When UND?

There's a lot of talk about UND at wks 4 and 12.  But everything I've read on tx only talks about a 2 log drop by wk 12.  Perhaps for many, this equates to UND, but there are some, myself included, where a 2 log drop is still a ways off from UND, especially using the more sensitive tests.  Which raises the question as to when should a person expect to achive UND?

It seems most tx will also measure at a tx half way point, should UND be attained by then?  If not, is the person SOL as far as the IFN/Riba tx working for them?

What factors would figure into these expectations of UND (i.e. IFN/Riba dosages, augmenting tx with meds for anemia, depression, neupenia, etc.)?

It would be greatly appreciated if anyone who has information on this would share.  I see all kinds of info on duration of tx as far as attaining SVR, but all seems to hinge on UND early in tx.  While all well and good, it is painting a dismal picture for some who still have sights set on simply reaching UND, especially when several months into tx.

[fishdoc]

well, the most important factor is the smegma levels...

oops wrong thread... I think the term for 12 week und may fall in the group EVR... early viral response... they have the best chance of svr... next is the ones with a minimum of 2 log drop, or less than 6000 viral count.. they are responders.... I failed at both, and was considered a "nonresponder", even tho I was only 8000 lousy viral bas!ards away from a two log drop...Consult Dr. gave my less than 5% chance of svr if I had continued the same protocol...  now this is just my memory, and these days between cheating with brian and smegma smeared mice, I am easily confused and could be dead @ss wrong..

[tonybuck]

what do you meam when you say a 2 log drop

[GrandOak]

A 2 log drop is a logarithmic drop in VL.  The following link explains how VL equates to a logarithmic value:

http://www.hepatitis-central.com/hcv/hepatitis/loadchart.html

[Dale_Ray]

Confused issue to say the least. I know what my treatment plan was based on Pegasys/Copegus guidelines. The term UND was never used by my doctor. Only that if I had not responded with a 2 log drop in the first 12 weeks the treatment would be stopped. At week 12 I dropped from slightly over 1 million to 826. The doctor (hep specialist)was very happy with this result and said we would check the VL again 6 months post treatment. Remember this though I have low to mild fibrosis based on biopsy and my liver enzymes have always been in the mid range of normal. Your condition at the time of treatment has everything to do with it. My primary care physician was against me going to treatment. He contended that going through this treatment was not necessary. I was in good health and just to keep doing what I was doing. I made the decision to push forward on the treatment. I treated in 96/97 with interferon (3 shots a week) and did not respond in 4 months so the doctor stopped the treatment. So again there is another element to the puzzle. My doctor says if you respond in 12 weeks the next key check will come at 6 months post. Eveything else in between is patient curiousity. I'm not that curious. I believe we over think this virus sometimes because we are so desperate to clear. I want to clear permanently but I may not. It will probably be in five years time there will be a little white pill you take one time and it clears hep - wishful thinking. Dale

[tonybuck]

great link I read through it briefly I will get back to it agian. It led me to want to ask my doctor what virus eguivalents they are using to test my blood. Thanks

[GrandOak]

Thanks for sharing your experiences.

I talked with someone last week at our HepFest who actually went through 5 tx's (both old 3 times per wk and new 1 per wk IFN) before finally attaining SVR.  It gave me hope that while one may lose the battle with Draco during a tx, the war is not actually over until one is defeated.

As I originally indicated, I too have seen most dicussions center on log drops.  When mine dropped from 72 million to 1.8 million in 8 wks, I was elated to see a response and hopeful of a one shot tx to kill the dragon.  Since then things have not gone as planned, which is why I'm more curious on all the emphasis on early UND vs. later UND and their impact upon attaining SVR.

While I applaud all who have attained UND, I can also understand how it can be discouraging for those of us who have not to maintain hope that it can be attained when those who have a tougher row to how are fewer and their testamonies are rarely heard.  That is why I'm looking for these and information which can be shared with others who have to travel this less worn path during their battle.

