neg after 4 weeks treatment only 24 weeks for geno 1a?

I asked my doctor if I were to treat and became svr after 4 weeks of treatment if I would only need 24 weeks of treatment and he said no it would still be 48.I do not have any damage so I do not plan on treating now but will as soon as treatment gets better or my alts are no longer normal.It seems as though I have read of people doing this.I probably will not be this lucky but if I were this would be something to consider.

[Teufelhunden]

I asked the same thing to my doc and he told me the same thing you're being told. I guess it's because we're geno 1a which is harder to get rid of. I guess the extra 24 weeks is kinda like insurance. Anyway, week 42. I guess I'll finish it out (Ha! Gotta have a sense of humor). Good luck!

[colts]

What about anyone that may have svr after 4 weeks and shortend treatment on their own and remained svr or other wise.

[cruelworld]

if the idea treating now is still bugging you, try this idea, its probably illegal and immoral but maybe not. go into treatment, no matter the projected
lenght but quit at 6 weeks if not undetectable. bad side effects cause many people to quit early. if you do get UND soon, you will have to stay on the treatment (of course) but your numbers will be worth it.
if you fail, you know you need to wait, this medicine wont work for you like you want it to. the new meds are right around the corner. the only problem is, it might disqualify you for drug trials. this shouldnt worry you as you might easily have a 10 - 20 year window (a guess) to wait for FDA meds. im considering bailing out of my treament early since im not there yet at week 19, especially when i think about 72 weeks. havent deciced yet. its a tough decision, you hate to throw away this round. but the sobering failures of NYGirl and Mrs Ockert and many others reminds you of the reality.

[zazza]

I started treatment November 8th 2006, hoping to be able to join a study which is to verify the already approved guidelines in EU for genotype 1, low baseline viral load (ie less than 600 000 IU/ml) with Rapid Viral Response (UND at week 4). These guidelines say that for this subgroup of patients 24 weeks of treatment is sufficient.

Before starting treatment I read the study by Zeuzem et al: "Efficacy of 24 weeks treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C infected with genotype 1 and low pretreatment viremia", which concludes that "HCV-1 infected patients with a low baseline HCV-RNA concentration who become HCV-RNA negative at week 4 may be treated for 24 weeks without compromising sustained virologic response rates." (Published in Journal of Hepatology, 44 (2006), page 97-103.)

The rate of Sustained Viral Response was in this study 89% for the subset of patients with low baseline viral load UND at week 4. The control group treated for 48 weeks had an SVR rate of 85%.

I have genotype 1a. Unfortunately I did not make RVR, and was still detectable at week 12 but UND at week 15, so since I believe in the new approach of individualizing treatment, I am going for 72 weeks.

I have also read study abstracts which show my chances of SVR to be somewhat increased because of my low baseline viral load although I am a slow responder.
http://www.hivandhepatitis.com/2006icr/aasld/docs/103106_d.html

[copyman]

valtod & cruel have some good ideas. i'm geno 1a and when i tx if i'm unde at 4 weeks i'm only doing 24 weeks. the other 24 weeks will just damage your body beyond repair. the new protocol will be 24 weeks for 1a's if unde at 4weeks in the near future. no one can make you continue this tx, when you want to stop you stop.

[mauilady]

I'm 1b and doing 24 because I was undetectible at 4 weeks.  I really questioned my doc when he told me I qualified for the shorter Tx; basically he said what Copyman said: Why subject my body to any more abuse than necessary?  Hey, if this works, I'll be SOOO stoked!

[goldyn]

Are you the one that is on stronger doses?, because I dont think 24 weeks is a good idea for a geno type 1 there are so many relapses already even after 48 weeks i believe the extra 24 weeks is for a little more insurance  on trying to get to svr,,,,with the new treatments yes,  but with the regular one now i think you are  really pushing your chances.....

[cruelworld]

if you have no liver damage, i like your approach. just be prepared for another 24 later with better meds. when i find myself in an RVR situation i will probably make the whole 48, as i do have liver damage.

[cruelworld]

if you decide to do this unusual strategy, im assuming that you wont be able to tell your doctor about it. if he doesnt like it, (and he wont like it) he wont prescribe the meds.

[copyman]

Hey gold, i have not started tx yet but considering pre dosing with riba first and double dosing the peg for the first 4 weeks. hit this virus early & hard. what you say about relapsers may be true but i bet most of them were not unde at 4 weeks. this is why having a 4 week pcr is so important! if or when you have unbearable sx you can look back on the 4 week test and if unde and beyond 16 weeks (24 weeks for 1a's) of tx you can stop and have a great chance of svr.  according to recent studies doing the extra 24 weeks does not up your chance of svr by that much, like 9%. i do not know if damaging my body with these harsh drugs for only a 9% better chance of svr is worth it. i would feel much better if i was to relapse if i only went 24 weeks but my body was still somewhat in good shape to try new drugs in the future.

