shorter treatment duration

i am a hepatitis c genotype 1 responder after 4 weeks of pegasys & ribavarin. Viral load dropped from 600000 to <15 iu/ml as per hcv quantitative analysis by taq man method  on the 4th week and viral load is <15 iu/ml after 11th week. Liver is normal and complete bloodcounts appear  ok. Currently completed 21 pegasys injections and  take 1000mg of ribavarin per day. My gastro doc says i can stop treatment at 24 weeks but it would be better to complete 48 weeks Will i need to complete 48 weeks or will 24 weeks of treatment sufficient? I am confused as to what decision to take. All your valuable input would be useful

[Trinity4]

The 24 week SOC protocol which is mostly used in Europe applies to those with a low viral load and current standards define low viral load as 400,000 or below.  You do not meet that criteria.  Genotype 1 is the most difficult genotype to cure and if it were me, I would not stop at 24 weeks.  You appear to be tolerating treatment well and I agree with your doctor that 48 weeks will give you the best chance at SVR.

Trinity

[Poobah_Johnny]

I'll probably be the only one on this site to tell you it's OK to stop at 24 weeks, specifically because you achieved UND by Week 4. The 24 week treatment IS used in the US, not just in Europe, but only it UND is achieved by Week 4. Any UND response great than 4 weeks, then the treatment protocol is extended. Since your bloodwork is in good shape, the choice is really up to you. There is so much data to be found online regarding the 24 week treatment protocol. Please read some of this and make your own decision.

P.S. CONGRATULATIONS!!!!

[meakea]

Congratulations enterprise2009 for being UND by week 4...that is wonderful news.

As far as my opinion goes...I agree with Trinity that your starting VL was not low enough to fall within the "low VL" category.  If it were me, I would go for the 48.  

I am(was) geno 1b with a starting VL of 30,100 and THAT is a low VL.  I was UND by week 4 but my doc still did not want me to quit at week 24 so I went the distance to 48.  I am 8 mos post treatment and I am still UND.

It's all a crap shoot and it's all about what YOU feel comfortable with.  I didn't want to add any extra risk to my treatment which is why I went for the 48.  However, that's just me.  On the other hand, if it had been my hubby who was in my shoes, he would have stopped.  It's all has to do with our own personal comfort zones combined with what the doc suggests.

Good luck and let us know what you decide.  

[enterprise2009]

thank you all guys but i found something on low viral load
http://www.janis7hepc.com/Viral_Loads.htm

Interpreting Viral Load Test Results
HCV viral load is often reported as low or high.
Expressed as copies/mL:
·Low: less than 2 million copies
·High: more than 2 million copies

Expressed as International Units (IU/mL):
·Low:less than 800,000 IU/mL
·High:more than 800,000 IU/mL

My initial viral load of 600000 iu/ml before treatment will fall in the bracket of low viral load and not high viral load. As per the European protocol or SOC, i have a normal liver with low initial viral load and achieved RVR at 4th week and 11 week. Hence their recomendation is that I can stop treatment at 24 weeks.

The second opinion from another hepatologist is expected on 11th March 2010, so in the mean time would appreciate your comments

[Poobah_Johnny]

Way to go girl!
I'm glad you're doing your own homework!

[meakea]

That's good news about the "low viral load".  

Keep us posted.

[Marcia2202]

Just wanted to add that the new standard for low viral load is 400.000. This is the one they used on the studies/trials to determine the 'new' 24 week option.

What I mean to say is that they used this number in all the studies to determine this shortened treatment.

[enterprise2009]

Hi Marcia2202
new standard for low viral load is 400.000 expressed in what units? Is it IU/ML or COPIES/Million. There is a difference in both these units so which unit are u refferring to?

Can any one give me an email id of any doctor to whom i can write to and discuss?

Thanks again and keep posting in the "united heppers cause to slay the dragon"  

[cb867]

I am g type 2. I stopped at 23 wks. Having severe mouth sores. I was UND at 4 wks. I go in next month for 3 month blood work. Hope I am still UND!!!!!!!!!!!

[Bill1954]

They are using 400,000 IU/mL, not copies/mL as their guidelines now; this was established via 2007 EASL. From the paper:

".... the cut-off of >400 000 IU/mL identified the greatest difference in SVR rates between patients with LVL and HVL... (70% vs 43%, vs 63% vs 43% for , and...60% vs 43% for )..."

http://www.natap.org/2007/EASL/EASL_41.htm

Bill

[eureka254]

It IS essentially a cr@apshoot.  We can juggle numbers all we want but both the possibility of SVR and relapse do exist, whether you do the 24 or the 48.  

That aside, I think a lot is dependent on what your comfort level is, on many levels...
Did you have tough side effects, or was the treatment tolerable thus far?  Do you have any significant liver damage, or do you have no/minimal liver damage so that you have plenty of time to wait for newer drugs to hit the market?  Are you in a situation where healthcare coverage will be an issue later down the line?  Are the treatment demands (i.e. on your personal or professional life) such that another 24 weeks would be difficult? If you stop at 24 weeks and relapse, would you be able to roll with that, or be full of self-recrimination? Although it's essential to be well-informed about your odds, there's really lots more to consider than just the 'data,' imho.

