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Options if not UND at week 24
Hi,
I've been on peg/ribavirin for 20-21 weeks. Genotype 1. Viral load had decreased log 5 as of 2 months ago. At my last meeting with nurse at liver clinic about 2-3 weeks ago, she said I would 'probably' be UND at week 24 but obviously she couldn't be certain. Qu: if my VL is next to nothing at week 24 (but still detected) will they offer me ongoing treatment? What are the options if I am not offered further treatment?
Also, is there anything I can do over the next 2 weeks to help render this damned virus UND (I guess that's the million dollar question...).
Cheers
CBO
I've been on peg/ribavirin for 20-21 weeks. Genotype 1. Viral load had decreased log 5 as of 2 months ago. At my last meeting with nurse at liver clinic about 2-3 weeks ago, she said I would 'probably' be UND at week 24 but obviously she couldn't be certain. Qu: if my VL is next to nothing at week 24 (but still detected) will they offer me ongoing treatment? What are the options if I am not offered further treatment?
Also, is there anything I can do over the next 2 weeks to help render this damned virus UND (I guess that's the million dollar question...).
Cheers
CBO
Personally, I would heavily factor in the amount of liver damage into any treatment scenario but especially an extended tx scenario with both diminishing and unclear/less studied outcomes.
In other words, if you have minimal liver damage, then stopping and cutting ones losses to fight another day with perhaps better drugs, makes sense to me. On the other hand, if you have significant liver damage, then a more agressive/extended tx scenario seems quite reasonable.
Bottom line is to have as much data as possible in terms of what your chances of SVR really are before extending beyond week 24, or even week 12 for that matter. This includes talking to your doc, maybe an outside consult and independent research. Then, once you know the odds, make whatever decision you are comfortable with.
Smart and reasonable people can look at the same odds and come to different conclusions in terms of extending or not -- but at least they're starting from as factual a base as possible.
-- Jim
In other words, if you have minimal liver damage, then stopping and cutting ones losses to fight another day with perhaps better drugs, makes sense to me. On the other hand, if you have significant liver damage, then a more agressive/extended tx scenario seems quite reasonable.
Bottom line is to have as much data as possible in terms of what your chances of SVR really are before extending beyond week 24, or even week 12 for that matter. This includes talking to your doc, maybe an outside consult and independent research. Then, once you know the odds, make whatever decision you are comfortable with.
Smart and reasonable people can look at the same odds and come to different conclusions in terms of extending or not -- but at least they're starting from as factual a base as possible.
-- Jim
I'm going to be curious to hear what other's say. I just hit my 24th week and showed a still detectable level of 50. I was able to persuade my doctor to let me continue on a month by month basis. At week 28, I'm at detectable but <10. I expect to be fully undetectable next month.
The problem with the standard treatment models is that they only apply in the context of 48 weeks maximum of treatment. None of them talk about the chance of clearing if you are a very slow responder but can go 72 weeks or longer.
In my opinion, if you don't clear but have a very low detectable viral load I would try to persuade them to let you cautiously continue.
Here's one more point: the studies on which the standard treatment approach are based used qualitative tests that had a sensitivity of 50 iu/l. Now there are newer tests that are more sensitive. It stands to reason that some of the people who perviously were coming back as negative actually had low but still detectable viral loads according to the newer tests. My doctor, who is a traditionalist, did seem to find that argument persuasive and let me continue. Good luck!
The problem with the standard treatment models is that they only apply in the context of 48 weeks maximum of treatment. None of them talk about the chance of clearing if you are a very slow responder but can go 72 weeks or longer.
In my opinion, if you don't clear but have a very low detectable viral load I would try to persuade them to let you cautiously continue.
Here's one more point: the studies on which the standard treatment approach are based used qualitative tests that had a sensitivity of 50 iu/l. Now there are newer tests that are more sensitive. It stands to reason that some of the people who perviously were coming back as negative actually had low but still detectable viral loads according to the newer tests. My doctor, who is a traditionalist, did seem to find that argument persuasive and let me continue. Good luck!
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