 24 are absolutely crucial. There's not much difference in the rates of SVR of 80 to 85% or so for young people with genotypes 2 and 3 with a 16 week or 24 week treatment, but the difference for older people with stage 3 or 4 cirrhosis is something like 18% SVR after 16 weeks to 52% after 24 weeks.
Female gender : male
White race : yes
Body weight < 85 kgs : I'm close to 95
Absence of diabetes mellitus : I have type II diabetes, but just over borderline, not serious yet
Absence of steatosis on liver biopsy - not sure - I have stage 4 cirrhosis
Fibrosis on liver biopsy ≤ 2 : yes
IL 28B polymorphisms : ?
rs12979860 (CC allele) : ?
rs8099917 (TT allele) : ?
Viral load : 250,000 in 2003, 2,400,000 in 2005
I think I have about a 50% chance of SVR, because the nearly undetectable viral load shows the drugs are working. From the studies I've seen on the internet, for older people with cirrhosis and genotypes 2 or 3, weeks 17 to 24 are absolutely crucial. There's not much difference in the rates of SVR of 80 to 85% or so for young people with genotypes 2 and 3 with a 16 week or 24 week treatment, but the difference for older people with stage 3 or 4 cirrhosis is something like 18% SVR after 16 weeks to 52% after 24 weeks.
If I were you I would first try to reach true undetectability by very sensitive
PCR before you start estimating your SVR chances.
The fact is you don`t have RVR and you are still detectable.
Also being borderline diabetic you are propably insulin resistant
combined with advanced disease and previous tx failure
I would try everything in my power to improve glucose metabolism
and I would try to tx as long as my Dr. is willing to rx and insurance is
willing to pay unless you have serious sides preventing you from doing so.
just my two cents.....
b
(Geno4,no RVR,60wk,SVR)
PCR before you start estimating your SVR chances.
The fact is you don`t have RVR and you are still detectable.
Also being borderline diabetic you are propably insulin resistant
combined with advanced disease and previous tx failure
I would try everything in my power to improve glucose metabolism
and I would try to tx as long as my Dr. is willing to rx and insurance is
willing to pay unless you have serious sides preventing you from doing so.
just my two cents.....
b
(Geno4,no RVR,60wk,SVR)
Thanks for the comments. I am concerned and so I will discuss it with my doctor. The plan is for no test for negative/positive until the 24th week.
I think there are flaws in how we are treated at the Lair Center here in Vancouver .They seem extremely reluctant to do viral load tests. Before treatment began, the doctor told me my chances of SVR are 80 to 85%, but I did some research and found it's much lower - about 50% - for people my age with stage 4 cirrhosis. The doctor also seemed to ignore my diabetis and when I told him about the very unpleasant side effects of the rebetron in 2003, he still pushed for me to go ahead with this Pegatron treatment.
I felt much worse after rebetron in 2003. I had been physically very fit and energetic prior to 2003, despite having Hep C, but I gained weight even during treatment because I became much less physically active, and continued to gain after treatment so my clothes didn't fit. I became unable to feel really rested. I thought the reason for the fatigue was the increase in viral load (I know it was 250,000 pre-rebetron to 2,400,000 two years later). But a specialist nurse at the Lair Center said viral loads fluctuate all the time and so are not a good indicator of anything.
I think there are flaws in how we are treated at the Lair Center here in Vancouver .They seem extremely reluctant to do viral load tests. Before treatment began, the doctor told me my chances of SVR are 80 to 85%, but I did some research and found it's much lower - about 50% - for people my age with stage 4 cirrhosis. The doctor also seemed to ignore my diabetis and when I told him about the very unpleasant side effects of the rebetron in 2003, he still pushed for me to go ahead with this Pegatron treatment.
I felt much worse after rebetron in 2003. I had been physically very fit and energetic prior to 2003, despite having Hep C, but I gained weight even during treatment because I became much less physically active, and continued to gain after treatment so my clothes didn't fit. I became unable to feel really rested. I thought the reason for the fatigue was the increase in viral load (I know it was 250,000 pre-rebetron to 2,400,000 two years later). But a specialist nurse at the Lair Center said viral loads fluctuate all the time and so are not a good indicator of anything.
Hi Peter. Maybe at this point don"t get to caught up in the facts and figures on chances of success and just do your best with treatment.
Hopefully the next PCR will show UND(as you are so close now)
Good luck ..
Will
Hopefully the next PCR will show UND(as you are so close now)
Good luck ..
