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still present

the hcv is still detected at 8 weeks...from what ive read about 2wks n tx hcv gone....a lot of 4 weeks n tx hcv  undetected and God bless all of you.....I can't seem to shake it and Im not doing wrong don't reccon.....any others stay hcv  detectable for weeks into tx and still win?   getnby
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1815939_tn?1377995399
Just to clarify for everyone, Getnby is Genotype 3 and on Interferon and Ribavirin.

First of all, many people attain SVR (cure) even though they take longer than others to clear the virus. Being Undetected early is great, but many achieve cure even if they were not Undetected early (at 4 weeks).

Second, the majority of the people on the forum are Genotype 1. Most of the posts that you are reading are posted by people with Genotype 1. Most of the people clearing the virus at week 4 are Genotype 1 and they are treating with triple med treatment. Most of the people clearing the virus at week 2 are also Genotype 1 and are in studies with the new drugs. I am pointing this out because you are Genotype 3 so you cannot compare your treatment to the people on treatment for Genotype 1.

Can you tell us what your starting viral load was, what your viral load was at week 4, and what your viral load is now? I know it is Detected, but do you know the numbers?  I looked back at your posts and I don't see the viral load numbers for starting viral load, week 4 viral load, and now the week 8 viral load. It would help if you could post all three of those numbers.

I did see that you said that your doctor has decreased your Interferon shot to only 1/2 of a dose. If he is doing that because of your platelets, maybe you can ask him about Promacta to bring your platelets up instead of reducing your Interferon dose.

I would also ask, are you on a weight based Ribavirin dose (or are you on a fixed dose)? If you are not on a weight based Ribavirin dose, you may wish to discuss getting on a weight based Ribavirin dose with your doctor.

Also, depending on your fibrosis level and depending on when you do reach Undetected status, you may wish to discuss treating longer than 24 weeks. Treating for 48 weeks may be of benefit to you. (See below.)


" Ribavirin Dosing Readdressed: Weight Based versus Fixed Dose"
"The ACCELERATE trial used a lower, fixed-dose of ribavirin (800 mg/day), whereas previous studies had utilized weight-based ribavirin dosing (1000 to 1200 mg/day), yielding conflicting results and raising the question whether the lower, fixed-dose of ribavirin could be associated with lower SVR rates and/or higher rates of relapse. One study demonstrated that in patients with genotype 2 and 3 treated with the standard, fixed-dose ribavirin (800 mg/day), SVR rates were greater in the patients who were exposed to the higher mean dose of ribavirin, based on body weight [20]. Similarly, other studies have found an association between higher average doses of ribavirin per kilogram of body weight and higher SVR rates[10,11].  In contrast, in a large multicenter trial that involved 1,831 patients with genotype 2 or 3 infection, investigators found similar overall SVR rates with weight-based versus fixed ribavirin dosing (67.7% and 65.0% respectively) as part of a 24-week treatment course[21]. Of note, within the weight-based ribavirin group, SVR rates were consistent across all weight categories, whereas SVR significantly decreased with increasing weight in the fixed-dose group (Figure 5).  Weight-based ribavirin dosing could be considered for those patients that may be more difficult to treat due to underlying host characteristics such as obesity or advanced fibrosis."

" Extended Treatment for Patients who do not Achieve RVR"
"Patients with genotype 2 or 3 who do not achieve a rapid virological response have low SVR rates, ranging from 26 to 41% (Figure 6)[16,22].  Although current guidelines recommend treating all patients with genotype 2 or 3 infection for 24 weeks, the benefit of longer therapy for these non-RVR patients continues to be debated. Weight-based ribavirin may also benefit this subset of patients with genotypes 2 or 3 infection who do not achieve a RVR. One retrospective analysis of genotype 2 or 3 patients who did not achieve an RVR found a trend toward higher SVR rates among those who received 48 weeks of weight-based ribavirin compared with those in other treatment categories (24 weeks of weight-based ribavirin, 24 weeks of fixed-dose ribavirin, or 48 weeks of fixed-dose ribavirin)[23].  Another study found that treatment up to 36 weeks resulted in a small but statistically insignificant increase in SVR compared with the standard 24 weeks among genotype 3 patients who did not achieve an RVR (62% versus 52%, P=0.25)[24]. "

http://hepatitiscnewdrugs.blogspot.com/2013/07/management-of-treatment-naive-genotypes.html
10 Comments Post a Comment
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Avatar_m_tn
* I would ask to get tested again. Try and go to different lab. Before making any treatment decisions I would want back-up test to confirm.

