Viral Load Going Up during Treatment

I am in my 18th week of a 48 week treatment plan and received word that my viral load went up from approx. 52,000 to 63,000.  Is this something to be concerned with?  I cannot speak to my Dr. at this time and I am a little nervous about the call from the Dr.'s office.  The person calling could not give me any information.  The medication (shot) has to be refrigerated.  Could the medicine have been compromised during shipment causing this?  I know I need to visit with my Dr. and I will.  I was just wondering if any one else has experienced and increase, as I was expecting a decrease as all of my other results during treatment.

[NavyMan2219]

I have Geno type1 and only do the Ribo and Interferon for treatment.

[can-do-man]

A viral load at week 18 doesn't sound good, I am sorry to say but is doesn't sound like treatment is working for you... Please talk to your doctor.

[Idyllic]

Might I ask what was your baseline viral load?
Did you have ≥ 2 log 10 drop in viral load at week 12?

I am a Geno 1a and I had to stop dual therapy (Pegasys & Ribavarin) at week 19 since there was no change in my VL after week 12. I wanted to hang in there in hope something would happen but in retrospect I should have followed the stopping rule.

We Geno 1s don't have a good track record with dual therapy.

[ceanothus]

I hate to say it but this sounds like your treatment is unlikely to succeed. But why is it that you are taking only interferon and ribavirin? This was all that was available for a very long time but it never did offer very high success rates for those with genotype 1. I took it for 15 months and still failed to achieve SVR. I think the rate of SVR with genotype 1 and those 2 drugs alone is only about 30%. The next generation treatment has been available since May 2011 and it has much better rates of SVR for genotype 1. This treatment includes the interferon and ribavirin, but also adds a protease inhibitor drug for part of the tx, either Incivek or Boceprevir. The combo is hard to take but is far more effective, with genotype 1 (without cirrhosis) getting SVR rates if around 85%. When I last treated with SOC (the term for the 2-drug treatment), it took me about 4 months of steadily decreasing viral loads to finally achieve UND. I stayed UND through 15 months of tx, but the virus returned within 6 weeks after stopping tx. I started again in Sept 2011 with the triple drug tx (and with cirrhosis), got to UND before week 8, stayed that way for the rest of my 48 weeks of tx, and now I am looking forward, hopefully, to being declared SVR in another 9 weeks (that will be if I am still UND at 24 weeks after tx). Is there a reason you weren't put on the three drugs?  I hope it is a good reason and not just that your doctor is hopelessly out if date. If your doctor is unaware of current best treatment standards then it would certainly be time for you to find a doctor with more current and in-depth training - ideally a hepatologist who has treated a lot if Hepatitis C patients already.

Whatever is the reason for your current tx, you should also know that if you have a recent biopsy showing little or no damage to your liver then you might want to discuss the option of waiting a couple of years to treat. This is because there are new drugs now being tested that seem to offer far better results with very few side effects, and it is expected they will be on the market in a couple of years.   I hope I haven't depressed you too much, and I hope some of this info is helpful. Best wishes!

[timothy141]

Not that I am as knowledgeable as I wish I were, have been treatment for eight weeks. I have 3a, and because of that my tx is dual,peg and copeg. I am surprised that your not tx with a a 3rd med, for sure you you not be seeing an increased VL,@ 18 weeks or at any point actually.
I have to agree with ceanothus"Is there a reason you weren't put on the three drugs?  I hope it is a good reason and not just that your doctor is hopelessly out if date. If your doctor is unaware of current best treatment standards then it would certainly be time for you to find a doctor with more current and in-depth training - ideally a hepatologist who has treated a lot of Hepatitis C patients already."
Obviously your committed, seek out another route if need be, I cant imagine how I would feel other than highly perturbed. Good Luck  

[NavyMan2219]

First thank all of you  who responded. After writing the Q the Dr. called and wanted to see me. I get to stay on treatment one more month to see what viral loads do. To answer some of your questions...I am a geno type 1a. My Dr. tells me that the treatment for my type is 3 ribov pills 2x a day and 1 shot of peg interfero n each week. My levels began at 1.3 million.  I looked at my numbers yesterday and last month it had dropped to 51 thousand but this month it went up to 68 thousand.  I am glad to hear there are new treatments on the horizon. I am lucky in the fact that I have no liver damage to date.  My wife wants me to get a second opinion before abandonong treatm.   Everyone I delt with seemed to question why I wasn't on the third drug but my Dr. assured me this type only used the 2 txs.