[NYgirl]

The new data from the new studies is saying that two log drops no longer are the defining rule = that in order to be pretty much guaranteed the 50% chance at SVR you need to be BY WEEK 4. (For geno1, nobody is studying the other geno's for some stupid idiot reason).

Otherwise it is looking like additional treatment is WARRANTED to cut down the odds.

As you know I was not UND until somewhere between 12 - 24 so we have to go by 24.  

Does that mean give up? Discouragement? No it just means I'll extend treatment and fight harder.

MOST doctors do NOT have any idea that this NEW logic exists as they have NOT been involved or researched the STUDY data that I posted on before.

Ask your doctor flat out to explain the TeraVIC study to you to see if they have a clue or not.

Does it mean anyone who is not UND at week 4 and does NOT do extended will not get SVR?  No.  It just GREATLY improves your odds.

That is all.

[NYgirl]

PS I had a 3 log drop by week 4 and then stayed flat at 400 lousy little virus until I cleared between 12 and 24 somewhere.

So while I was a very rapid responder...I got stuck and turned into a not rapid responder in the end.

That's why I think they are changing their logic...cause by all FIRST accounts things looked fantastic (for ME a geno 1A and 1B especially) but in the end...really WERENT so great.

[bobbyullc]

an und at 4 weeks says loads about svr. the chance of svr goes way up if svr at 4 weeks as opposed to 12 weeks. i would have paid for my own @ 4 if i had known.
bobby

[Mister beagle bailey]

It's very confusing as we are all seeing.  My take on this is with all the studies, very few have the same conclusions.  I think they hand pick those they want to study and base their fining on that.  I find the forum here the best study of all as we all come from all different backgrounds, genders, race, geno types,some first time responders and others not, etc.

When you look at all the members here and see a geno 2 with a 2 log drop and they didn't clear, then another who is geno 1A with a 1 log drop and the did clear the virus, it goes againist all we have been told.

Just my option, that's why I stopped reading studies and drs options awhile ago.  Like the FDA, in the last few years look how many drugs were approved because of studies and then 2 or so years later they pull the drug becuase of the dangers and deaths they caused not seen in the studies or Drs reports.

Beagle

[NYgirl]

Yup but think of this if you were UND you were UND = whether you really knew it or not.

I knew I wasn't but was darn close...

The doctor I went to this week believes a PCR every four weeks is the way to go. Said it's totally not necessary BUT because he is so into data and percentages and odds...he LIKES to know.

Man I wish I could have had a PCR every month, I tried but gave up not realizing I'd go UND somewhere between 12 and 24.  That is a huge dayum stretch.

But it didn't change my status of not being UND at 4.  Those people apparently got it golden. After 4....it gets harder. But certainly NOT impossible.

[cajunlady]

I have to agree with you.  It is what it is, and it is going to be what it is going to be.  No one persons can say they have control.  I will complete my treatment and wait for the post 6 months.  The results will be the results.  If I happen to have to go again.  Like you, I will take a much needed break and enjoy life for awhile and then try again with the new stuff.
I had gotten to the point that I worried about every little thing with this tx and I finally just said enough is enough; and life goes on with or without sx for right now; I just try to make the best of the really good days.

Cajun

[St. George]

Nice Rocky reference.

[Dale_Ray]

You just confirmed my sanity or insanity. At least I won't be in the padded cell alone. You'll make good company. You have common sense. At least it's common between us. How much longer do you have on treatment? Haven't spoken with you in a while but I haven't spoken a lot either. I hope you have a wonderful weekend. 10 more weeks to go for me. I can't believe 38 weeks have passed already. How time flies when you're in a daze. :)Dale

[Alady1620]

2 logs equals moving the decimal 2 places to the left.

It is my understanding that it is best to be UND at 12 weeks but that does not mean it is impossible to clear and reach SVR after that point.

Good luck to you!

[NYgirl]

From what all the doctors told me personally as long as you are UND by week 24 they won't make you stop.

I was sweating that since he wouldn't let me have a PCR between 12 (419 per) and week 24 (UND).  I was pretty pissed. But of course...he was right making me keep going after all.

