Question for those that SVR'd after 48 wks

There is a current post showing those that have reached SVR after 72 wks and have remained virus free.  It also lists those that have relasped after 72 wks.  They have my upmost respect.  Anyone who goes through this whether it's 24 wks, 48 wks or 72 wks is a hero in my book.  Extended treatment (geno 1's)  is usually based on whether a person is UND by 12 wks and in some cases they are repeating treatment and the recommendation is to go 72 wks.  I understand the percentages and logic for extending treatment but I'm wondering how many on this board were not UND by 12 wks (like myself - still had 793 IU/ml of the rotten SOB's having a party) and chose to do 48 wks and still reached SVR?  If anyone would like to share that I would certainly appreciate it.  It's a mute point if I don't clear by 24 wks but I'm curious to see how many of you got your SVR under those circumstances.  Thanks for your input.
Trin

[Trinity4]

bump

[wyntre9]

Hi Trinity.

I got your note.

I still had detectable virus at week 12, I think it was around 900, but by week 17 I was UND.  I discussed extending to 72 weeks with my gastro based on Drusano, Berg and Tapias-Sanchez studies and he agreed.  I have been UND since week 12.  I finished tx 3 months ago and so far I'm still UND.  The 6 month PCR is, apparently, the most important post-tx PCR so I have my figers crossed.  Some on forum told me that UND at 3 months post tx correlates with 95% UND at 6 months.

My starting VL was 1,400,000.

Biopsy indicated I was 1A, stage 1, grade 1.

I'd recommend that you check the Berg and Drusano studies.

GL,

wyntre

[Trinity4]

Thanks Wyn.  All logic points to extending but OMG, I dread the thought.  I will print that study and some others for my doc - he's not a proponent of extending so if it becomes an option I'll have hit him with the irrefutable facts.
Trin

[zazza]

As you might know, I recently completed 72 weeks. My 12 week test during tx showed a borderline result, which meant that my viral load was detectable but not quantifiable. I was told this meant I had between 5 and 20 IU/ml.

What should I do, was the question I asked myself at this time. 48 or 72 weeks? All studies I found had used tests of no better than a sensitivity of 50 IU/ml, so what should I classify myself as - an early responder or a slow responder? I could not find any guidance in the studies.

What finally made me decide was dr Thomas Berg from Germany who draws the line at UND with a test of the sensitivity of 10 IU/ml. So I decided for the 72, but kept an open eye for others who also had very low viral load at week 12, preferably under 50 IU/ml. I have been a member of the forum since February 2007, and during this time I have seen many of these slow responders with very low viral load week 12 go only 48 weeks, and I can not remember anyone who did not relapse. Many of them urged me to go 72, because of their own relapse.

As you see in the thread of the 72 week club, everybody does not reach SVR even with extended tx. But it seems that many do, and many who don't have cirrhosis or have had a liver transplant, which has lowered their odds. It is our best bet as slow responders. I wanted to give it my best shot at my first try. Rather go too many weeks than have to do it all over again.

Right now I am 4 months post and was UND 3 months post, so I am hopeful for SVR. My advice to you is just do the 72, and if nothing else you can be satisfied knowing that you have done everything in your power.

Good luck,
Zazza

[zazza]

This is a good paper to read. It summarizes the Berg, Sanchez-Tapias and Pearlman studies. It is called "Seventy-Two Weeks of Peginterferon and Ribavirin for Patients with Partial Early Virologic Response?"

http://www.liverfoundation.org/downloads/alf_download_321.pdf

[Trinity4]

Thanks zazza - you really had a dilemma on your hands. It's kind of a no brainer in my case.  And yes, you're right about knowing that I've done everything in my power.  If I do clear by 24 wks and extend and don't reach SVR, that's it for me with the current SOC.  Even though I'm at stage 3, I'll take my chances and wait for the new meds but only if the percentages are better and duration is shorter before considering treatment again.  
Trin

[zazza]

Remember that once you are UND, it is the relapse percentage that is interesting, not the SVR percentage.

[ADESI]

It seems that if you are not undetected @ week 12 it is a no brainer-
but I was und @ week 8 (probably sooner - vl 77 @ week 4) and my
Dr. wants me to extend to 72 weeks.
Now I have been trying to decipher these studies for a while to determine
whether I am going to do that.
These studies all show how many subjects acheived SVR and how many
relapsed , but what about the other 20% not listed in either catagory-
don't you have to either acheive SVR or relapse?

[Trinity4]

Is this your 1st or 2nd tx?  I know those that repeat tx are advised to extend but I don't think I've heard anyone say that they were told to extend after going UND at 8 wks.  It's getting crazy with the 4 wk thing anymore and I know some say that's the ticket - not UND at 4 wks - extend.  Geno 2's & 3's really need the 4 wk UND because they only go 24 wks.  What did your doctor base this on?
Trin

[ADESI]

First time TX- geno 1a,no fibrosis
I think just on the basis of handling the TX well- I know I'm handling it better than most
but it's no cakewalk.
but maybe because according to studies shown (Berg & Sanchez ) if you are
not clearing in 4 weeks then you are a slow responder.

[Trinity4]

I'd have ponder that long and hard if only one study is indicative of this.   I've tolerated tx pretty good too, refuse to give into the sx and attitude does have a lot to do with it but 72 wks is scary as hell to me.  I need to start stashing the bail money away now, probably going need it!!!
Trin

[zazza]

"These studies all show how many subjects acheived SVR and how many
relapsed, but what about the other 20% not listed in either catagory -
don't you have to either acheive SVR or relapse?"

You can also be a non-responder (i e null-responder, partial responder, breakthrough).

If you don't reach UND, you cannot achieve SVR or relapse. This applies to the null-responders and partial responders. They are taken off tx.

Those who have breakthrough are obviously not UND when they stop treating, and can therefore neither achieve SVR nor relapse post tx.

[HCA]

I am geno 1. Less than 1000 at 12 weeks-relapsed after 48.
Viral serum however low at 12 weeks,extension is essential.