Treatment in 24 and 48 weeks with genotype 1 and 2?

I was at my specialist-doctor at Tuesday and he tells me that I could have 24 weeks treatment and not 48 weeks like I was told first. That because I was a "responder" I had 7.200 000 copy with start and UD after 4 weeks. My ALT and AST are normal for first time in 20 years. He tells me that my chance of SVR is 10 % lower than 48 weeks treatment. If it was him he had stop treatment after 24 weeks. He told me also that he think I has most of genotype 2, maybe 80 % and little of genotype 1 which is a 48 weeks tx.
What thinks the people on the forum to stop treatment after 24 weeks with genotype 1 and 2?
I feel also bad, and struggle every day during the tx.

Thanks to all who answer me :)

[newleaf09]

You bump into an emotional quandary when stopping at 24 weeks.  You get yourself all ginned up to do whatever it takes and then worry that you are dooming yourself if you don't end up needing to go that extra mile.

There is currently a great deal of literature on the success of 24 wk. TX for those geno 1's who have a rapid virological response (UD by 4 weeks).  I can send you the sites for some of those articles if you like.  Personally, I'm a believer.  If you cleared by 4 weeks, your system is very responsive to interferon and 24 weeks would give you 5 more months to clear the virus out of your liver cells. Follow your doctor's advice.  Being very responsive and stopping at 24 weeks means 20 fewer weeks being subjected to IFN.

[chemister]

Thanks....yes I read a lot of HCV literature, and reading of 24 week success will help me to decide the dilemma :)

[epiphiny]

First of all I am not sure how they can determine that most of your VL is G2 rather than G1!  If anyone knows how they would do that I'd love to know!

Secondly,  there is no way I would consider dropping to 24 weeks if I had Geno 1 in the picture!  It is true that there are studies about dropping to 24 weeks of tx if you achieve RVR but there are also several other requirements needed to make this decision and as far as I know none of them involve a double infection of 2 genotypes.

I would ask your doctor to provide you with some concrete examples, studies and statistics before making any deciosion and also ask him about the criteria req.

As far as I know some of the others are: low viral load to start with, being female, having a normal BMI, degree of liver damage and age.

Do you want to go for a short treatment and then find you have relapsed and then have to do it again, or even worse find that because you failed your first shortened treatment you are not able to treat again??

You need to get some solid research behind you before making such a big decision. And also consider whether you want to take that chance, and be an experiment seeing whether shorter treatments work?

Perhaps your doctor might be considering shortening your treatment to save some money for the government?

Good luck!

[newleaf09]

Those things, like low VL, female gender, BMI, age, histopathology are not requirements.  They are useful predictors.  Viral kinetics drive the decision for shorter TX in all of the genotypes.  Being RVR and staying UD until the 24 wk. PCR are the significant factors in length of treatment decisions.  Normalized liver enzymes so early in TX are also a useful predictor.

I agree that guessing at the genotypic mix is pretty useless, just idle conversation, not any basis for a logical decision.

[chemister]

The doctor told me that I had better change to respond with G1 and G2 than people with only G1. He don’t determine how much G1 and G2  I had, but told that maybe G2 was 80 % which is a god thing, but that is only a estimate, nothing for sure. I had no biopsy, but fibro scan: 5.8 and the doctor told that I had any fibrosis. UND after 4 week and normal ALT and AST after 12 weeks. I had the virus for 25 year and always had little to high ALT and AST these years. I will ask for several RNA-PCR these 24 weeks and be sure that I will take the right choice. Now the estimate for SVR is 80 %, and after 48 weeks and 70 % SVR for 24 weeks. It’s my choice to decide how long I will stay on the Peg.interferon and Ribavirin.
I don’t know how seek people are on the treatment, but I feel not good during this treatment, and 24 more weeks are a long time to be treated...but SVR is the most important anyway :)

[nygirl7]

The doctor told me that I had better change to respond with G1 and G2 than people with only G1"

There is no difference whatsoever when you treat a double geno or single geno it is treated the same way and you should be considered a geno1 by all accounts.

While studies have shown that RVR at week 4 is a good predictor of eventual success if your doctor is saying that you have a 10% less chance than at 48 weeks.......that means what? The odds are usually 50/50 a geno1 succeeds - but they do go up greatly with the 4 week UND.

It is still not a 100% guarantee and if you are to relapse you will have to do it all over with more meds for a longer duration. I personally do not think it worth it and would continue with the 48 weeks and the higher percentage that you have lifelong success.  48 once is much better than 24 + 48 or 72 weeks to me.

