how long to remain on TX

[Krisso]

Hi everyone,

I'm 52, 1a, stage 3, infected when I was 17.  I began TX 8/27/07, and didn't clear the virus until 1/10/08, but remain undetectable today.  My doc said I need to be on TX for 9 months after clearing.  He said I will stop on Oct 10th.  My question:  is this the optimum time?  I am completely fed up with the side effects, but don't want to take any chances.

Thanks for any help you can offer

Krisso

[toughluck]

That is a tough decision, if you stop and clear great, if you relapse have to start over again.

[jmjm530]

Please check my math, but it appears you cleared the virus at week 17. If so, in general  that means you should treat a minium of 72 weeks total for a decent chance of SVR. That also assumes you had a two-log drop by week 12, although not 100% sure on the last statement. Based on this, it appears your doctor is recommending a sub-optimal (too short) treatment period. You might want to pose this question to Dr. Dieterich in the professional forum and/or see a liver specialist (hepatologist) who has your full medical records  for a consult.

Professional forum: http://www.medhelp.org/forums/show/272

[Krisso]

Thanks for your response, Jim.  In fact, thanks for ALL of the thoughtful answers you share with us.  I've learned so much from you.   My VL dropped from 6 million to about 200 by week 12.  I've been trying to do some research here while waiting for a response, and that number (72 weeks) keeps appearing.  I will certainly post to Dr Dieterich, as soon as I can get through.  We moved to Arkansas about a year ago, right before my Tx began, and lost my wonderful Hepatologist in San Diego.  I haven't been impressed by the gastro I have now.  He seems to have quit on me before I even began; has been unenthused about my chances for success because ALT and AST have lowered only moderately during treatment (from 96/104 to  62/64).  I have been working to remain positive, and don't want to hurt my chances of SVR, so I'll do whatever it takes.

And toughluck, thanks for weighing in on this, too!

[fretboard]

I am a geno 1a as well so your question caught my attention.  I have not tx'ed yet and of course I don't have any kind of opinion to offer you.  Just to give you the heads up, I have looked to see if I could find any statistical information on this, but I haven't come across anything.  There is information on 1b, but that doesn't do you any good.  It must be awful to tx with a doctor like the one you are seeing, I wish you well with your decision.  The movie Dr. Dietrich made is on my profile if you haven't watched it yet, it lasts a little over 40 minutes.  I play guitar as well, but you don't want to hear me sing.  LOL   God Bless  

[Krisso]

Here's try # 2.   It must be time for bed...  I'm even spacier than usual.  Nice to hear from another musician, and I'm just SURE you can sing, too!   LOL    Thanks for the tip on Dr D's movie.  I'll check out it out in the morning, and try to post a question of my own.  DOn't stay up too late!

[jmjm530]

You shouldnt be concerned about the slightly elevated enzymes. It's sometimes like that on treatment. As a stage 3 plus, still detectible at week 12, I think Dr. D. will recommend at least 72 weeks.

All the best,

-- Jim

[Krisso]

Help!  I've been trying to post a question to Dr Dieterich since last night related to my original thread here.  Apparently, they have already received their quota of questions for today.  I was trying to search the MedHelp Expert forum to find a similar answer, bu so far, I haven't  been able to find a single relevant answer that Dr D has posted.

Can anyone refer me to any articles or studies I could print to show my doctor why I need a longer Tx?  Thanks for your help!

[frijole]

You have had excellent response, but as someone who was not clear at week 12 and did the 9 months (36 weeks) after UND by sensitive test AND did not clear, I think you should listen to the voices in your head that say  72   72    72   72   72   72


frijole

[nichole572]

I am also gentype 3 and my doctor told me I have to be on treatment for 24 weeks. I am on week 10 and going strong. I alreadt had my viral load checked and I am negative.

[Trinity4]

This is a good paper to read. It summarizes the Berg, Sanchez-Tapias and Pearlman studies. It is called "Seventy-Two Weeks of Peginterferon and Ribavirin for Patients with Partial Early Virologic Response?"

http://www.liverfoundation.org/downloads/alf_download_321.pdf

[fretboard]

Here's a study, I'll leave the link where I got it from.  If the link don't work you can just Google pubmed and go from there.  Oh there's more stuff to find from pubmed, if you care to look.  Good luck with whatever your decision making is.  God Bless

Extended-therapy duration for chronic hepatitis C, genotype 1: The long and the short of it.

Pearlman BL.

Center For Hepatitis C, Atlanta Medical Center, Medical College of Georgia, Emory School of Medicine, 315 Boulevard NE Suite 200, Atlanta, Georgia 30312, United States. ***@****.

With pegylated interferon and ribavirin, more than half of all chronically-infected hepatitis C patients can achieve a sustained virologic response; however, patients with genotype 1 infections and those with other poor prognostic factors have relatively inferior treatment response rates. Since new therapies are still years away from approval, it is incumbent upon providers to maximize the therapeutic efficacy of today's treatment. The later the virus is undetectable in serum during treatment, the less likely it will be eradicated. Patients with a delayed or slow virologic response to therapy (at least a 2-log(10) decrease in baseline hepatitis C RNA yet detectable viremia at 12 wk of therapy and undetectable virus 12 wk subsequently) may, therefore, benefit from an extended therapy course beyond one of standard duration. Although higher rates of treatment discontinuation may plague this approach, 72 wk of treatment for genotype 1-infected slow-responders may improve response rates and diminish relapse rates relative to those of 48 wk. Based on data from both viral kinetic and clinical studies, therapy prolongation in slow responders may be a reasonable strategy to improve response rates in these treatment-refractory patients.

http://www.ncbi.nlm.nih.gov/sites/entrez