Will
The rash did indeed get worse the past few days, last night I felt like I was covered by a thousand ants. I have been prescribed hydroxyzine and betamethasone by my family doctor.
I also talked to the Lair Center nurse today and she said she will see if it's possible to do a viral load or at least a positive/negative test next week, but she said it is very expensive in Canada to test for viral load.
I also talked to the Lair Center nurse today and she said she will see if it's possible to do a viral load or at least a positive/negative test next week, but she said it is very expensive in Canada to test for viral load.
I'm confused. Up above you said you have stage 4 cirrhosis, but you also said that your fibrosis score is <2. I don't understand, that seems contradictory. If you truly have stage 4 cirrhosis, you may want to ask your doctor about the possibility of treating longer than 24 weeks. I don't know very much about genotype 3 though.
Advocate1955
Advocate1955
I made a mistake - I misread it as > 2.
I have stage 4 cirrhosis - still, I think if I've not achieved SVR after 24 weeks, there's no sense in prolonging my torment and possibly be more disappointed later on. But I will discuss it with the doctor on March 9.
I have stage 4 cirrhosis - still, I think if I've not achieved SVR after 24 weeks, there's no sense in prolonging my torment and possibly be more disappointed later on. But I will discuss it with the doctor on March 9.
It would make a huge diference to me which IL28B genotype I was if I were geno3 and did not RVR.
"Differences between IL-28B genotypes were greatest among patients who failed to attain RVR (VD24 SVR rates: CC, 87%; CT, 67%; and TT, 29%"
I would seriously consider having the test done.
http://www.gastrojournal.org/article/S0016-5085(10)00841-3/abstract
Background & Aims
Polymorphisms in the region of the interleukin (IL)-28B gene on chromosome 19 have been associated with peginterferon-alfa–induced clearance of genotype 1 hepatitis C virus (HCV); there are no data for patients with genotype 2 or 3 HCV. We evaluated the effects of IL-28B polymorphisms on response to treatment with peginterferon and ribavirin in a well-characterized cohort of genotype 2/3 patients.
Methods
DNA was analyzed from 268 patients (Caucasian: genotype 2, 213; genotype 3, 55). Patients were randomly assigned to groups that received standard duration (24 wk; n = 68) or variable durations of therapy. Patients who received variable durations (VD) and had a rapid virologic response (RVR) were treated for 12 weeks (VD12; n = 122); those without an RVR were treated for 24 weeks (VD24; n = 78). IL-28B genotypes (rs12979860) were analyzed for association with treatment response.
Results
The frequencies of the IL-28B genotypes were as follows: CC, 37%; CT, 48%; and TT, 15%; 82% of patients with the CC genotype achieved a sustained virologic response (SVR), compared with 75% with the CT and 58% with the TT genotypes (P = .0046). Differences between IL-28B genotypes were greatest among patients who failed to attain RVR (VD24 SVR rates: CC, 87%; CT, 67%; and TT, 29%; P = .0002). Among patients with RVRs (61%), the IL-28B genotype was not associated with SVR (>70% for all IL-28B genotypes). In a multivariable logistic regression model, IL-28B genotype predicted SVR (odds ratio, 1.76; 95% confidence interval, 1.16–2.7).
Conclusions
An IL-28B polymorphism was associated with an SVR in patients infected with genotype 2/3 HCV who did not achieve a RVR. Analysis of IL-28B genotype might be used to guide treatment for these patients.
"Differences between IL-28B genotypes were greatest among patients who failed to attain RVR (VD24 SVR rates: CC, 87%; CT, 67%; and TT, 29%"
I would seriously consider having the test done.
http://www.gastrojournal.org/article/S0016-5085(10)00841-3/abstract
Background & Aims
Polymorphisms in the region of the interleukin (IL)-28B gene on chromosome 19 have been associated with peginterferon-alfa–induced clearance of genotype 1 hepatitis C virus (HCV); there are no data for patients with genotype 2 or 3 HCV. We evaluated the effects of IL-28B polymorphisms on response to treatment with peginterferon and ribavirin in a well-characterized cohort of genotype 2/3 patients.
Methods
DNA was analyzed from 268 patients (Caucasian: genotype 2, 213; genotype 3, 55). Patients were randomly assigned to groups that received standard duration (24 wk; n = 68) or variable durations of therapy. Patients who received variable durations (VD) and had a rapid virologic response (RVR) were treated for 12 weeks (VD12; n = 122); those without an RVR were treated for 24 weeks (VD24; n = 78). IL-28B genotypes (rs12979860) were analyzed for association with treatment response.