Did you test at 4 wks?
If you are on triple thearpy and still detected at 8 wks then you should talk to your doctor about stopping. Spare yourself from this harsh treatment it is not working for you. Perhaps go to 12 wks but most likely will be same result.

Hang in there, there are new drugs in the pipeline.

Best of luck
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1815939_tn?1377995399
Just to clarify for everyone, Getnby is Genotype 3 and on Interferon and Ribavirin.

First of all, many people attain SVR (cure) even though they take longer than others to clear the virus. Being Undetected early is great, but many achieve cure even if they were not Undetected early (at 4 weeks).

Second, the majority of the people on the forum are Genotype 1. Most of the posts that you are reading are posted by people with Genotype 1. Most of the people clearing the virus at week 4 are Genotype 1 and they are treating with triple med treatment. Most of the people clearing the virus at week 2 are also Genotype 1 and are in studies with the new drugs. I am pointing this out because you are Genotype 3 so you cannot compare your treatment to the people on treatment for Genotype 1.

Can you tell us what your starting viral load was, what your viral load was at week 4, and what your viral load is now? I know it is Detected, but do you know the numbers?  I looked back at your posts and I don't see the viral load numbers for starting viral load, week 4 viral load, and now the week 8 viral load. It would help if you could post all three of those numbers.

I did see that you said that your doctor has decreased your Interferon shot to only 1/2 of a dose. If he is doing that because of your platelets, maybe you can ask him about Promacta to bring your platelets up instead of reducing your Interferon dose.

I would also ask, are you on a weight based Ribavirin dose (or are you on a fixed dose)? If you are not on a weight based Ribavirin dose, you may wish to discuss getting on a weight based Ribavirin dose with your doctor.

Also, depending on your fibrosis level and depending on when you do reach Undetected status, you may wish to discuss treating longer than 24 weeks. Treating for 48 weeks may be of benefit to you. (See below.)


" Ribavirin Dosing Readdressed: Weight Based versus Fixed Dose"
"The ACCELERATE trial used a lower, fixed-dose of ribavirin (800 mg/day), whereas previous studies had utilized weight-based ribavirin dosing (1000 to 1200 mg/day), yielding conflicting results and raising the question whether the lower, fixed-dose of ribavirin could be associated with lower SVR rates and/or higher rates of relapse. One study demonstrated that in patients with genotype 2 and 3 treated with the standard, fixed-dose ribavirin (800 mg/day), SVR rates were greater in the patients who were exposed to the higher mean dose of ribavirin, based on body weight [20]. Similarly, other studies have found an association between higher average doses of ribavirin per kilogram of body weight and higher SVR rates[10,11].  In contrast, in a large multicenter trial that involved 1,831 patients with genotype 2 or 3 infection, investigators found similar overall SVR rates with weight-based versus fixed ribavirin dosing (67.7% and 65.0% respectively) as part of a 24-week treatment course[21]. Of note, within the weight-based ribavirin group, SVR rates were consistent across all weight categories, whereas SVR significantly decreased with increasing weight in the fixed-dose group (Figure 5).  Weight-based ribavirin dosing could be considered for those patients that may be more difficult to treat due to underlying host characteristics such as obesity or advanced fibrosis."

" Extended Treatment for Patients who do not Achieve RVR"
"Patients with genotype 2 or 3 who do not achieve a rapid virological response have low SVR rates, ranging from 26 to 41% (Figure 6)[16,22].  Although current guidelines recommend treating all patients with genotype 2 or 3 infection for 24 weeks, the benefit of longer therapy for these non-RVR patients continues to be debated. Weight-based ribavirin may also benefit this subset of patients with genotypes 2 or 3 infection who do not achieve a RVR. One retrospective analysis of genotype 2 or 3 patients who did not achieve an RVR found a trend toward higher SVR rates among those who received 48 weeks of weight-based ribavirin compared with those in other treatment categories (24 weeks of weight-based ribavirin, 24 weeks of fixed-dose ribavirin, or 48 weeks of fixed-dose ribavirin)[23].  Another study found that treatment up to 36 weeks resulted in a small but statistically insignificant increase in SVR compared with the standard 24 weeks among genotype 3 patients who did not achieve an RVR (62% versus 52%, P=0.25)[24]. "

