Type 3A Dr. Appt. Tomorrow

Hello - I was just diagnosed with hep C type 3a.  My mother died of HCV a year ago (she was 50).  I am in my 20s and very healthy otherwise.  I had an ultrasound done on my liver and they said there was some sligh echogenicity, but other than that it was okay.  My VL is 949,000.  I am just curious if anyone thinks I will need a liver biopsy?  Also, how painful is it really?  I see the doctor tomorrow, but I'm sure they'll make it not sound so bad (assuming I need it).  Also, I know since I am a type 3a that I have an "okay" chance at getting rid of it with meds.  Are there any other type 3s on meds out there?

Thanks!

[jools57]

Hi, I'm a type 3, heading into week 41 of treatment(tx). I am a slow responder(wasn't undetectible(UND) at week 4), so that's why the extended tx. They usually don't biopsy geno 3's, because they assume we will treat and clear easier then geno 1's. My Dr. did an ultrasound, but in retrospect I wish I had done the biopsy to have a better picture of how my liver was/is. I may have been more aggressive with the meds at the beginning of tx.
Wishing you all the best,
J

[desrt]

Yeah, get the biopsy. I've had a couple and they're not a big deal, especially if you have an ultrasound guided procedure. A little Versed, a little pinch, and you've got a much better idea what's going on. There is a small risk of complications (like 1 out of 5,000) but even if you're already determined to treat, I'd be curious about what shape my liver was in. Geno 3 has about a 80% cure rate, so it's your call whether you want to take that small chance or just go ahead and do the treatment. I was geno 3 and have been undetected 5+ years. Good luck.

[booocooo]

Thanks for the info!  Everything I have read/heard says do the treatment, but I am such a wimp with needles.  I know, wrong thing to worry about.  What is Versed?  Are there any drugs I can take before the biopsy that will semi-put me out (halcion?)?  

Is there a place to find out how bad the side effects will be?  I know they can be different for everyone, but is it something where I am going to have to take work off?  Thanks so much for the info, it really means a lot!

[desrt]

Versed is a sedative/hypnotic that will make it real easy to lay on your side for a few hours after the procedure. You have to be still for a while to minimize the chance of bleeding, but the V makes this no problem.

[medicmommy]

Hello!
I'm also a 3a...Getting a liver biopsy tells you where your liver is at with the inflammation and damage...If you decide not to treat right now, when you do, you may get another and compare it to your first...The antici[pation of it is way worse than actually getting it done...Versed will make you forget (or just not care!lol) about it...The side effects of treatment (tx) is different for all...I'm at day #10 of 24 weeks and each day a new side pops up...The worst is fatigue...I'd recommend taking a month off from work if you have a highly demanding job...just to see how txing effects you...As I'm a Paramedic, I didn't know how this would effect mine...So far, I'm really glad for the time off...I can't imagine trying to dose on time, resting or eating when I needed it or just trying to make it on a 12 hour shift picking up 300+ lb people...

[CockSparrow]

I am a G3 2 time non responder, not even had the joy of relapse – yet.
I like to consider G3 as the interesting Geno. At one and the same time we are easy to treat and yet can be quite difficult.

This was posted in another forum in a thread discussing short couse Tx.

Below is what the Accelerate study has to say.

Results
The sustained virologic response rates in patients with a pretreatment serum HCV RNA level of 400,000 IU per milliliter or less was 82% with the 16-week regimen and 81% with the 24-week regimen. Among patients with a rapid virologic response (an undetectable HCV RNA level by week 4), sustained virologic response rates were 79% in the 16-week group and 85% in the 24-week group.

Now for the Accelerate Stats

Per Protocol Analysis
GT............16Wk........24Wk
G2............65%..........82%
G3............65%..........71%

Modified ITT Analysis
GT............16Wk........24Wk
G2............62%..........75%
G3............62%..........66%

As you can see G2s gained quite a lot by extending.
For G3s this is not so apparent, as there was only a trend to higher SVR.
Interesting that the SVR rate was identical with in the 16 weeks arm, even though G3s had a lower on Tx VR, see below.

On Treatment response for each Genotype.

