Relaps from Triple Tx?

Question

I see posts from people that treated and their labs were UND, but, the hep c came back later. Just wondering if anyone knows what the percentage rate of people that did triple tx with incivek successfully but relapsed? What causes it to come back? I never ever EVER want to go thru tx again! JUst trying to stay hep c free.

pooh55811 · Accepted Answer

"I see posts from people that treated and their labs were UND, but, the hep c came back later. .."
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Just want to clarify a couple of things:

The Hep C does not "come back." It never left in the first place.

The viral load tests cannot always detect the virus if the viral count is very low. So the test may say Undetectable, but in reality, the virus could still be present, just in very low numbers. 

You will notice that all viral load tests will give the reference range numbers (ie how low they can count and/or how low they can detect). So, if the test can detect virus down to 10, then if the virus is present in numbers below 10 (10 per milliliter), then the virus will be there, but the test does not know it. 

There are two situations in which you will see viral detection after the person became Undetectable. 

One situation is called a viral breakthrough. A person had a viral breakthrough if a person became Undetectable during treatment and then had a Detectable viral load while still on treatment. 

The other situation is called a Relapse. A person has a relapse if the person became Undetectable during treatment, stayed Undetectable throughout treatment, including the end of treatment viral load test, but later, after treatment was stopped, the virus became Detectable again. This is a Relapse. 

In both of these situations the virus was Undetectable for awhile, but it was not truly gone from the body. It was just not Detectable.


"What causes it to come back?"
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The virus was never gone in the first place so once the meds were discontinued, the virus was able to replicate faster and soon there was a Detectable viral load again.

What causes these two types of treatment failures? Probably several factors, including  Race/Ethnic Origin;  Liver Fiibrosis Stage;   whether a person has a CC, a CT, or a TT allele;  Drug Efficacy ... absorption, metabolism, distribution;  Interferon Insensitivity;  Length of Treatment;  Drug Dosages ... is the dose high enough.

 
"Just wondering if anyone knows what the percentage rate of people that did triple tx with incivek successfully but relapsed?"
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Here is a summary of the outcomes for people who did not attain SVR and I will include the link:

On treatment Virological Failure:  7%  of treating subjects (On treatment Virological Failure includes those who met a protocol defined stopping rule and/or had DET HCV RNA at end of treatment with viral breakthrough)

Relapse:   4%  of treating subjects who completed treatment and who had UND status at end of treatment   

http://pi.vrtx.com/files/uspi_telaprevir.pdf

kittyluvr420 · Answer

Thank you for the information!

pooh55811 · Answer

If you read the data in the link, you will see that there is another 11% who fail Tx but they do not fall into the Relapse or Viral Breakthrough categories. 

I agree the statistics are encouraging. Still, I feel we need to be vigilant and realize that SVR is not 100%. We need to do everything we can do to help ensure that we have a successful treatment and attain SVR.

RN1234 · Answer

Thanks for the information Pooh!  I think these statistics are encouraging!

orphanedhawk · Answer

Nobody wants to ever do this again. Most people don't want to do this once.

I don't have the statistics but from watching this forum, I'd say a good majority,  in fact, a very strong majority do clear the virus with the triple tx.

BoceprevirGal · Answer

Some of the things that predict SVR (susained viral response, aka cure) are "early or rapid viral respose", meaning, how fast your virus beame Undetected, and also your "elle marker" (CC clears the best, CT second best, and TT, not as good), what condition your liver was in prior to Tx (cirrhotic liver may be tougher to cure), a persons' ethnicity (Black people, and Latino people, to a lesser extent, tend to be harder to cure),  and perhaps people with a vitamin D3 defficiency. Also, some strains of virus are just harder to erradicate. Also, if a persons Ribaviran level was lowered, prior to them going Undetected can be a fator, and people that missed doses of their meds.  Also, being older or over-weight can factor in~ 
   As far as mentiuoning people on this website, who
have relapsed after being Und at End of Tx, I wouldn't
feel comfortable mentioning personal accounts, even though this is a public forum, bu you can do a search, using tag words like "relapse post tx from triple x incivek/boceprevir"

Relaps from Triple Tx?

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