Good luck. Having geno 1 means you ARE geno1...the 2 does not trump the 1 for any reason.  It just means you have both. I've seen people with geno 1A and 1B only beat one of them and still have geno1 after all........it's tricky stuff and you should be vigilant and do all that you can while you can.

[portann]

This is an unusual situation, having both a dream genotype (2) and a difficult-to-treat genotype (1).

To my rusty knowledge, the European revised protocol for geno ones is twenty-four weeks only  if you meet TWO criteria:

1) RVR and
2) low starting viral load

(Zazaa would know for sure.)

The following 2009 study lays it out clearly enough but for every study saying one thing, there could be another saying something different:


"In HCV-1 patients with a rapid virological response, 24weeks of combination therapy with PEG-IFN alpha and ribavirin should be considered only in subjects with low baseline viral load. However, the optimal cut-off defining low baseline viral load and the impact of the presence of other factors capable of altering treatment response, remain subject to debate."

http://www.jhep-elsevier.com/article/S0168-8278(09)00649-7/abstract

It's not clear what your starting viral load was but if it was in copies, then your IU/ML may have been (7, 200,000 times 2.7, depending on the method), which equals too high to qualify as a low starting viral load. Hmmm....

I'd show my doc the above study and ask him to comment and consult. If I had both RVR AND low starting viral load, I'd go for what he suggests for sure. That doesn't appear to be your situation. The high viral load is something to seriously ponder.

My guess is that having two genotypes is rare enough to not be well understood, so it is tricky to make treatment decisions.

Good luck. Treatment ***** but you do come out of it at the other end in one piece.

[portann]

That is:

Good luck. Treatment s-ucks but you do come out of it at the other end in one piece.

[mikesimon]

I agree with Portann.

".....However, when patients were re-evaluated using the more sensitive TMA assay, the SVR rate in patients who achieved HCV RNA < 5.3 IU/mL by Week 4 was 93% after 48 weeks of treatment and 80% after 18-24 weeks of treatment (P = NS). Moreover, in patients with baseline HCV RNA ≤ 800,000 IU/mL and undetectable HCV RNA by the TMA assay at Week 4, the SVR rate was 91% after standard treatment and 100% after short, tailored treatment (P = NS). Adverse events commonly associated with peginterferon/ribavirin treatment were observed in the standard-duration and individualized-duration arms with a similar overall incidence, and serious adverse events were reported at rate of 6.6% and 2.6%, respectively. These findings support the idea that a shorter course of combination therapy may be an appropriate option for select groups of patients, such as those with low baseline HCV RNA in whom HCV RNA is below the low detection limit of 5.3 IU/mL very early during treatment..."

From: Clinical Care Options:
Individualized, Short-Duration Therapy for Treatment-Naive Patients With Chronic Genotype 1 HCV Infection

See: http://tinyurl.com/yarxyot

[damosaab]

i had rvr and low viral load and really tought about stopping at 24 weeks i asked my doctor about stopping early and he told me it would be crazy to do so.so  i am on 42 weeks now. only person who can make that call is u

[FlGuy]

There is another possibility to consider. If you start treatment and get to undetected status and continue to the end of treament that way, whether it's 24 or 48 weeks it is possible to get rid one of the the geno types and not the other.  So, you could go for 24 weeks and get rid of geno 2 and then still have geno 1.  I think it was Susan400 who had both geno 1a and geno 1b and got rid on one of those in her many treaments.

[portann]

Following is an article about the revised European protocol. I don't know for sure if it's applicable to Norway where you live but am guessing it is. Note the emphasis on low starting viral load, something you should point out to your doctor.

(To give credit where credit's due, I pinched this from Orleans' excellent thread at http://www.medhelp.org/posts/Hepatitis-C/Is-it-a-FACT-that-the-protocol-in-Europe-has-been-changed-/show/661127)

March 6th, 2007

PEGASYS(R) Gets European Approval for a Shorter Treatment Duration for Some Genotype 1 and 4 Hepatitis C Patients who Show a Rapid Response to Therapy
http://www.prnewswire.co.uk

- Shorter, Simplified Treatment Option May Encourage More Patients to Seek Treatment

Some hepatitis C patients with difficult-to-treat HCV genotype 1 who respond quickly to treatment with a combination of PEGASYS(R) (pegylated interferon alfa-2a (40KD)) plus COPEGUS(R) (ribavirin) can benefit from a shorter and simplified course of therapy, following Thursday's Commission decision. With the new approval, a subset of patients with genotypes 1 and 4 HCV who achieve rapid viral response can now receive a shortened, 24-week duration of treatment with Roche's PEGASYS plus COPEGUS. This is half the normal treatment duration.