16 Weeks
Rapid virologic response rate
Genotype 2, 69% (257/372)
Genotype 3, 64% (230/358)

Early virologic response rate
Genotype 2, 91% (338/372)
Genotype 3, 87% (312/358)

Virologic Response rate at End of Treatment
Genotype 2, 90% (335/372)
Genotype 3, 89% (317/358)

Sustained Virologic Response rate
Genotype 2, 62% (232/372)
Genotype 3, 62% (221/358)

24 Weeks
Rapid Virologic Response rate
Genotype 2, 69% (247/356)
Genotype 3, 59% (219/369)

Early Virologic Response rate
Genotype 2, 94% (333/356)
Genotype 3, 85% (314/369)

Virologic Response rate at End of Treatment
Genotype 2, 84% (299/356)
Genotype 3, 80% (296/369)

Sustained Virologic Response rate
Genotype 2, 75% (268/356)
Genotype 3, 66% (244/369)

So how did the various subgroup go.
................................16 Weeks..................24 Weeks
HCV GT.....................Number.....SVR..........Number.....SVR
2..............................232/372....(62%).......268/356....(75%)
3..............................221/358....(62%).......244/369....(66%)

Pretreatment HCV RNA level
Genotype 2
400,000–800,000..13/19........(68%).......27/34........(79%)
>800,000................167/290.....(58%).......196/267....(73%)

Genotype 3
400,000–800,000..29/45........(64%).......32/46........(70%)
>800,000................113/216.... (52%).......138/232.....(59%)

Cirrhosis or Bridging Fibrosis pretreatment
Genotype 2
No...........................180/269.....(67%).......210/266....(79%)
Yes..........................52/103......(50%)........58/90.......(64%)

Genotype 3
No...........................186/277.....(67%).......207/294....(70%)
Yes..........................35/81........(43%).......37/75........(49%)

Liver Steatosis at Baseline
Genotype 2
No............................129/198.....(65%).......151/192....(79%)
Yes...........................24/44........(55%)........27/35.......(77%)

Genotype 3
No............................91/140......(65%).......102/143.....(71%)
Yes...........................58/109......(53%).......60/109.......(55%)

Rapid virologic response
Genotype 2
Yes...........................200/257.....(78%)......210/247....(85%)
No............................ 27/103.......(26%)......53/100......(53%)

Genotype 3
Yes...........................185/230.....(80%).......187/219....(85%)
No............................31/117.......(26%).......57/145......(39%)


So Accelerate tells us that G3s have slightly lower RVR rates than G2s
G3s also have lower EVR and EOT rates than G2s.
As can be seen G2s gained a far greater benefit by extending to 24 weeks than G3s
This stat jumped off the page at me Surprised the hell out of me that did.
For G2s it would seem that HVL begins at 800K whereas for G3s HVL begins at 400K.

Whats also clear is that G3s who RVR are dead easy to treat, at least as easy as G2s.

However G3s have several negative predicts at baseline. These are;
• HVL
• Steatosis
• Fibrosis Stage

For G2s only F3-4 Fibrosis stage produces slightly lower SVR rate. This is contradicted by the Canadian Power study which showed that G2s had minimal differences in SVR regardless of Fibrosis stage. Whereas for G3s reduced SVR rates occurred when F2 and above with F4 having particularly bad SVR rates.

http://www.hivandhepatitis.com/2007icr/aasld/docs/110907_c.html
Future Studies Should Avoid Combining Genotype 2 and Genotype 3 Patients Due to Lower Response Rate in the Genotype 3 Population

Power Study Stats
Baseline.....G2 (n=276) G3 (n=389)
HVL...........83...............65
LVL...........79...............76
F0 - F1......80...............80
F2.............81...............68
F3.............80...............71
F4.............77...............47

• Numerically, more genotype 3 than genotype 2 patients had high viral load (HVL; 49% vs 44%) and advanced fibrosis or cirrhosis (stage F3-F4) (40% vs 33%).
• Genotype 3 patients had lower SVR rates than genotype 2 patients (72% vs 79%; P = 0.04), attributable to a lower end-of-treatment response rate (77% vs 86%, P = 0.01);
• Relapse rates in genotype 2 and genotype 3 patients were identical (7%).
• An inverse relationship was observed between SVR and fibrosis score in genotype 3 patients.
• Less than 50% of genotype 3 patients with cirrhosis attained SVR.

