To extend or not to extend Tx

please help me to decide
My starting/baseline RNA was 859000. I am Gen 3a doing 18/24 wk. here is the excerpt from my lab report done in 5th week

RNA Detected,  < 15 IU/ml
The result for HCV RNA is below the linear range of the assay and thus the exact value cannot be calculated "

Wk 12  UNDE
Since I was still detected at wk 4/5 thus I am not sure whether I should finish at wk 24 and  or extend it to be on safer side and how many wks to extend. Thanks for any input

[desrt]

Tough call since you could have been UND at 6 weeks or not UND at 11. If I were <15 at 5 weeks, I think I'd do the 24. In a case like yours the doc should probably have ordered an extra PCR at week 8.

[mj6000]

I know you would feel so much more confident to go ahead and extend,maybe even past 24 to be sure you SVR the first time.It's tough to think that...I know!

[mj6000]

Since the only test showing UND was at 12,I'd do at least 20 weeks past that,treating for 32.

[nygirl7]

I dont think any studies have been done to determine any benefit from extension as a geno 3. Only geno1 has been studied as far as I am aware at this time.

Sometimes those of us who start with a low VL have a harder time to clear those final dumb virons.  I don't know why since it's supposed to be in our benefit but I started with 568,000 and (geno1a and 1b) was still UND at week 12 but not 24 so I had to extend - but again geno as prescribed by Sanchez Tapis, Berg and all the other various little pubs that I could find.

When I first started on here someone had told me about this problem and they are right....sometimes it's just harder.

I would err on the side of caution and finish the treatment as planned originally.  As you might know, geno3 and can be as tough or even more tough than a geno1 at times.......you don't want to have to retreat just over a few weeks right?

It's either a lucky geno or a not lucky geno - it can go either way but  you just don't know until the end.

Good luck.

[Marcia2202]

I was a geno 3a and did not clear by week 4. My next PCR was at week 8. I extended treatment. The 'formula' used was UND + 24 weeks, so I ended up doing 32 weeks.

It seems that the new trend is to individualize treatment. And this 'formula' is being used for geno 3's by some doctors. Dr. Douglas T. Dieterich had suggested this to me (online) and my doctors here in Denmark decided to use the same formula after having been at the 'Liver Meeting' in San Francisco last year. Even though the studies to confirm this are still being done, they have started doing this.

Actually we do have a Swedish member who was in an extension study for geno 3. He treated for the second time, as he had relapsed after the first treatment. He treated for 48 weeks and achieved SVR.

So they are working in the right direction.

[Marcia2202]

Oh, I forgot to say that my result was 80 at week 4, so I most probably was clear by week 5. I'm sure you were too.

I have a friend who had around the same result as you, and she did 28 weeks. That's what her doctor decided. You see, everyone does their math a bit differently.

[waterjoe]

Did you have a biopsy pre-tx? I think the determinant factor would be liver damage. Stage 1 or 2 fibrosis might indicate that 24 weeks might do the job. Stage 3 might be iffy. If you're a stage 4 then even extending past 24 wks may not do that much good.

My week 4 viral load was 18. . . stage 2 fibrosis. . . SVR on 24 wk tx. I have a buddy who had similar viral results with stage 4 fibrosis. . . he relapsed after 48 week tx. Both of us are geno 3a.

[Charismatic]

My biopsy was done 5 yrs ago and the result was no fibrosis.3 months prior to Tx,my fibroscan was done and the reading was around 8.6 and my Dr said that it is fibrosis stage 1/2. Thus as per my stat you think I should be O.K for 24 wks. I also wish for the same

[GoofyDad]

My sense is that fibrosis stage means little against the viral decline slope.  I was a 3a stage 4, slated for 52 weeks. After a 4 week RVR, my docs suggested I switch plans from 52 weeks to 26. That's what I did and all's well.

Charismatic - I'd be inclined to add a few weeks on to make up for the probably 1 week you went over the 4 week RVR.

The other question is dosage. How much riba/body weight? Higher riba seems to make a difference with 3a's.  

If you want some interesting reading look up the Mangia study and the VonWagner.

[zazza]

New guidelines for treatment of hepatitis C were accepted in Germany in 2008. The recommendation for genotype 3, detected at week 4, is to extend to 48 weeks.

You need to consider what is most important to you. If you want this to be the only time you treat I would recommend extending.