Shorter, Simplified Treatment Shows Excellent Chance for a Cure
The EU approval is based on data from two pivotal clinical trials for PEGASYS plus COPEGUS.(1,2) Results from these trials show that among patients who achieved a rapid viral response (undetectable viral load at week 4) in the first month of treatment up to 93 per cent of patients with genotype 1 HCV with a low pre-treatment viral load and 83 per cent of patients with genotype 4 were cured following only 24 weeks of therapy - a similar cure rate to that seen following 48 weeks of therapy.(3)

"This is excellent news for patients with hepatitis C," said Dr Peter Ferenci, Professor of the Department of Internal Medicine IV, Gastroenterology and Hepatology, at the University of Vienna, Austria. "This means that patients can find out within one month of starting therapy if they have an excellent chance of being cured and can benefit from a shortened treatment duration. This is likely to encourage patients to seek treatment and motivate them to stay on therapy."

New Recommendations for Treatment
A shorter, 24-week course with PEGASYS plus COPEGUS is now an option for the following patients:(4)

Genotype 1 HCV with a low pre-treatment viral load (defined as <800,000 IU/mL) and an undetectable viral load at weeks 4 and 24;
Genotype 4 HCV regardless of pre-treatment viral load and an undetectable viral load at weeks 4 and 24.
"This licence change reflects Roche's commitment to finding better treatment solutions for patients with HCV by improving treatment with existing therapies and developing new medicines to treat hepatitis C," said Claire Steers, PEGASYS Lifecycle Leader at Roche in Basel, Switzerland. "Roche is committed to finding solutions for a broad range of hepatitis C patients by continuing to simplify treatment with PEGASYS."
Clinic of Internal Medicine II, Department of Medicine, Saarland University Hospital, Kirrbergerstrasse, 66421 Homburg/Saar, Germany. [e-mail]
BACKGROUND/AIMS: Previous studies using standard interferon and ribavirin combination therapy suggested that patients infected with HCV-1 and a low pretreatment HCV-RNA level can be treated for 24 weeks without compromising sustained virologic response rates. The aim of the present study was to investigate this schedule in the era of pegylated interferon-alpha plus ribavirin. METHODS: Patients chronically infected with HCV-1 (n=235) and a screening viremia < or =600,000 IU/mL (real-time PCR) were treated with peginterferon alfa-2b 1.5 microg/kg subcutaneously once weekly plus ribavirin 800-1400 mg/day based on body weight for 24 weeks. RESULTS: End-of-treatment and sustained virologic response rates were 80 and 50%, respectively. The 48-week historical control (Manns et al., Lancet 2001;358:958-65) had similar end-of-treatment (74%) but higher sustained virologic response rates (71%). This difference was due to a high virologic relapse rate after 24 weeks of therapy (37%) compared with the historical control (4%). A subset of patients who had undetectable serum HCV-RNA at treatment week 4, however, achieved similar sustained virologic response rate (89%) as in the control group (85%). CONCLUSIONS: HCV-1 infected patients with a low baseline HCV-RNA concentration who become HCV-RNA negative at week 4 may be treated for 24 weeks without compromising sustained virologic response rates.

[Isobella]

Thanks for clarifying what low VL actually is.  At my center, if your vl is <400,000, they consider it low and you could be a candidate for shorter tx.  I like the <800,000 number better.

[Marcia2202]

Dizzy Mizz Izzy, my sis'

The <800,000 number is the old number. Nowadays the <400,000 number is used to determine low viral load. So unfortunately nix with the higher number...

Chemister:

According to whatever I've read so far, the only way one could treat for 24weeks being geno 1 would be having a low viral load and being RVR. Since you viral load was 7 + million, you would not fit into that category.

Having 2 genotypes, one of the being geno 1, I would personally not even think of doing 24 weeks. I'm sorry to take the wind out of your sails, but I really truly would not do it.

According to what I have learned so far is that being a geno 1 and achieving RVR gives you a 90% chance of SVR, if you do 48 weeks.

So far I have not seen any studies claiming anything else, unless you are on a PI drug as Telaprevir, then 24 weeks would be fine.

[Isobella]

Look at that....I have state of the art info without even knowing it ;)

(i'm so badss)

[portann]

I would definitely consult with your doc - who you said is a specialist - to ensure he hasn't overlooked the significance of low starting viral load for shortened tx.

