UND at 4 vrs 6 weeks

Dose anyone know if it makes a big diffreance if you missed your 4 week tx VL test ? Is it okay to check it at 6 weeks? . Will that be telling information as to how I'm responding to the tx . My doctor dose not think I should be worried about the  VL . Just stay on the full dose.
The side effects are getting worse here in the 6th week and I would be interested to see how well it is working or not . I would like to return to work but feeling to ****** . Wondering if I cut back on the Riba I would feel better ...enough to return to work .  But wondering about the % of not getting a great result if I cut back . I'm geno type 2b . I read somewhere that I could clear in 16 weeks for good...... any one have the numbers ? So far I'm being $$$ wiped out and still have months to go . I cannot imagine having to endure this for 9 months congratulations to all of you trying to kick this virus .

[Texas714]

If you didn't get the test at 4 weeks, there's nothing that can be done about it now.  I'd say test as soon as you can.  The fact that you did not test has nothing to do with the tx working or not.  It would be importaint to know so you could base what to do with your tx going forward.  Why did you miss it?  As far as cutting back on your meds, I would never want to do that and I never would think of doing that unless the dr. insisted on it.  And as far as treating for 9 mos. I think 2bs treat for 6 months typically.
Good Luck to you what ever you decide to do.

[rita863]

JJ said it all,

my doctor did not test until 12 weeks, had i know i would have demanded a test at 4 weeks and 8 weeks but there nothing i can do now.  

peace
rita

[Trinity4]

The latest approach is to check vl at 4 wks however, some doctors such as mine don't check until the 12 week mark.  The whole point of checking vl at 4 wks is to see if you are UND and if so gives you a much greater chance of clearing the virus.  You are a geno 2 and your odds of clearing are higher than those of us who are geno 1's.  I agree with your doctor about staying on the full dose.  You don't want to reduce dosages this early in treatment unless you absolutely have to because it will lower your chances of SVR.  The standard length of treatment time for geno 2's is 24 wks.  Yes, you can clear in 16 wks but I would stay on the 24 wk course just to make sure. I am on my 13th week of tx and work full time.  I'm a geno 1 so I've got to go the full 48 wks unless I am not UND at 24 wks and then I will not continue tx because my chances of clearing are only like 2%.   I don't feel great but keep going because I need the insurance and the money as well.  Sometimes I just want to have a fit and fall in it as they say down here in the south but because there is the possibility that I can be healthy again I just keep going forward.  Good Luck and stay on course  - hoping you get your SVR
Trinity

[jmjm530]

Unlike the four week test, there is no data for a six week test that I know of. Still, a situation may result where extrapolating may be better than outright guessing. If it were me, I'd get a vrial load test the day before my next injection, and get the most sensitive test available -- at least down to 50 IU/ml or lower.

[H20Lover]

Hi there....I too am (hopefully was) a geno 2.  I did the full 24 weeks at full dose.

As for your quyestions, yes it would have been best if you could have been checked at 4 weeks, but I would still encourage you to have it done ASAP.  

Being negative of course is the goal and the sooner you go negative the better your chances of SVR are.  Having a negative result or not having one tells the doctor how you are responding to the threatment and this gives you either a Positive indicator or a Negative indicator.  If you are not undetected by 12 weeks for instance they doctor would (you would think) consider extending the treatment.

The stuff you are reading about with the 16 week studies will work for some, but I beleive you must be undetected at 4 weeks to even consider that.  I was, but did the whole 24 weeks because I only wanted to do this once and wanted to give myself the best shot at it I could.

The sides are not fun that is for sure, and I was lucky in that respect that I could keep trucking on, but to me it was worth it to do my best to get rid of the creeping crud that was in my body.  It seemed a small sacrifice to me.

I too though don't know how some of these geno 1's do up to 72 weeks and some have done it several times.  

Geno 2's (although not 100% cure rate) are the lucky ones.  I alwyas treid to remember that when things got a bit rough and I did not want to go to work.