[Valtod]

I agree with Cruelworld.

The only thing I would add is that you can try induction Tx in your first 6 weeks to improve your chance for RVR, if this is really what you're hoping for.

In my case, I knew I couldn't realistically reach RVR, so I took the slow and long road (72 weeks). Which was probably a mistake, when I look at it retrospectively.

Good luck!

[ladybug52]

"What about anyone that may have svr after 4 weeks and shortend treatment on their own and remained svr or other wise."
SVR is different than RVR. Rapid viral response is being und early in tx, at least by week 4, SVR is determined by your ability to be und at 6 months or a yr post tx.
I'm a geno 2. I was a RVR and EVR (early viral responder) by week 3 I was UND. I shortened tx on my own to 16 weks. I'm still waiting for my Heptimax to come back to see if I'm still UND. Tx  and tx length is a personal choice no matter how many people try to tell you what is best.
Bug

[Bill1954]

From C-5 above:

[copyman]

yes i stand behind my statement. jim was right,  perhaps i did not word it correctly but the point i was trying to make is true. thanks jim for the link for bill to refer to. things are changing in the tx protocol and i have read enough to make the statement i did. i am in no way telling others to treat this way. this is the way i would treat. if you notice in my posts i refer to the way "I" or "my" would tx. by all means follow what a good hepatologist wants you to do, i was speaking for myself and what i will do. and i do have a top hepatologist but it is not his body that will endure 48 or 72 weeks! of course this is all a moot point if i'm not unde at 4 weeks. i have said before that when i start tx i will see where i'm at with pcr's at 2 & 4 weeks if at least 2 log drop at 4 weeks or i stop.  i will continue to 12 weeks if not unde by 12 i STOP and wait for better drugs. just MY thoughts on tx and not reccomending to anyone. FOLLOW YOUR DOCS ADVICE.

[jmjm530]

Like to add that I wish, like yourself, that  I had some kind of game plan going into treatment. My case was similar to many. I had absolutely no knowledge of different types of dosing, treatment protocols, studies, etc, prior to treatment. Only thing I knew was my odds were around 50-50. Spent a good part of treatment scrambling around to figure things out while under the influence of the drugs, probably not the best filter for assimilating new ideas and making decisions.

Like you say, regardless of how many diplomas your doc has on their wall, it's your liver hanging in the balance, not theirs. And while many of the top liverheads are quite brilliant, I do note a lack of creativity when it comes to translating all that brilliance into individual treatment protocols, like the one you suggest. Of course liablity may be one reason, but I'm not sure that accounts for it all.

-- Jim

[Bill1954]

Gents;

Fair enough; I meant no disrespect to anyone in particular; *especially* Copyman. (By the way, I agree with both of you in substance, if not in semantics :o)). My concern was predicated by the fact that many people read through here within days of initial diagnosis, with the depression and shock still in there system. For the na

[cigaso]

copyman/jmjm,

I recently started tx for the second time. Being tx'ed out of a teaching hospital, Mayo Clinic.

My NP was a NP for Dr Detrich(sp) in NY. I pleaded with my NP for only 24 weeks of tx. The NP said I must tx for 36 weeks after und. The NP stated that although your blood may be cleared, one could still have HCV in the liver or other organs. The first time I tx was for 16 weeks and was clear the whole way. The HCV came back. Everyone is different. This may or may not happen to others.

jmjm,
Thanks for the link I will send that to my NP.

Bill,
Good point.

[jmjm530]

I do agree that there is always the risk that someone new here -- or even some oldtimers -- will take bits and pieces of information and run with it, often in the wrong direction. It happens, we see it all the time here.

So a snippet of info gets picked up by others and you end up with an adult version of the kids game called "whisper" where a statement is whispered to one kid in a classroom and by the time it goes around the room "Sal is a bore" turns into something quite defamatious to "Sally".

Hopefully, everyone will do their own independent research and use what they learn here as just another resource. I know that's how Copyman has done it, how you do it, and it's also how I do it.