[pooh55811]

"I am a geno type 1a. My Dr. tells me that the treatment for my type is 3 ribov pills 2x a day and 1 shot of peg interfero n each week...... Everyone I delt with seemed to question why I wasn't on the third drug but my Dr. assured me this type only used the 2 txs."
-------------------------------------

If you have Hepatitis C Genotype 1 a, your doctor is dead wrong. The current guidelines for treating Genotype 1a or 1b is the triple medication regimen using Interferon, Ribavirin, and a protease inhibitor (either Incivek or Victrellis). The triple med regimen has been the treatment for Genotype a since June 2011. (Approved in May 2011).

"Approved Treatments for Hepatitis C"

The current standard of care (SOC) for hepatitis C:

•  Genotype  1:
A combination of pegylated interferon, ribavirin and an HCV protease  inhibitor (boceprevir or telaprevir). The standard duration of  treatment  is a total of 24, 36 or 48 weeks.
o Pegylated interferon is a subcutaneous  injection—once weekly.
o Ribavirin is a pill. The dose is based on body  weight (1,000/1,2000mg) and divided into two equal doses twice a
day.

HCV  protease inhibitor (boceprevir or telaprevir) is taken every 7 to 9  hours  with food – boceprevir can be taken with a snack or meal; telaprevir  is taken with food that is not low-fat.
*Ribavirin tablets should be taken with food"

http://hepatitiscnewdrugresearch.com/approved-treatments-for-hepatitis-c.html

Here is a PDF that gives you some information. Go down to page 4 under standard of care and you will see that the current standard of care is the triple medication regimen.

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Interferon,%20Ribavirin%20and%20HCV%20Protease%20Inhibitors.pdf


"My wife wants me to get a second opinion before abandonong treatm. "

I agree with your wife. If you have Genotype 1, your current doctor may be jeopardizing your current and future treatment by prescribing the incorrect treatment protocol for you. This is very blunt but, if your doctor does not know the correct treatment protocol for treating your Hepatitis C, then it is imperative that you get a Hepatologist who does know what he/she is doing. If it was me, I would run, not walk, to a reputable, knowledgeable, and competent Hepatologist. I do not know where you live but most major cities have Hepatologists. They will sometimes be listed under Hepatology and sometimes under Gastroenterology (with a specialization in liver diseases). Seeing a competent and knowledgeable Gastroenterologist would be fine. Those who treat liver disease should say that when you look the up (ie specializing in liver disease).

Wishing you the best. I hope you can find a doctor who is competent and experienced in the current treatment for Hepatitis C Genotype 1.

[NavyMan2219]

Thank you all for your information.  However after reading this I wanted to make sure of my genotype.  I am so sorry that i wasted your time as I am a genotype 1b.  I would have sworn I was a 1a but i was mistaken.  If you have a link to where you got this information for treatment I would really appreciate it.
Thanks, and again I am sorry.  I hope you know how this medication messes with your mind/memory.

[pooh55811]

You did not waste anyone's time. Genotype 1 is Genotype 1 whether it is Genotype 1a or Genotype 1b. Triple med treatment is used in both Genotype 1a and Genotype 1b.

The links have to be copied and pasted. The forum is not set up for "live links." In other words, you cannot just click on the links I provided. You have to copy each link and paste it into the address bar. Then you can search for it and it will come up.

The following information is from Hepatitis C New Drug Research and Liver Health. It specifically states 3 drugs are used to treat Hepatitis C Genotype 1 (that means both 1a and 1b). The link is at the bottom:


"Approved Treatments for Hepatitis C"

The current standard of care (SOC) for hepatitis C:

•  Genotype  1:
A combination of pegylated interferon, ribavirin and an HCV protease  inhibitor (boceprevir or telaprevir). The standard duration of  treatment  is a total of 24, 36 or 48 weeks.
o Pegylated interferon is a subcutaneous  injection—once weekly.
o Ribavirin is a pill. The dose is based on body  weight (1,000/1,2000mg) and divided into two equal doses twice a
day.

HCV  protease inhibitor (boceprevir or telaprevir) is taken every 7 to 9  hours  with food – boceprevir can be taken with a snack or meal; telaprevir  is taken with food that is not low-fat.
*Ribavirin tablets should be taken with food"

http://hepatitiscnewdrugresearch.com/approved-treatments-for-hepatitis-c.html


And ...Here is a PDF that gives you some information. Go down to page 4 under standard of care and you will see that the current standard of care is the triple medication regimen. You need to copy and then paste the following URL  into the address bar

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Interferon,%20Ribavirin%20and%20HCV%20Protease%20Inhibitors.pdf


These articles will tell you what you need to know about treating Hepatitis C Genotype 1b. But the bottom line is, if you have Genotype 1b, then you should be on the three medication regiment (not the 2 medication regimen).

