Two Log Drop Questions / HR, JMJM???

Two Log Drop Questions / HR, JMJM???

I was informed today that my 12 week Viral Load results were in,…and that while HEP C was detected, there is (almost) a two log drop and we will continue with treatment.  

A few questions:
#1: So this is good news …right? Not great- as UND would be great, but good???  

#2: So why do I feel anxiety and like I have been punched in the gut?

#3: I guess my question really is … how many people who were DETECTED at 12 weeks, but did have a two log drop went on the achieve SVR by the end of Treatment?

I am Genotype 1A – treating for 48 weeks with “Pegetron” (Peg-interferon.)  

Thanks so much to all for your ongoing knowledge, support and understanding 
Albany

[albany]

see above post...it was meant for all ... but i wanted to call attention to HR & jmjm to get their input as well.  thanks
Albany

[jmjm530]

Some studies suggest that if a genotype 1 has a  two-log drop but is  still detectible at week 12  (that's called an early viral response or EVR for short) then treatment should be extended to 72 weeks
for a better chance of SVR. At least one of those studies also suggests, that if you do not have a two-log drop at week 12, then even extending to 72 weeks is not beneficial, therefore treatment should be terminated.

Of course, it gets more complicated when trying to match your stats with the study stats, for any number of reasons including that some of the studies did not use weight-based ribavrin and the fact that you say you had "almost" a two-log drop. Do you know your pre-treatment viral load and what it was at week 12. Those are important numbers to have on file.

Other factors can also come into play such as did you have any dose reductions on Peg and Riba so far? What dose of the Peg are you on?  How much ribavirin have you been taking and what is your weight? What was your pre-treatment hemoglobin and what is it now? How about side effects so far -- easy, hard? What stage liver damage do you have? Is this your first time treating? Any other conditions such as fatty liver?

As to your specific questions:

1: So this is good news …right? Not great- as UND would be great, but good???  

UND is always better, but you probably would be considered by some doctors a responder if very close to two-logs, and depending on some of the other stats in question.

#2: So why do I feel anxiety and like I have been punched in the gut?

Because your're on treatment. We all feel anxious, especially if we don't see UND next to our viral load.

#3: I guess my question really is … how many people who were DETECTED at 12 weeks, but did have a two log drop went on the achieve SVR by the end of Treatment?

Again, a lot depends on your individual stats, but in general if you have a two-log drop by week 12 -- and extend to 72 weeks -- you have a better chance at SVR. Wish I could pinpoint those odds but some of those studies used fixed-dose riba. Maybe 40% chance with 72 weeks but that's a guess. Hopefully, you're seeing a liver specialist who can give you something more specific, as well as anecdotals from their practice.

All the best,

-- Jim

[jmjm530]

This study seems to suggest 77% chance of SVR with EVR if extended to 72 weeks with only 37% chance of SVR with 48 weeks of treatment. This is more optimisitic than some of the other studies I've read. Also, note that the study in question qualifies EVR at week 12 as  HCV RNA between 50-600 IU/mL. Frankly, these studies can give you headaches trying to match up stats -- but I think the one thing they have in common is that extending treatment to 72 weeks will in general benefit those with a two-log drop by week 12, assuming of course they become UND by week 24.

-- Jim

[jmjm530]

Here's that study: http://www.natap.org/2006/AASLD/AASLD_34.htm

[albany]

YOU ROCK ... exactly what i need is food for thought :)
I will def. find more info, post, AND see doctor with a LIST of questions
thanks :)
Albany

[nygirl7]

#3: I guess my question really is … how many people who were DETECTED at 12 weeks, but did have a two log drop went on the achieve SVR by the end of Treatment?

I had the same problem.  Did not become UND until somewhere before week 24. So using the Berg and Sanchez Tapias studies I determined it would be best to go to 72 weeks. At the time this was not commonly done like it is now so I went to Dr. Jacobson in NYC - he was the lead investigator of the Berg study.  He advised me if I wanted to do everything I could to make sure I reached SVR that it would be a good plan.

So I did it.  I am not 11 months post treatment and SVR.  I was geno 1A and also 1B.  It wasn't the easiest thing in the world but it worked.  

From my experience it's the only way to go. Roughly *using all the study data you can find and then smushing it together* I figure it takes us from having about a 50 - 50 chance to having only a one third chance of relapse. That's HUGE if you ask me and made it worth the effort!

Best of luck. It's not fun doing the whole 72 but you CAN do it and get SVR and THAT IS THE GOAL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Debby