Please let us know what he says about this next time you see him. (My specialist didn't want me to do treatment at all but here I am, at the other end of it, in one piece.)

Can you confirm your starting viral load? If you used the PCR method, and your result was 7, 200, 000 copies, as you mentioned, then I think your number in IU/ml is 26,666,666 IU/ml. (Copies/mL = IU/mL x 2.7) 7, 2000, 000 DIVIDED BY 2.7)

Twenty-six million IU/ML is very far away from a low viral load.

If I had geno one and two, with RVR and low viral load (which you apparently don't), I'd personally do the shortened tx without hesitation. I would NOT shorten conventional SOC tx (i.e. only interferon and ribavirin) with a high viral load, unless circumstances required it.

You said you are feeling bad every day and struggling with  tx - geez, I remember that nightmare but am trying to forget it. It goes by, though, one day at a time and then you're done and almost shocked at how you got through something so nasty.

You can do it, too, like so many people here - just think and take a step at a time.

Please keep me posted.

Susan

[epiphiny]

Thank goodness for the bright, well informed people on this website!!  You have got awesome information here, Chemister, I really do wish you the best in your decision making.

As an aside, the treatment is difficult but as many others will tell you we all get through it, one day at a time, or even one hour at a time.  When I look back it seems like a vague dream and I am so much happier now that I have achieved SVR.

You can do it!!

Best of luck,

Epi :)

[portann]

Sorry, Chemister, I meant your starting load in IU/ML was about 2.6 million. Sorry about my google calculator input error (math WAS my forte!) but the correct figure nonetheless is interpreted as high, not low.

Epi is right - you can do this tx, forty-eight weeks and all. It may seem too daunting when you think of how much lies ahead but an hour at a time adds up and up and up.

Then you know you've given it your all.

Good luck and let me know.

[Bill1954]

Good luck Chemister!

All:

To agree with Marcia, and also to add authority to the 400,000 IU/mL cut-off for low viral load:

http://www.natap.org/2007/EASL/EASL_41.htm

“…AUTHOR CONCLUSION
The current GAM analysis demonstrates that an HCV RNA level >400 000 IU/mL is the most clinically relevant definition for HVL. This threshold, based on using the COBAS AMPLICOR HCV Test, best differentiates the probabilities of achieving an SVR with peginterferon alfa-2a (40KD) plus ribavirin. A 400 000 IU/mL HCV RNA cut-off resulted in the greatest difference in SVR rate between patients with a LVL and a HVL. While HVL remains a poor prognostic factor, it must be remembered that HCV genotype 1 patients with a LVL have a high chance of SVR, which increases as baseline HCV RNA decreases. Others have also demonstrated that a baseline HCV RNA cut-off of 400 000 IU/mL best discriminates between LVL and HVL in HCV genotype 1 patients based on the probability of achieving an SVR.[8,9] This validated cut-off can now be incorporated into the design of prospective studies that are examining alternative treatment strategies in this 'difficult-to-cure' population…”

Bill

[Trish77]

I've seen people quoting 90% chance of success for Geno 1's with an RVR but I'm wondering where that number came from.  I recall around a 75% or 78% chance of success with an RVR but not 90%.  

[chemister]

Viral Load in Europe is (EQ / ml). EQ = copies. I don,t no what that are in  IU/mL
I will find out, but a note from Norway: (EQ / ml).

200 000 til 1 000 000 low
1 000 000 til 5 000 000 medium
5 000 000 til 25 000 000 high
More than 25.000.000 very high

So my virus load is medium, not high.
RVR is rapid virus respons?

[Bill1954]

Hi Chemister,

Yes, RVR = Rapid Viral Response = undetectable for virus measured at 4 weeks.

This is from Janis and Friends website; it might help with EQ/mL IU/mL conversion:
~~~~~~~~~~~~~~~~~~~~~
Viral load given in IU

Giving the viral load in IU probably soon will replace all other ways to express the viral load - until recently it was expressed most frequently  in eq or Meq. But at the moment and in old lab reports a wide variety of ways to give the viral load still can be found.

The IU = International Unit for the hepatitis C viral load is a unit more or less arbitrarily fixed. Labs now can take part in international comparison tests using a calibrated sample and thereby normalize their results to an international standard. So, in the future results from different laboratories should be directly comparable.

For converting numbers from eq to IU and vice versa, different labs use different conversion factors, in the range from 2 to 5 viruses per IU. If you do not know the factor that your lab uses, using a factor of three might be reasonable. That means: Viral loads given in eq/ml have to be divided by three to get the viral load in IU/ml. And, viral loads given in IU/ml have to be multiplied by three to get the result in eq/ml.
~~~~~~~~~~~~~~
http://janis7hepc.com/Viral_Loads.htm

Bill

[chemister]

Thanks Bill,
Sorry my virus load was 2700000 and not (7200000).
Divided by 2.7 = 1 000 000 IU/mL, not far from 800 000.
I will ask my doctor about that: had I a low starting viral load, or not?
I am RVR for sure.