If you're on he fence it's definitely good that you've got a second opinion coming -- best of luck whichever you decide. ~eureka

[WriteItDown]

It really come down to deciding whether the extra percentage points chance of SVR is worth it to you to go another 24 weeks. The stuff I've read put it at from around 6 - 11% (with a low viral load) greater chance of SVR with 48 weeks.

http://www.natap.org/2007/AASLD/AASLD_44.htm

So is it worth it to you to go another 24 weeks to increase your odds?  That's a very individual decision. Some people would rather be more certain of SVR; and some people would rather not subject their bodies to another 24 weeks of the tx drugs.

Whatever you decide I wish you the best of luck attaining SVR!

[desrt]

Log value, the difference between 600000 and 400000 is 5.778 to 5.602. Not huge.
The choices aren't just 24 or 48. You could take it one month/one blood panel at a time and see how it goes.
Good Luck with it.

[chemister]

Don’t thing to much about 400000 or 800000 IU/mL I wonder a long time self about 24 or 48 weeks. Less than 800000IU/mL and RVR is what doctor recommends 24 weeks Tx.
I stop Tx after 24 weeks.
Start virus load 2 700 000 IU/mL
1 week 6300 copies,
Week 3 = negative
Week 4.  negative
Week 18 = negative
Fibro-scan = 5.8, I had no fibrosis. My specialist-doctor tells me to stop after 24 week.
The Tx drugs are not candy. I had high virus load start, but was about clear after 1 week Tx. I would talk with your doctor, he told me to stop, I had geno 1 and 2 and also ill after Tx and the drugs. 24 weeks, RVR and low virus load start is standard 24 week Tx. Very few % SVR for 24 more weeks to go, your choice :)

[willing]

seems to comes down to how lucky you feel though either way you're looking at very good odds (congratulations!). Recent Swedish consensus guidelines call for a flat 24w for RVRs:
"For genotype 1 patients with rapid viral response (RVR), 24 weeks treatment is recommended."
http://www.ncbi.nlm.nih.gov/pubmed/20001276

whereas a recent Chinese comparison found that a full 48w can improve the already very good odds (from 89 to 100)
http://www.ncbi.nlm.nih.gov/pubmed/18508296
as your gastro suggests

If you weigh less than 163 with BMI lt 24, stopping  at 24w seems a good choice: if it doesn't take, you'll probably get to redo a 6month tx with benefit of a PI.

However if weight is higher, that 1000 may not have been optimal and continuing seems advisable.

[newleaf09]

I think the VL numbers (which study considers which cut-off point to be 'low') are less the issue than the RVR.  I agree with those who ask 'How lucky are you feeling'?  If you think it will be unbearable to go again if you fall into the small percentage of RVR's who need 48 weeks for a more guaranteed cure rate, keep going.  If you feel confident from your labs that it's gone, wrap it up and get on with your life.

[copyman]

I think it would be ok to stop at 24 weeks. Of course it would be better to complete the 48 weeks, especially if you have severe liver damage but I would personally stop. Studies have shown only a 2% difference of SVR when genotypes 1 & 4's stop at 24 weeks when meeting all the criteria. I know the study may have used 400,000 for the test but 600,000 is not much different.
This a tough decision only you can make. The longer you are on these harsh drugs the more damage done to your body.
I stopped at 33 weeks after tapering down the doses of interferon & ribavirin starting at 28 weeks.
Best of luck

[d1555]

in a week or 2 i'll be starting my treatment,i want 2 know will the treatment stop me from feeling sick?and how long dose the treatment go 4?please can some one help me,ive have had hep c now for 10 years,i just didn't want 2 tell the doctors about it but my hubby made me do it.

[WriteItDown]

If you make a new post to ask your questions, more people will see it that way and respond.  Also it will help if you give some more info: like your Genotype, and how you're feeling now.

How long you treat depends on your Genotype.  It will likely be either 24 or 48 weeks. Didn't the doctor discuss this all with you?  They should have told you all about this, so if not ask questions next time.  I'm not sure what you mean about will the treatment stop you from feeling sick -- unfortunately the treatment makes most people feel sick, many of them were asymptomatic beforehand. But if it works, it will prevent you from possibly getting very sick down the line.  Good luck with it!

[FlGuy]

Here is a question that you might ask the liver doc on 3/11 - it's somewhat based on some of the foregoing posts.  It is: what is the difference between high viral load and low viral load if you are sensitively undetected by week 4?  I've never understood the distinction, especially when it's drawn in such a narrow line of demarcations of a few hundred thousand iu/ml.  In addition, counting of the detected virons (above undetected) is also somewhat of an estimation rather than an actual census.  Why 24 and not 26 or 29?