Results
The frequencies of the IL-28B genotypes were as follows: CC, 37%; CT, 48%; and TT, 15%; 82% of patients with the CC genotype achieved a sustained virologic response (SVR), compared with 75% with the CT and 58% with the TT genotypes (P = .0046). Differences between IL-28B genotypes were greatest among patients who failed to attain RVR (VD24 SVR rates: CC, 87%; CT, 67%; and TT, 29%; P = .0002). Among patients with RVRs (61%), the IL-28B genotype was not associated with SVR (>70% for all IL-28B genotypes). In a multivariable logistic regression model, IL-28B genotype predicted SVR (odds ratio, 1.76; 95% confidence interval, 1.16–2.7).
Conclusions
An IL-28B polymorphism was associated with an SVR in patients infected with genotype 2/3 HCV who did not achieve a RVR. Analysis of IL-28B genotype might be used to guide treatment for these patients.
I'll ask the doctor about CC, CT, and TT on March 9 when I go for my 8 week blood tests and appointment. I know they took a lot of tests before approving me for my current treatment, and I've had numerous tests in past years, so perhaps he already knows.
Honestly, maybe I'm being overly optimistic, but I feel I became undetectable at week 5 or 6 anyway, so I don't think the 44 result at week 4 will make a huge difference.
I have a gut feeling that if I meticulously follow the treatment and complete week 24, I have a good chance of SVR. My gut feelings have never been wrong before.
Honestly, maybe I'm being overly optimistic, but I feel I became undetectable at week 5 or 6 anyway, so I don't think the 44 result at week 4 will make a huge difference.
I have a gut feeling that if I meticulously follow the treatment and complete week 24, I have a good chance of SVR. My gut feelings have never been wrong before.
Since you seem to be determined to finish your 24vweeks, it probably would be a waste of US$300+ to have the test done now. For myself it would be imoportant if my chances were 87%, 67%, or 29% - especially if I started having problems midway through tx, But I'm a whiny wimp with a lot of (subjetive) extreme sx, even though my blood counts stayed close to norm. The doctor may, in fact, have you pegged as a CT, which would be in line with his "over 50%" statement.
If, in fact, he has not done the test and just pulling fugures out of ,,,,,, well you know, this could also be valuable info in so far as you're being able to trust your docs tx decisions.
If you get or have gotten the test, hope you're CC. Good luck.
If, in fact, he has not done the test and just pulling fugures out of ,,,,,, well you know, this could also be valuable info in so far as you're being able to trust your docs tx decisions.
If you get or have gotten the test, hope you're CC. Good luck.
Well, I have my 8 week appointment tomorrow.
I'm not feeling bad these days, since I now have the nasty rash under control with the ointment and strong antihistimines I got with prescription.
Since I'm 9 years older than I was when I had the rebetron treatment, I'm surprised that I have a bit more energy with pegatron this time, at least so far. But then again, in 2003 the most severe fatigue didn't hit until around 10-12 weeks, so the worst may be yet to come.
I requested about ten days ago that my viral load count or at least a positive/negative test should be done tomorrow, but they said they are not sure it's possible. I'd feel a lot more confident in my chances of SVR if I could be sure I'm now undetectable.
I'm not feeling bad these days, since I now have the nasty rash under control with the ointment and strong antihistimines I got with prescription.
Since I'm 9 years older than I was when I had the rebetron treatment, I'm surprised that I have a bit more energy with pegatron this time, at least so far. But then again, in 2003 the most severe fatigue didn't hit until around 10-12 weeks, so the worst may be yet to come.
I requested about ten days ago that my viral load count or at least a positive/negative test should be done tomorrow, but they said they are not sure it's possible. I'd feel a lot more confident in my chances of SVR if I could be sure I'm now undetectable.
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I know we are different Genotypes, but I was <43 but still Detectable at 4 weeks. I was happy to be able to continue treatment but disappointed I was not UND. However, at 8 weeks I was UND. and that helped boost my spirits. I am doing 48 weeks so I know what it means to have to extend the time of treatment.
Of course this is a very personal decision and you will have to come to this decision with your doc. but I hope you will treat long enough to have your best shot at reaching SVR. You are only 56 and potentially have 25-35 years left for living a happy and productive life.
I wish you the very best.