relapse rate

[hipps]

any info on relapse rate at 6 months when 12 weeks  PCR is undetectable? I realize it's all individual, just wondering if you are familiar with any studies on the subject.
Thanks

[pls]

I'd love the same information.  I did a lot of web research at one point and only found one research study talking about this.  I'll see if I can find it again -- but it basically said that relapse after 12 weeks was rare.

[jmjm530]

Given a neg PCR at 12 weeks...

If you're talking about the relapse rate six months *post* treatment, it depends on a number of factors, including genotype, age, length of treatment, liver damage, etc.

If you're talking about the relapse rate six months *into* treatment, I don't have any figures but I believe it is low. Most people who clear by 12 weeks tend to stay clear while on treatment. The majority of relapses occur post treatment.

[pls]

I can't find the study that I found earlier, but I did find this:

http://qa.hopkins-hepc.org/forum/view_question.html?section_id=121&id=81571&category_id=239

[Honey15637]

It is a small percent to relapse after your 3 month mark.  Dr Cecil states your chances after 3 months is 95% and after 6 month mark 99%.  I just made it through my 6 month post and was clear...Still holding out for 1 year for 100% but the odds are great considering what we started out with on the tx.  For geno 1's,,,like 40 to 50% to beat and 2's of course are up in 80%.
I could almost bet if your liver enzymes are still in normal range,,,you are good!  Good Luck!

[landfill]

You're SVR.  Congratulations.  I was treated by Mark Sulkowski at Hopkins who ran the Q&A that pls pointed to, above.  It's been dormant for the last year.  I tried to get him to resume but no luck.  When I was where you are I asked him about relapse.  He said he hadn't seen a relapse after 3 months but a few had been reported by others.  He said that he expected SVR to be redefined as undetectable at 3 months but I guess that didn't happen.  He said that researchers think that worldwide there's a reinfection rate among SVRs of a few percent/year so they may not really be relapses.

I saw him for the last time in April.  I love being fired by a dr.  I asked him about news that a researcher in England and one in Japan had found viruses in SVRs.  He said the community is watching it because it would be sigbificant if confirmed.  He said that the results were in doubt because others had been unable to duplicate the results.  Also, the VLs reported were above the detection thresholds of sensitive tests yet the tests were negative.  I hope the people here who follow the research post any developments.

[jmjm530]

Hips would only be SVR if he's virus free six-months post treatment. While I hope that is the case, I'm not sure that's what he said.

[cuteus]

THREE MONTH HCV RNA BY PCR POST IFN AND RIBAVIRIN THERAPY FOR SUCCESSFULLY TREATED CHRONIC ACTIVE HEPATITIS C (HCV) CAN BE USED TO DETERMINE SUSTAINED VIROLOGICAL RESPONSE (SVR)
Lino J. De Guzman, Bradley Collins, Inland Empire Digestive Diseases & Liver Center, Redlands, CA.

AIM:
The purpose of this trial was to evaluate the earliest time point (one or three months) before patients (pts) can be classified as having a SVR after a complete response (CR) to HCV treatment (TX). Currently, the standard is to wait 6 months after TX before identifying pts with a SVR. It is estimated that 98% of pts with a SVR at 6 months will remain virus free indefinitely unless re-exposed and infected.

Methods:
A total of 60 HCV pts who had a CR had quantitative HCV RNA by PCR collected at the end of TX and at 1, 3 and 6 month intervals thereafter. There were 33 males, 35 pts were Genotype (G)1, 11 pts G 2 and 14 pts G 3. In order to qualify, pts must have completed 24 weeks if G2 or G3 or 48 weeks if G1 of either PEG IFN or standard IFN plus ribavirin. Metavir scores were the following: F0 (7 pts), F1 (22 pts), F2 (14 pts ), F3 (11 pts) and F4 (6 pts). This trial also examined if any underlying relationship existed between a pts total white blood cell count (WBC) and amino alanine transferase (ALT) levels after cessation of therapy to predict ultimate response or relapse.

Results:
HCV RNA by PCR taken at 1 and 3 months after completing TX correlated highly with viral loads obtained at 6 months. A total of 13 of the 60 pts (21.6%) with CR relapsed. All of the 3 month HCV RNA measurements were in exact agreement with those taken at 6 months (100% specificity). Only one (G 3) pt who had a CR after 24 weeks of TX became HCV RNA(+) between the 1 and 3 month blood draws (98% specificity).

Conclusion:
The specificity of the HCV RNA by PCR at 1 and 3 months post HCV TX for pts with a CR is similar to the viral load at 6 months. Based on the results of this data, we feel that SVR can be made with assurance at 3 months post HCV TX. and perhaps as early as 1 month after the end of TX. There was no significant relationships between WBC or ALT levels in predicting SVR.