[Idyllic]

Pooh has the right of it: Genotype 1a and 1b follow the exact same treatment protocol.

This is why it seems unusual you are on dual therapy rather than triple therapy. There are some Geno 1s who might attain SVR with dual therapy such as those with favorable IL28B phenotypes. Other than that I too was wondering why you are treating with only the Interferon & Ribavarin since we Geno 1s (a or b) do not have much luck attaining SVR with just those two drugs.

[copyman]

I'm sorry to inform you that treatment is NOT working for you and you should stop. For you to even have a remote chance of cure you would had to have been clear of virus at 12 weeks.

I'm even more sorry to tell you that your doctor knows nothing about treating HCV ! They should be sued for malpractice! They have subjected you to needless pain and suffering by allowing you to continue treatment past 12 weeks!

The biggest question is WHY you are not on triple therapy? Unless you are in a country were one of the third drugs are not available?

Consult with a Hepatologist (liver specialist). They will know the latest protocols. One of the most important protocols is to be undetected by 4 weeks.

best of luck

[BoceprevirGal]

   I was Undetected, after 4 weeks on the Ribaviran, and Interferon, but I took 6 200 mg Riba pills a day. Can you look and see how many milograms your Riba pills are?
   It goes by weight, but Men usually take the same as what I took, (a big woman, lol) which is 1,200 mgs.
   I am under the impression that it is important to discontinue the Interferon, as soon as your viral load goes up.
   You could try adding the Incivek now, and do that for 12 weeks, and then 18 more weeks of the Interferon shot and Riba only, again, which would be unconventional, but still has a shot at working.
   The more rapidly you respond to Interferon,and go Undetected, the better chance you have, of remaining cured, after you are finished taking the meds.  You havent even gone Und yet, and it is week 18. Interferon can cause permanent joint pain.
   Your Doctor may have been trying to Treat you, with just the SOC, but it is obviusly not working. He was supposed to add the third med, a Direct Acting Agent, which specifically targets Hep C, Incivek at onset, or Victrelis at 4 weeks.
    There are new Interferon Free Treatments coming along, withinn 5 yrs time.  You arent responding quick enough, to the Interferon, although your Doctor could try adding the DAA very late inthe ball-game, but I have never seen this done...but it could be done. Your viral load is lower now, so it may still work~

[ceanothus]

There is a lot of controversy about interferon because it not only makes most people sick while taking it, but it can occasionally cause permanent and disabling side effects. I generally have argued in favor of interferon if one has liver damage because I believe the risks of advanced liver disease are worse than the risks associated with interferon. Your case is quite different however. Once you went past 12 weeks of tx without achieving UND, you have gone into an area where it is pretty much ALL risk with almost zero chance of benefit. Your doctor is very badly out of date and is treating you with a level of knowledge that is less than most hepatologists had 20 years ago. Please see a good hepatologist ASAP! There is a thread that might help you in locating one near to you: http://www.medhelp.org/posts/Hepatitis-C/Who-is-your-good-doctor-/show/1715783
Please don't delay, this is important!

[Advocate1955]

I'm sorry to say that everyone who posted above is correct.  The current Standard of Care for Genotype 1a or 1b is triple therapy, which includes Interferon, Ribavirin and one of the two protease inhibitors (either Incivek or Victrellis).  These two new protease inhibitors became available in May or June of 2010.  Your doctor should have put you on three drugs instead of two, to increase your chances of clearing the virus.  Also, your doctor should have stopped your treatment at 12 weeks because you did not have a 2 log drop in viral load at that time, which means that Interferon and Ribavirin are not working for you.  It may be possible that with a good hepatologist or gastroenterologist who is knowledgeable about Hep C treatment, you could treat again with Interferon, Ribavirin, and one of the two protease inhibitors and still have an increased chance of success over the dual therapy that you are currently doing that isn't working.  I don't know if you would need to wait awhile before trying again.  On the other hand, since you have no liver damage, you could potentially wait until the new medications become available.  If I were you, however, I would see a gastroenterologist or a hepatologist before doing anything.  Make sure that you have copies of all of your lab results, your liver biopsy, and any other records too.
Advocate1955

[Advocate1955]

What country are you living in?
Advocate1955