Not Quite UND

Hi,

I'd like to solicit some opinion/comment on my HepDoc's decision to stop treatment.

I'm a white male, 51, genotype 1a, infected over 30 years, probable early cirrhosis (last biopsy was 3/3, about 3yr ago).  This is my third go-round at anti-viral treatment.

Starting with the Alinia trial, I did 8 weeks of Pegasys/Riba.  I left the trial (viral load not decreasing fast enough), and switched (with no break) to daily Infergen/Riba (15mcg / 1400 mg.)  I've kept this up for 31 weeks now.  I've been on Procrit 40,000 since week 12 of the Infergen, and have had two transfusions over the course.

My viral load started at 35,000,000 and has dropped steadily the entire time on treatment.  I've had monthly PCRs, every 2 weeks for the last two months.

So now my viral load is 153 IU/ml.  Two weeks ago, it was 550.  I've never had a viral load  number larger than the previous one.

My doc tells me that since I'm not UND at over 24 weeks, I should stop.

I recognize this is a standard protocol, and the odds of SVR at this point are very low, it seems like I should continue, for another month or so, to see if I can get to UND.  Presumably, I would then complete an additional 48 weeks.

Got to get to UND before SVR, and I'm so close...

This is a link to the Arase study, which, while a very small sample size, does seem to support the notion that it is possible to attain SVR after 24 weeks.

Thank you.

[Douglas Dieterich, MD]

I think that your analysis is a good one. Personally if you can get truly undetectable that is < 5 IU on TMA and keep it there for  48 weeks or so then you have a very good chance at a cure. However if you cant get < 5 then you are indeed wasting your time. You can certainly be eligible for the new drug trials and the new drugs when they get to the market in 2011, but as long as you are on the meds now I would keep going a few months longer to see if you can get to < 5. Good luck! DTD

[neptune235]

Sorry...forgot to paste the link to the Arase article:

http***www.jstage.jst.go.jp/article/internalmedicine/47/14/1301/_pdf

[pjpie]

Try to keep going, thats what I would do , I think if you can stand it your almost there now im not the expert but I feel your thoughts hold validity. and if it were me Id be fighting. Good luck to you I wish you un forever.