Keep the faith....time will pass....AND DO NOT REDUCE THE DOSAGE UNLESS YOU ABSOLUTLY HAVE TOO.  Ask for helper drugs if the blood counts get too low.  

Get the doc to order the Viral Load and go from there.  You may have to explain to the doc why it is important.  A lot of them just don't know enough aobut it.  Let us know what you find out.

Best of luck to you!
Pam

[HectorSF]

Without the test at 4 weeks you will not know if you can safely reduce riba. (you don't want to reduce meds if virus is You will not know if you have about a 90% chance of SVR. And you will not know if you can shorten treatment. All the data out there in studies to determine the above items are based on 4 week viral load test.

Do the test ASAP if you still have virus than none of the above apply so you will need to see if HCV RNA becomes undetectable by 12 weeks. Then you can do what the data says for EVRs.

Best of luck to you!
Hector

[HectorSF]

For more information about genotypes 2 & 3 see the following paper from Medical Crossfire. I have provided a few excerpts below.

"Chronic Hepatitis C
Strategies for Optimizing Current Treatment and the Potential Impact of Emerging Therapies
Jointly Sponsored by The American Academy of CME, Inc. and Medical Crossfire®/Liberty Communications Network".

"A number of PEG-IFN alfa-based studies show that when patients do not achieve an RVR there is a significant decrease in response rates if therapy is altered. The ACCELERATE trial showed that if a patient is not virus negative at week 4, the chance of response to shortened therapy is 27% versus 49% if therapy is extended to 24 weeks. So it is reasonable to make the extrapolation and ask, Should one consider extending therapy in a genotype 2 or 3 patient who did not have an RVR?”

...The fourth study, the ACCELERATE trial, was coauthored by Dr. Shiffman.15 “It is
the largest of the four studies and included 1,469 patients with genotypes 2 and 3,” observed Dr. Di Bisceglie. The patients were randomized to receive PEG-IFN alfa-2a plus
ribavirin for either 16 or 24 weeks. “This study was large enough to allow us to compare
responses in genotype 2 and genotype 3,” commented Dr. Di Bisceglie. The results
are summarized in Figure 5. Among patients with genotype 2, the SVR was 65% at 16
weeks and 82% at 24 weeks. Among patients with genotype 3, the SVR was 65% at 16
weeks and 71% at 24 weeks. Remarked Dr. Di Bisceglie, “Treatment response rates were consistently lower with 16 weeks of treatment.”

Having reviewed the data from these four key trials, Dr. Di Bisceglie drew the following
conclusions regarding the treatment of patients with genotypes 2 and 3: “First, 800 mg
of ribavirin a day is sufficient. Second, there are conflicting data on SVR rates when the
treatment duration is less than 24 weeks. Finally, some of the variables that may affect
response include the difference between genotype 2 versus genotype 3; the presence of
hepatic fibrosis or cirrhosis; and viral load.”

Cheers!
Hector

[jjhvc]

THANK YOU !
Okay looks like i got the incouragement i need to stay on the full dose for 24 weeks  1000 mg rib a day +  180 Peg-in alpha 2a weekly .  
Doctor said today I'll start feeling better soon. This is week six. The anti depressants have started to lift the depression blanket . I have more energy today than i've had in weeks .
I missed the vl test because  I had blood taken at my primary care providers last time before i left the country and they mess up and just did only the chem panel and the cbc. I went to my doc here and they can't do the frozen blood thing here so I'll wait till the 12th week i guess when I'm back in the US and go from there .
going to force myself to return to work next week no matter how i feel. Thanks again all of you for the info and support . One day at a time . Al the best recovery to all ... Jan

[jjhvc]

jjhvc  is UND at week 12 !!!!!!! Yeah yipppeeee
Thanks to all of you,  for your info and support and Much thanks to HectorSF for the post above. Just the info I needed to make an intelligent decision .
Doc said being UND at 12 weeks and liver being back to normal I could safely reduce the Rib to 800 a day. I'm trying to get my energy back to try to go back to work part time to help pay for all this -$$$ time off has accumulated.
Wishing all of you Success w/ your treatment ! Jan