However the following makes it difficult to draw too many conclusions, even if it does give a hint.
• Baseline viral load and fibrosis scores were available for
• 72% of genotype 2 patients and
• 37% of genotype 3 patients.

If the relapse rate were 7% for both G2s and G3s
how does 77% - 7% = 72%??
You have got to wonder sometimes.

Now there are studies that support the above findings on poor G3 response rates compared to G2.

Exploring differences in response to treatment with peginterferon alpha 2a (40kD) and ribavirin in chronic
hepatitis C between genotypes 2 and 3. Journal of Viral Hepatitis, 2007 doi:10.1111/j.1365-2893.2007.00889.x

This was also a Canadian study that produced strikingly similar results to the Power study. However G3 F4 only had a 17% SVR rate in this study.

All the European short course studies Mangia, Dalguard, von Wagner all had lower SVR rates for G3s than for G2s.

For both G2s and G3s non RVR makes us quite difficult to treat as the SVR rates are 80% regardless of Tx length. Its only when we have multiple negative predicts and especially when we fail to RVR that we become quite difficult to cure.

Reply
It looks as if the crucial factor is viral load. Below 400,000 treatment length does not seem to make any significant difference, assuming no other contributory factors are present. The other factors such as cirrhosis and steatosis are likely to be the problem as very few biopsies are done pre-treatment for G2 and G3.

[CockSparrow]

Correction
For both G2s and G3s non RVR makes us quite difficult to treat as the SVR rates are 80% regardless of Tx length. Its only when we have multiple negative predicts and especially when we fail to RVR that we become quite difficult to cure.

This para should have read
For both G2s and G3s  RVR makes us quite easy to treat as the SVR rates are >80% regardless of Tx length. Its only when we have multiple negative predicts and especially when we fail to RVR that we become quite difficult to cure.

[desrt]

Thank you for putting that all in one place. Good one for G2s/G3s to bookmark when making tx length decisions.

[zazza]

"If the relapse rate were 7% for both G2s and G3s
how does 77% - 7% = 72%??
You have got to wonder sometimes."

1% of 77% = 0.77%
0.77% x 7 = 5.39%
77% - 5.39% = 71.61% (which is almost 72%)

:)

[CockSparrow]

Trust you. So i cant count wotz new. I work in IT 1s & 0s only for me.
CS

[CockSparrow]

Thanks
Had to cut bits out, believe it or not but theres 8000 chars in that.
Word didnt think so but hey.
CS

[CockSparrow]

Just realised MedHelp doesnt like less than 400,000 with the < sign
To anyone else < at the begegining of a line = delete
so here they are again

Pretreatment HCV RNA level
Genotype 2
l400,000–800,000...13/19........(68%).......27/34........(79%)
>800,000................167/290.....(58%).......196/267....(73%)

Genotype 3
l400,000–800,000.....29/45........(64%).......32/46........(70%)
>800,000.................113/216.... (52%).......138/232.....(59%)

[CockSparrow]

One more time
Pretreatment HCV RNA level
Genotype 2
Less=400,000.........52/63.......(83%).......45/55........(82%)
>400,000–800,000..13/19........(68%).......27/34........(79%)
>800,000...............167/290.....(58%).......196/267....(73%)

Genotype 3
Less=400,000..........9/97........(81%).......74/91........(81%)
>400,000–800,000...9/45........(64%).......32/46........(70%)
>800,000..............113/216.... (52%).......138/232.....(59%)

[zazza]

Medhelp really should get that function working. That is a bother.

Remember, it is 7% of the EOT UND who relapse, not 7% of the total group.

You can too count, I saw that on the other side. OK, it was a bunch of 1's and 0's, but apparently you have total control over them!

[medicmommy]

Thank for the #s! I'm a 3a, so these are significant to me...gives me hope, if I'm unable to finish tx because of sides, and I SVR early, there's hope...But for now, I'm doing the 24 weeks...(This being said at day #11!LOL)