[cajunlady]

You are right how time flies when you are in a daze and having fun. (NOT)  I do shot 33/48 tonight.  I am right behind you.  I have 15 more.  I am geno 1b, I will be checking in on you and hope you will be posting all that good feeling your feeling after tx, RIGHT.

You know I almost drove myself crazy at the beginning.  Once I felt like the INDY 500 was roaring around in my chest, I thought that my chest was going to explode.  Well the good old AD's corrected that.  I just get so tired sometimes that I do not want to put extra energy in trying to figure things out.  I will take what ever rescue drugs and keep on trucking.

I don't know if you caught my post the other day about my girlfriend coming out to visit.  She has MS and I am on tx.  Mine will end and hers is permanent.  She still smokes the old wacky tobaccy; I told her we would get her a seeing eye dog and it would be special, retired from the police force.  So, that when she lost her stuff, he could go find it for her. LOL LOL LOL
She said that fine and all, but, you just better dress me right.  Instead of being stressed and depressed about it, we had quite a few laughs.  We did confirm that we are both still wild and crazy.  LOL  Wouldn't have it any other way.  Being a little crazy has always kept me from going insane.  Does that make since.  HA HA HA

Well time for me to leave work for the weekend.  YEAH!!!!  

Lanette

[can-do-man]

What i don't understand is why these ideal studys are not doing 4 week pcrs and their first at 12 weeks? It would benifit them the most to get people doing 72 week then 48. More drugs they sell at that price = lots more money in their pocket

[can-do-man]

Hey girl, your friend make it all right? you two behave yourselfs? Truth now

[Dale_Ray]

Can do - They want us all on maintenance something $$$. Get those baby boomers and drain them is the logic I think. I'm drained:)

GrandOak - I believe it was Snowave or Wave (I could have the wrong names) that was UND at 4 weeks, went the entire treatment time, 100% compliant and relapsed at 3 or 6 months. What does that tell us? I don't remember what his type was. I'm a 1A. Look at it this way if we don't kill the rascal this time we will charge the hill together again. After a reasonable break and something new comes out that is. I figure that if the drug doesn't work with me then why continue or extend with it. I waited for this one to come out. I can wait for the next one.

[bobbyullc]

yeah,

if i was told i was NOT und at 4 weeks i would have been bummed.

i asked for end of tx pcr and was told almost 99.9% show und then but not at 6 months so i will wait and wait and work on my patience and try and enjoy life.
i did end tx a little early as my son got married and i may NOT
have done that.
bobby

[fresnoborn]

1b 48weeks of tx pegintron/riba. i was undetectable at week 20 which scared me because i had heard so many others saying they were undetectable at week 4 or 12. i went ahead and did 48 weeks of tx and am now post tx 9 weeks. so far the virus hasn't come back and i have my fingers, toes and eyes crossed.....lol

[cajunlady]

Yes, we did to a point.  It was the best dose of medications either of us could have taken.  I have to admitt, we did think about flying around in the cage; the kids were with us, DARN.  She is doing as well as she can with being diagnoised with MS.  You make the best of things.  Her and I tend to laugh at alot of things; funny or not.  Think it has made us make it through the years.  The Good, The Bad and The UGLY.

How are you doing lately.  Still waiting for that cruse down Las Vegas Strip with the gang. LOL

Cajun

[GrandOak]

I hear you about crossing everything.  I'm 1A stage4 at wk 28 tonight and what troubled me most was at wk 24 VL actual rose 1.1 mil from wk 12 instead of dropping.

But I was told to not worry because we were playing with Riba and Procrit dosages to obtain proper tx cocktail that allowed me to get to 1400 mg of Riba.  So now I'm looking at 69 wks, or 72 since getting to 1400 mg, as tx if in another 9 wks I show a 2 log drop from my original 72 mil at start of tx last January.  Since wk 24 was 2.9 mil, I'm also crossing everything, and then some, that at least 2 log drop occurs.