3a - Asking for your SVR stories... please?

[HCVinPDX]

I'm on 150 mcg Pegintron 2b and 1200 ml ribavirin and completed my 4 week viral load test.   VL started at 4,210,000 mL and 4 week VL is 968 mL.  This is over a 3 log drop, however, I'm disappointed that I'm not undetected.  I recently read some discouraging information about 3a and the virus coming back later.  It seems that they are learning it's not the genotype that's "easy to treat".
I will talk my my Dr. about IL28B testing but my appt. isn't for another month.  Does anyone have some good treatment results to share to keep me going for now?
Thanks so much.  I'm trying not to be discouraged.
Rebecca

[desrt]

I think IL28B testing is an excellent choice to help you decide length of tx or whether to discontinue and wait for something better. Please keep in mind there are those who are non-RVR and TT on this test who go on to SVR, so part of your decision should be based on how well you are tolerating tx.
I was 3e and took the same meds you are taking. I only had baseline (625,000) and 12 week (UND) to base my decision on. (Txd 2002-2003) My gastro wanted me to do 48 (based on his experience with geno 3s) and all my bloodwork stayed close to normal, but I felt I just couldn't go on after the 23rd shot. April10th will be 10 years SVR.
Hang in there.

[Dannyboi7]

Another link

http://hepatitiscresearchandnewsupdates.blogspot.ca/2012/01/treatment-of-patients-with-genotype-3.html#.USpuZhzfuLc

[Dannyboi7]

‘Easy to treat’ genotypes were not created equal: Can rapid virological response (RVR) level the playing field?


Patients with G3 infection were randomized to a standard 24-week regimen (pegIFN-α2b 1.5μg/kg and weight-based RBV 1000–1200mg) or to a variable duration therapy of 12 or 36weeks according to the presence or absence of RVR, respectively. In patients with an RVR, a difference in SVR could not be demonstrated between patients receiving the standard (82%) or 12-week (83%) regimens, although a non-significant higher rate of relapse was observed in patients who received the shorter course (10% and 15%, respectively). When considering patients without an RVR, extended therapy (36-week) yielded a 10% increase in SVR (62% vs 52%)when compared to the standard 24 weeks...

.....The proposal to extend and intensify treatment (48weeks with weight-based RBV) in patients with G3 infection who do not achieve RVR needs to be confirmed by prospective studies. These would need to stratify by at least two of the major adverse factors for an SVR, fibrosis stage, and baseline viral load [3], [14], as they can significantly influence the outcome of antiviral therapy. This was shown when re-analyzing the experience of a Canadian multi-centered and non-randomized study in which the rate of SVR in G3 patients with cirrhosis was 17%, in comparison to>60% in the absence of cirrhosis [25]. The ongoing EXACT-R(3) is a randomized clinical trial exploring the benefit of an extended regimen (48- vs 24-week) of pegIFN-α2b, using weight-based RBV, with proper stratification for fibrosis and baseline viral load. .....



To date most of the data on the IL28B SNP come from patients with G1 infection [40], [41]. Mangia et al. studied this polymorphism in G2/G3 patients from their randomized clinical trial comparing short and 24-week therapy according to RVR. A positive effect on SVR was observed in patients bearing the favorable IL28B allele, although it was attenuated when compared to G1. This related to the high RVR rate (63%), as the effect was only seen in patients not achieving an RVR. Surprisingly, in the non-RVR group patients, the CT variant showed an intermediate effect between CC and TT (SVR: 67%, 87% and 29%, respectively). Although their reduced sample of G3 patients limited interpretation of the data, the prognostic usefulness of IL28B was higher for G3 (OR: 5.5, 95% CI=1.2–25) than for G2 (OR: 2.3, 95% CI=1.2–4.5)


http://hepatitiscnewdrugs.blogspot.ca/2011/07/easy-to-treat-genotypes-were-not.html

[timothy141]

After reading this a couple of times I too became interested in what IL28B is or means. Here is a paragraph from my Pathology report.
Quest Diagnostics also offers the Accu Type (R) IL28B test, which can help stratify HCV-infected individuals into those who are predisposed to respond less favorably to standard HCV therapy. A favorable IL28B genotype (ie, CC) predicts improved treatment response for individuals infected with HCV genotype 1. Reference: Clin Gastroenterol Hepatol. 2011;9:344-50 To order the IL-28B test please submit a new whole blood sample for test code 90251.

http://education.questdiagnostics.com/faq/HCV/Genotyping.

Hope this helps.
Keeping the faith.

Timothy

[timothy141]

I understand your feelings! I have been treating since 11-30-2012. (3a) With pegasys & copegus. Did not reach UND until week 8. And was told," If I could tolerate a full 48 weeks!"that was the path I was headed for.
There are moments I want to give up, then in a moment of clarity, or someone who understands brings me back to reality!! I made a decision to see This through to completion.
There was a time when I was grateful for being a 3a, thinking that this was a blessing.Having the "easiest to treat". LOL
There has been very few days in the past 3 months that have felt lucky about anything, other than I am fighting a battle worth fighting, an extension of life to be spent with greater insight with those I love and cherish.

[Dannyboi7]

  Sorry hear you didn't get a RVR,don't get discouraged there is still hope.As rk mentioned I didn't get a RVR and I did 24 weeks and got a SVR.


      In my case I got PCR done @ 4 weeks(virus detected) and 12 weeks(UND).Thats all my health care plan had to offer so I didn't have any choice,and I didn't have any choice on how many weeks I could do,they only offered a 24 week treatment for my genotype.And to top it off they don't do the IL28B testing yet in Canada.

So in essence I don't know at what time I became UND between week 4 and week 12.I have a feeling it must have been shortly after week 4.

    Now here you got 2 options that will work for you.From everything I've read what is done with the genotype 3 who doesn't get a RVR is they add 24 weeks of treatment from the moment they are UND.For example if you are UND at week 8 you add 24 weeks to that and you would do 32 weeks of treatment.The other option would be to find out your IL28B genotype if it happens to be a cc than 24 weeks of treatment would be sufficient enough since the cc without an RVR still has a 80 to 90% chance of a SVR.If you happened a ct or tt than the latter options is better in which you add 24 weeks from the moment you are UND.

    Contact your doctor before your 8 week app to make sure you can get a PCR and IL28B done on that date.Mind you a 3 log drop is still very good.And also remember that the first 12 weeks of treatment it is very crucial that you take 100% of your meds or close to that as possible.

Hang in there and all the best to you.

[HCVinPDX]

Thanks, rk.  Yes, I read about relapsing after treatment.  I don't care if I have to extend it.  I just want it GONE!

[rk2761]

Hi,

Not sure what you mean by the virus coming back later - do you mean later while you are on treatment? Or after treatment? There's always a chance it will come back in the six months after you end treatment.

I'm a G3 and was detectable at 4 weeks and UND at 12 and then again at 36 weeks (I treated for 36 weeks). Six weeks after treatment, my ALT was still low, so that's a good sign. I don't get my 6 month test until April.

Someone else on this site, Dannyboi, is also a G3 who was detectable at 4 weeks, UND at 12 and, after 24 weeks treatment, was declared SVR just a few weeks ago.

I too was disappointed after my week 4 detectable status, but my nurse said I should not be too upset - my chances of success were still 80%.

I hope that helps a bit

rk