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80575 tn?1207135964

1b - Slow Response

Today I received my results from a week 24 PCR.  I remain HCV RNA posititve with 5,000 IU/mL.

The good news is that I have lowered my viral count from 3,080,000 IU/mL at the start of tx to 9,000 at week 12 and now at 5,000 at week 24.

My doc wants to keep me on tx and monitor for undectable HCV RNA.  Then stay on tx for 36 weeks after undetectable.

Question 1:  "Will I get to undetectable?"
Question 2:  "What are my chances for a SVR?"

Thanks,

Mike
24 Responses
80575 tn?1207135964
Thanks.  I've seen your logon at hepCnet; you are knowledgeable on the topic.  How do you know that I'll go undetectable and not stay at 5,000 or elevate?  My inclination is to suck it up and stay the course.  Mike.
Avatar universal
In the UK you would be taken off the medication if you had not cleared the virus by 24 weeks. I am willing to believe that is because we only do 48 weeks max, there is no culture of extended tx (as far as I know). I don't wish to be too pessimistic, but I do think your chances of clearing the virus are slim. However, "slim" may be enough for you to feel happy about continuing.
Avatar universal
My questions would involve the following:
1.  What type of interferon are you using?
2.  What  dosage level?
3.  What is your height, weight, genotype, duration of infection?
4.  How much Ribavirin (or Copegus) are you taking?
5.  Have you treated before this tx?


Possible strategies, depending on the above answers include:

1.  RAISE the interferon dosage, to bump the viral decline curve.  You have obviously hit a resistance level, and need more horsepower.  Note:  This MAY not work, but SHOULD work.
2.  Change to a different interferon...especially if you are on Pegasys.  Going to Peg-Intron may be more powerful, and may be more flexible as far as dosing levels.  You can more easily do MORE than standard protocol with Peg-Intron.  Another choice would be daily, high dose infergen, using 15 mcg. / day.
3.  Make darn sure you are using the very maximum allowable Ribavirin dosage for your weight.
4.  Keep pushing until you do get undetected, using some combination of above strategies, and then go AT LEAST the 36 weeks after first undetected result, as your doc suggests.  I would seriously consider going for 52 weeks minimum, AFTER clearing.

Please take heart:  You are responding, you are just a slow responder, and are probably taking a sub-optimal dosage of drugs necessary to getting the proper decline curve.  You DID get the necessary 2-log drop at 12 weeks, but have bogged down, and need an adjustment , in order to really give you good odds.  You most definitely will need extended therapy, if you do indeed become undetected.  Please let us know all your variables, regarding the above questions, so that you might receive appropriate suggestions from the members of the forum.  Many of us have been there in the past, and had to get creative in order to get our SVR's.  I had to do a 'double dose' of Peg-Intron, in order to get the right decline curve, and still needed to extend to 18 months.  This is just my opinion, please consult your doc, and/or top prominent HCV practitioners, with lots of exp. treating difficult responders!  This period of tx is very critical to your success.

Good Luck!!!!  Don't give up, just push harder!  You are in a position to overcome this obstacle, and win.

Doubledose
Avatar universal
You are responding to medicine which is a good sign.  If it was me,,,I would follow your drs advice and continue and once you reach "undetectable",,,then go another 36 weeks past that.  People that are 1's are clearing so hang in there but just taking some extensions and determination...Good Luck!
Avatar universal
PS

Britgirl is correct, generally therapy would be discontinued as a result of not becoming undetected by week 24...but in your case, there are other variables to consider, AND, the possibility of changing the entire dosing paradigm, by bumping up the dosages, and keeping them at the increased levels...MAY do the trick, and MAY be what you needed from the beginning.  There has not been much research around ADJUSTMENTS to dosing, for people not getting undetected by week 24.  Most of our discouraging data comes from 24 week detecteds, who finished out the 48 weeks using the SAME dosage, AND who did not extend therapy.  In those studies, the SVR rate dropped to about 3%....
BUT, they did not use flexible, creative approaches, that now are being used from the beginning, to increase the SVR results.  You MAY just need a different regimen, AND you are very close to the 24 week undetected level....If you adjust, and get undetected in the next 4-6 weeks, YOU may indeed have a good shot at SVR.  I think it is worth a real attempt.  You have come too far, and I do not believe that scrapping the entire tx is the best strategy.  On the other hand, I think you do need to be aggressive, move quickly, and monitor whether or not it causes a rapid undetected result.  If that happens...you just need to stay on the dosage level that gets you there, for a long, long time.  Going for a full year at undetected (by VERY sensitive PCR testing) could give you high odds of success.  You just need to get undetected, and QUICKLY!!!!  (My Opinion, of course)

DD
Avatar universal
Miked
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