[jmjm530]

Regardless of the study posted, I would stay on weight based ribavirin for the duration, and ask for Procrit (epo) if my hemoglobin and side effects warranted it. I have not read the full-text study in detail so don't know the parameters but do know that the trend with a number of cutting edge clinicians is weight-based ribavirin for all genotypes and the use of helper drugs like Procrit instead of dose reductions.  I think this would especially be important if you have significant liver damage or are unsure of an RVR which seems to be the case since I believe the first time you were tested for viral load was week 12?

All the best,

-- JIm

[desrt]

What Jim says is correct, but if you are unable to get epogen in a timely manner, I wouldn't worry about reducing by one pill, especially if it's in the latter half of tx.

[jmjm530]

I agree with "desert" about not worrying much if your side effects warranted reduction now as epo (Procrit) may take 2-4 weeks to kick in. So if your hgb and side effects do warrant reduction now, one possible strategy to discuss with your doc is to start epo (Procrit) now along with dose reduction, and then go back to weight-based ribavirin when your hgb comes back up. What I take from all the riba studies is that it's role is still not fully understood (compared to Peg for example) but that its role seems to become increasingly more important the more it is studied. So, if you can tolerate it, and especially if your liver damage warrants it, then IMO try not to reduce it.

[H20Lover]

Hello, I too am (was) a genotype 2 as you may remember from earlier in this thread and I still feel the same that you should not reduce it unless you have to.  Hopefully helper drugs can work for you.  

It is important though not to slack just because you think you can because  there seems to be a link between high concentrations in the blood of the Ribavirin and a higher rate of SVR.  Our goal here is not just to beat this thing but to beat it the first time if we can.  

My blood work got real low, but fortunally I did not need helper drugs (my doc was brave with me) and I never reduced my 1000 a day even though I lost weight.  

We have to give ourselves every opportunity we can to beat this.

Good luck!

Pam

[nygirl7]

I'm not quite understanding what being UND at week 12 has to do with your "liver being back to normal" and being able to ''safely" dose reduce?

When all of the current studies say stay on weight based riba why would anyone assume that first that your liver is "normal?" and second it would be ok.

At all costs please....stay on the full dose of meds.  Just in case you are not REALLY UND (being UND and REALLY being UND are two SEPARATE things completely) you need to make sure your body is 100% synch to fight any infection that is left.

What was the sensitivity of your test?

Please.......if you have any way possible to stay on weight based - please stay there.  You have so FEW weeks left of treatment...it's almost over for you try and hang on.

You do NOT ever want to do this treatment again - for longer - on stronger doses.

[jjhvc]

By normal liver I was referring to the AST and ALT being in the normal range  for the first time in years .
The Procrit as a helper drug is a possibility if the RBC gets below 10
it was 10.8 at 12 weeks .
The catch 22 here is that the $600 a week it would cost.
If I could get some energy back I could go back to work and afford the helper meds to stay on the full dose of Rib .
What I discussed  with the doc was if she thought it might be safe to reduce the Rib if I was UND at 12 weeks.
The lack of energy has me so  down and out . I need to get back to work to afford the helper drugs that would help me be able to go back to work and stay on the 1000 a day.
Now after reading your post I guess I could go back to the full dose and hope my RBC dose not drop to low and not go back to work until it's over and worry about getting out of debt then.
Looks like all the advice here is to stay on the full dose in spite of the doc's advice . So I'm back to popping the full dose and hoping the helper drugs won't be necessary.
For sure I do not want to do this again!
I'll have to ask about the sensitivity of the test and get back to you after the weekend if Fay dose not come my way.
Please stay on Power !!!!!! Scarry thought the Bugs the Heat and the  Rash!