Yes Susan, I will take a step at a time. Today I took my 15 inj, and I feel
better now than week 2 -10.

Thanks to all who answer me and give me the information I need... :)

[Marcia2202]

It seems like you are running on old information.

Nowadays viral loads are only divided into 2 categories, either high or low.

The cut off between low and high is 400.000 IU. This is International, meaning the whole world.

I really hope you will pull through with your treatment. It can be very tough. Personally I treated for 32 weeks, genotype 3a. I was in bed during the whole time. Sometimes it was so bad, that I could not even turn in bed for hours. I would lie and stare at the ceiling, not being able to move. I'm glad I pulled through, stubborn as I am. No matter how bad I felt, I never considered quitting. I'm glad I didn't. I am now SVR.

Hang in there... I'm cheering you on from neighboring Copenhagen.

[chemister]

Hei Marcia,
yes we are almost neighbors, I live in Oslo. On the forum I read about people who work, but I could never do that, I am ill that the simplest things do me tired. I feel fatigue and had nausea mm. In 8 week I went down 25 kg. I wonder that we who had Rapid Viral Respons maybe get more ill, or we who respond to the Interferon???

Godt å høre at du har blitt SVR, og 32 uker er også et alternativ for meg. Det er alltid prat
Om 24 eller 48 uker. Blitt litt sent så orket ikke skrive mer engelsk. Synes synd på deg som var sengeliggende under hele behandlingen.

Hvorfor valgte du 32 uker og ikke 24?
(regner med at du leser norsk, dansk er lett å lese).

Hilsen Kjell Olav, Oslo.

[Marcia2202]

I treated 32 weeks, because I was not RVR. I was EVR at 8 weeks and extended treatment.

The formula which was used was EVR + 24 weeks.

Min bedste veninde bor i Oslo, og jeg plejede at besøge hende ***. Har ikke været i Oslo i et styk tid, fordi jeg var i behandling etc. Men nu er jeg rask igen, men gider ikke at komme til Oslo i den kolde vinter... :-)

[chemister]

Hello Marcia…
Ok, that is maybe an option for me to?
I am RVR, but had not a Low Virus Load. Even I had higher virus load I was at zero almost
after 3 weeks. The doctor thinks that was rare and very rapid. 32 weeks is better than 24 weeks to be SVR.  My doctor thought my changes to suckside after 24 weeks were very high. But want to be sure, and SVR is most important. I hope I never have to start this treatment more times. I have to decide 24, 32 or 48 weeks treatment. And 32 weeks was your idea 

Hilsen Kjell Olav

[epiphiny]

Sorry to butt in on your conversation with Marcia but I think it is very important to note the difference between yourself and Marcia - different genotypes! She was Geno 3, you have Geno 1 AND Geno 2. From where I sit it looks like 48 weeks is your safest bet.

[Marcia2202]

I Think you misunderstood me. I did NOT suggest you should do 32 weeks. The formula EVR + 24 weeks is solely for geno 2 or geno 3. If you have one genotype. There are no studies confirming this formula for geno 1.

This is in NO way my idea for your tx.

If I was a geno 1 and 2, I would definitely do 48 weeks.

If one has multiple genotype, the length of treatment should always be  the one used for the harder one to treat. In your case that would be for genotype 1. 48 weeks

[Marcia2202]

Sorry for the typos. I can't find my glasses.

[chemister]

I know that you don’t suggest to me 32 weeks Treatment. But when I talk with my
Specialist-doctor in Norway he suggest 24 weeks treatment to me, and he told me that my changes to SVR was very good after 24 weeks. If he was treated with mine result he would for sure stop after 24 weeks without a question. That because my good result during the treatment. He tells me that my change to SVR is about 10 % lower than 48 weeks treatment. The estimate for SVR after 24 weeks treatment is ca 80 %, and with 36 weeks treatment will be in the theory 5 % more, and longer time to analysis all the blood test every 4 weeks.