http://hepatitiscnewdrugs.blogspot.com/2013/07/management-of-treatment-naive-genotypes.html
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Avatar_m_tn
I agree with pooh that if at all possible you need to be on full dose. Another thing is since you are genotype 3 the protocol for viral load testing is week 4 and 12 so there could be many that won't know if at week 8 they were still detected. Not sure if being still detected at week 8 concerns me as much as being on half dose... Hoping for the best for you.
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4113881_tn?1390588112
There are other genotype 3's on this forum that didnt clear at 4 weeks and went on to SVR. Its like can-do said, the treatment protocol for viral load testing is usually week 4, 12, and EOT it could be that some dont know they are still DET at week 8. One of the G'3s that wasnt UND until until I believe week 12 is Dannyboi...and there are others. Some still only do the 24 weeks while others opt to go longer. Tim is a G'3 doing 48 weeks. I am a G'3 who didnt clear until week 5 so my doc pushed for 36 weeks (I did 28). Dont give up on TX yet...hang in there.
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548668_tn?1394190822
I was a G3, still detected @ 4 weeks (<43 so I may have cleared around week 5);  I applied to have my tx increased to 36 weeks but was declined, but luckily managed SVR after 24 weeks - biopsy showing stage 3/4.  

The following post lists some of the possible reasons why G3's can be difficult, where still a high number obtain SVR - the test was not available when I tx'd:

http://www.medhelp.org/posts/Hepatitis-C/non-rvr/show/1915605#post_8938602

There were two other members 3a's treating when I did in 2008: ComeAgain treated for 48 weeks after relapsing first time around, and Gauf did 3 tx's before obtaining SVR.  

Do you know what your Viral Load was on the Week 8 test?  (and the VL at the beginning of tx, or week 4)?
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548668_tn?1394190822
Also, before commencing tx, and because of my biopsy results, my specialist intimated that he would recommend stopping tx if I wasn't UND by week 12.  (That was in 2008, so your specialist may or may not be more updated since the G3's were doing SOC 5 years ago).    
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5720485_tn?1373566655
Hi,  I'm g3 too.  I am finally undetected at week 10, my nurse put through an extra test for me.  But above comments are correct about VL test @ week 4 and 12.
And also agree with Pooh about the rescue drug for platelets rather than decreasing doses. . . If your doc approves.  Or try copying the aboved quoted studies to your doc, if he/she needs some evidence.  I'm on 1200 mg riba and 180 mg interferon, I weight just under 140 lbs.  
Also It's nice to hear that others have reached SVR, even though not RVR at wk 4. . . Gives us hope, right getnby?  
I am going to try to extend my treatment however, I'm not confident at all about being covered.  
I agree with others, hang in there, and I will too!
Shyrl
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1648173_tn?1373346535
Before any tx platelets were 175, at 4 weeks 88, at 8 weeks 50.  My genotype is 3a and before tx my AST 62,  my ALT 101.......at week 8 my AST 27  MY ALT 21.  I will ask for platelet booster and try to  keep my full dose.   I have a lot of scaring/fibrosis?  Guess that's rite, scar, that word just don't look rite to me.  I was told the alt & ast were my hcv enzyme levels is that correct. I have my labs but don't know what means what. Guess, maybe u saw my lab issues, q's & a's..and stuff.
getnby  
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1815939_tn?1377995399
Yes, ALT and AST are your liver enzymes. They have come down, which is good.

It is the viral load that will tell you if the treatment is working. But I agree with Can-do that the next viral load at week 12 will be important to see if you are Detected or Undetected at week 12. Hopefully you will be Undetected. It would be good to know what your starting viral load was (if you had a viral load drawn right before starting treatment) and then also the viral load from week 4. That would tell you how much of a drop you had in 4 weeks of treatment. But now just focus on hanging in there and try to stay at full dosages of medications if possible. Be sure to get a 12 week viral load. And the doctor should be checking your platelets often.
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Avatar_m_tn
Regardless of Genotype if you are still detected at 12 weeks consider stopping. There may have been some people that cleared late but not many.
The only way I would continue is if I had severe liver damage and then at least treatment would be giving the liver a much needed break.
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