Hope this finds you well,

-- Jim

[jmjm530]

Your NP has good credentials but again it's your liver. You'll note from the thread that I don't believe in a one-formula-for-all approach and it's quite possible that your individual situation didn't call for a shorter-course treatment. The fact that you relapsed before no doubt is one factor. The 36-weeks is based on the Drusano model, and while it is sometimes maligned here, I know of several well-known hepatologists who still use it selectively. I was RVR by some standards (more than 2-log drop at week 4, non-detectible at week 6) and none of the hepatologists I consulted with wanted me to stop at week 24. Admittedly, the shorter course studies were just starting to come out then, but given my stage 3 status and age (59) my feeling is that they would have wanted me to do the full 48 week course. Had I known then, what I known now, and had I been sure my liver damage was no worse than stage 2, I probably would have stopped at 24 weeks regardless of what they said. To put it mildly, treating 54 weeks totally screwed up my life for the last two years between treating and trying to recover.

All the best,

-- Jim

[ladybug52]

Bad news from my perspective as I quit at 16 weeks by personal choice. What geno are you, and how soon were you und by which test. Sorry for all the questions, personal involvement in your answers.
bug

[CrazyTrain]

I'm with you on this one Bill.

My case HepC Geno 1a Dx after a variceal bleed sent me to ER - Endoscopic banding and 3 days in ICU later I went home.

Finally found a Dr/ willing to put me on Tx PegInt/Riba. Seven weeks later blood counts forced me to discontinue Tx. (I was cheating and taking more PegInt than I was supposed to - oh well)

My baseline VL was extremely low 8,600  - Log 3.94.

I was tested (RNA-PCR) and came back negative - tested 2 more time since RNA-PCR & a Heptomax, both came back neg.

Dr's wanted me to start treatment again 3 weeks after discontinuing, I didn't. My logic being - why not just keep testing for virus, & ALT, AST values, if shows sign of virus returning THEN I'll consider starting Tx again. It's not like the virus builds an immunity,.

[jmjm530]

I didn't make the statement in "C5" above and might have worded it a little differently, but the underlying thought is not without support. Studies and some commentary (some of which I agree with and some I don't) can be found in this recent thread:
http://www.medhelp.org/forums/Hepatitis/messages/46062.html
But in general, several studies show similar rates of SVR in at least selected groups of geno 1's who treat 24 versus 48 weeks -- with a good argument that can be made that this particular group of geno 1's would have the risk/reward scale tilted in the wrong direction by treating longer.

-- Jim

[orphanedhawk]

I've seen the report on shortened tx. Do a google and it'll come up.    Unfortunately, one size doesn't fit all and in this stage of the Hep cure game, any size may or may not fit.    I'm grabbling with my heptologist's encouragement for me to extend tx based primarily on my cirrhosis. I can't come up with any reports to support him and I think its research they are working on at that clinic. I didn't think I looked like a lab rat.
    The thing to consider is: what if you aren't UND at 4 weeks? Personally, if I had no liver damage I wouldn't tx, just take good care of myself while hoping something better comes along. Good luck.

[nygirl7]

There IS a huge difference between being UND in blood test and being UND that leads to SVR.

RVR or not.

I would NOT change the standard of treatment depending on the results of ONE study.

It's just foolish.  And that is MY opinion.  Current SVR rates are ONLY 50% for geno one and to do LESS than that 48 weeks that gives someone the 50% because their "blood test" comes back UND - welll...let's see how many relapses come from this new course of theory before anybody advises anybody to try it.

Otherwise you come back and do that 24 + 48.  

My opinion but I think it's correct considering all the NON-SVRs we've seen over time to begin with.

I personally am 100% against it.

[FlGuy]

"the other 24 weeks will just damage your body beyond repair".  I certainly do not agree with that statement either.  Are you saying that all people who have done 48 weeks of combo treatment have irreversible damage?  That is what that phrase implies.

[copyman]

Of course i can not make a statement that says everyone will have permanent side effects for life after tx. As you know FL it is different for everyone. My statement was based soley on what i have read on many of the HCV forums. I would say that around AT LEAST 75% have problems after tx. Now mind you this is from people posting on forums not from the many that have no need to post in forums because they have no trouble. Anyone who thinks that their body can feel as bad as it does when tx'ing for almost a whole year and not "possibly" do damage is kidding themselves. Most of the time there is an ultimate price to pay to get rid of this virus but well worth it to say the least.

[cigaso]

ladybug/child24angel,

Sorry for not posting sooner.

My stats: 53, male, dx -2004 1b, vl at dx=4.5 mil, 6 month post tx vl=6mil, Bx=stage 1 grade 1. First tx lasted 4 months. Dropped out by Dr due to depression. Was on Lexapro. Und after 10 weeks.

jmjm,

I've read many of your posts and was curious how you were holding up. I didn't tx as long as you so I can only partially know what you're going through. My HCV sides mirror the tx sides even though the bx was 1 and 1. I'm going to bite the bullet and get this **** out of my body.

I know you attained SVR, so you've got to feel good about that. I hope your recovery is complete and attain pre HCV health.