No virus week 04

Question

I'm gen 03, and being on stage fibrosis 03, doctors want to tx for 48 weeks. But I'm not the virus in 04 weeks (inde)... I'm worried about having to extend the tx, rather than six months. Doctors say it is to ensure healing. Adverse effects are aggravated when the tx stretches over time?

willbb · Accepted Answer

I would agree with cando ..that there are many more incidences of "relapse " with Geno type 3 (according to study data),however still moderately low ( 18%) with 24 weeks of total treatment time.

The increased rates of relapse are thought to be somewhat attributed to incidence of fatty liver in G3's and also faster increase of fibrosis in many G'3's.

Also  these following are risk factors for relapse:
male,black race,>40yrs.old,high viral load, and higher than ideal body weight.

Given all that there is still a 86% of overall success with doing 24 weeks of therapy  so possibly looking at all these factors above you and your doctor must weigh the risk vs. benefit of extending treatment. (some info linked below)

Good luck..
Will

Present treatment for hepatitis C genotype 3
Predictors of response

According to the recent AASLD guidelines [15], PEG-IFN α-2b (1.5 μg/kg/week) plus RBV (800–1400 mg/day) or PEG-IFN α-2a (180 μg/week) plus RBV (800 mg/day) for 24 weeks are the established SOC regimens for patients with chronic hepatitis C genotype 2 or 3. However, optimal administration of PEG-IFN/RBV, in particular, the duration and the dosage have still not been clearly established in relation to outcome in rapid and slow responders. Based on the concept of ‘response guided treatment,’a recent meta-analysis evaluated the issue of decreasing the duration of treatment to improve tolerance and cost effectiveness, and most importantly to decrease viral resistance to the standard bitherapy [16]. Treatment with PEG-IFN and weight-based RBV for 16 weeks in patients a with rapid virological response (RVR) resulted in an SVR of 76.3% and 86.4% with 24 weeks of treatment, unlike genotype 2 which was 83.8% and 89.3% respectively. This was because of increased relapse rates in patients with genotype 3. Manns et al. [17] showed that the relapse rate was 26% after 16 weeks of treatment and 18% after 24 weeks in genotype 3 patients. The increased relapse rates could be because of steatosis, and as already mentioned, the increased rate of fibrosis in thes patients. In a cohort of 932 treatment-naïve patients, investigators of the ACHIEVE-2/3 trial [18] showed that hepatic steatosis significantly increases the risk of relapse independent of HCV RNA levels in patients with genotype 3 who achieve an RVR with IFN-based regimens. This may be because of altered IFN-α signalling, increased intrahepatic RNA levels or increased quasispecies diversity. Other known risk factors for relapse are male gender, black race, age over > 40, increased viral load, presence of fibrosis, body weight > 85 kgs and presence of diabetes mellitus.

willbb · Answer

Given all that there is still a 86% of overall success with doing 24 weeks of therapy 
------------------------------------
Should have said   "Given all that there is still a 86% of overall success with doing 24 weeks of therapy..with the RVR

Best ..
will

Idyllic · Answer

Bah! 48 weeks is just about a year! Still, I am so desperate to have the virus gone I would go along with 48 weeks. I guess. What choice is there. 

***Your question is a good one however: what kind of toll can 48 weeks of Ribavarin and Interferon have on the body? ***

can-do-man · Answer

Genotype 3 can be more tricky then geno 2. I have seen many more relapses with type 3 then type 2, that said RVR is about as good as it gets. If your main concern in doing 48 weeks is how much harm extending the extra 24 weeks will do to you I would not be to concern about that and would not base my decision on whether to go on just on the worry.

Here in the US they would more then likely do only 24 weeks, where your from is it easy to retreat if one does relapse? Good luck on going forward and see what your thought are when your at that stage of treatment.

liavera · Answer

Hi, My biopsy was made in June last year, accusing F3 of inflammation level 01

liavera · Answer

Hi, My pre-treatment viral load was 194,000 UI. To ensure UND, made ​​the qualitative PCR with a sensitivity of at least 30 UI, week 04

liavera · Answer

HI! What is your degree of fibrosis? Tomorrow I will complete weeks 07 of tx, with the 7th dose of pegintfe 120

liavera · Answer

Hi my dear friends! Here in Brazil the government is funding the treatment for all. There is a protocol which provides that, for the gene that has 03 , level 03 of fibrosis, the treatment is effective if done at 48 weeks, even if the bearer is UND at week 4. Doctors argue that the virus, in the case of F3, has a chance to return if the tx is made within 24 weeks. They say that some viruses can lodge in the liver, and then return to service if the tx stop at 24 weeks. I'm afraid of the extension of tx for 48 weeks. The consequences of drugs will be necessary, can be dangerous...? do not know how far it is necessary to extend my tx

desrt · Answer

Undetected at 4 weeks means 48 probably won't be any more effective for someone with genotype 3 and stage 3 fibrosis than 24. Do the 24, see how you feel, and take it from there.

Sentinel13 · Answer

Liavera: Please disregard my triple therapy question (thanks 1otClub). I'd like to replace that question with a different question. When did you have your biopsy that indicated Stage 3 fibrosis? Cheers, GB

1oftheclub222 · Answer

Genotype 3?   So you are just doing the Pegasys/Ribivarin?  

I am Genotype 2, doing the same treatment.I am just ending week 13 this Friday.  I am doing treatment for 24 weeks.  I thought the standard treatment for Genotype 2 and 3 was for 24 weeks. 

I don't know if the state of your liver has anything to do with extending the treatment, but I do know that there were pleanty of people who were type 1, that did the peg/Rib for 48 weeks and longer, before the new triple therapy came out for them.

If your doctor monitors your blood levels regularly, you should be able to catch most serious adverse affects before they become a problem...also make sure you keep your doctor informed of any side effects you amy be having...alot of times they have medicine that can help with the side effects.

Sentinel13 · Answer

Hi Liavera: What was your pre-treatment viral load?

Did you have a viral load test at week 1, 2 and/or 3?

What treatment are you on? Triple therapy with Incivek or Victrelis?

Cheers, GB