But the doctor has to explain why he suggests 24 weeks treatment, when I had higher virus load than recommended for a 24 weeks treatment!

Kjell Olav  :)

[epiphiny]

Just wondering if your doctor is a liver specialist (Hepatologist), a Gastroenterologist or a General Practitioner?  Is he associated with a hospital or teaching hospital or does he run a private practice?  Also, how many other Hep C patients has he treated successfully?

[epiphiny]

Also, do you know the type of test that was used to determine your UND status?  Either then name of the test or the lowest sensitivity of the test?

[epiphiny]

Just one more question:  did you have a biopsy and if so what were the results from that?  What Stage and Grade of liver damage do you have?

All these questions are pertinent to making your decision.

[Isobella]

Please, until all the above questions and factors are considered, Don't stop tx while figuring it out. I just don't want to see an interruption in your tx until you decide what to do.  Another day txing=another day fighting.  Keep going, keep researching.  My feeling is you won't find any research info telling you to stop, based on the info given.

I am (was) geno 1a, went from vl 919,000 to 616 in 5 days and went the full 48 weeks,  currently I'm 5 months post and still UND.  

Tx is hard. SVR is our goal.

I wish you all the best,

Isobella

[chemister]

My doctor Bent von der Lippe is the leader at the medical infection post (clinic) He is working with hepatics like B and C and moreover. My nurse always has to ask him if she have problems to solve.
Ullevål (Oslo) is the country's leading provider of treatment for severely injured patients (trauma), and one of the largest in the field in northern Europe.
At the medical infection post he knew most of hepatic C treatment, than the other doctors. He treats most of the people in Oslo and area round. So I believe a lot.
I believe that he is a Hepatologist.
The test is hep. C virus RNA-PCR
Start virus load 2 700 000
1 week 6300 copies, 3 and 4 week negative = 0
I have no biopsy, only fibro-scan = 5.8 (my choice),
Then I had no fibrosis. Doctor had 6.4 when he used the fibro-scan on himself.
I know that the biopsy and fibro-scan would give a better result.

[Trish77]

I think this comment from FlGuy is important for you to consider:

"There is another possibility to consider. If you start treatment and get to undetected status and continue to the end of treament that way, whether it's 24 or 48 weeks it is possible to get rid one of the the geno types and not the other.  So, you could go for 24 weeks and get rid of geno 2 and then still have geno 1.  I think it was Susan400 who had both geno 1a and geno 1b and got rid on one of those in her many treaments."

I would personally look at your treatment in reference as a person with Geno 1 and higher viral load.  If you're looking at it as someone who's MOSTLY Geno 2 (how he would determine that is beyond me), it really has no relevance if your treatment is insufficient for the remaining theoretical 20% of Geno 1 virons - if your treatment is insufficient for them, you'll still have Hep C, you'll simply be left with potentially only Geno 1 and no Geno 2.  Not a great scenario.

You do mention you're having a tough time and that bears some consideration.  If it were me in your shoes (and it's not, so easier for me to say but still .... )  I'd look more to getting help with the side effects that are causing you grief, either by making lifestyle changes that help you tolerate treatment better or some kind of helper drugs that offset the harsher side effects.....and resolve to dig in your heels and try to get through as many weeks as possible to hopefully only have to do this once - as long as your overall health is not threatened by continuation of treatment.  

In the end, that's a decision for your doctor with regards to the overall threat to your health.. and for you, with you taking all factors into consideration for your own situation.

Good luck with this.

Trish

[Joey_M]

This is a very difficult decision for you - I can relate. I was GT 3a but HIV positive (very low VL and acute infection and RVR) so they wanted me to do 48 weeks but I reviewed a ton of research, emailed hepatologists evrywhere, posted here and decided to do the 24 weeks. I estimated that my probability of SVR was only a few percentage points better by doing 48 weeks and didn't want to suffer through more of the tx than need be. Quality of life weighed in heavily for me. I finished tx 4 months ago and was clear 3 months post so expect a SVR. That's just my story and many people here might have done the longer tx.

Based on what I have read, it seems like the 48 week tx would increase your probability of SVR by 10 or 15%. You have to weigh everything you learn against the odds and how you would feel if you relapsed after only doing 24 weeks. Honestly, I don't know what I would do in your situation. I might try a middle ground and aim for 48 weeks and if things get too rough after 24 weeks, cut the dosage or end treatment. That might allow your head to get through a longer course.

Good luck!