24 VS.48 WEEKS TX

[chevyelcam79]

Im sure this has been posted prior but..... I've been thinking(with some help, u know who u are)...  

here is my scenerio:  1A begin vl of 26,000. Stage 2 inflammation grade 2-3 fibrosis (I think thats right)  UND at week 2 and have continued to stay that way yipee.  tx 180 mcg and 1000 mg riba.  Doc has decided to let me do 24 weeks tx.  Only two more weeks to go.  Female, 140ish lbs. good health(cept for this), caucasion, 41 yo.  the doc said that with all of these factors, there is a very slim chance that I will relapse.

Bloodwork not too bad; last month WBC 1010, hemo 11.3.  Not feeling too bad, did have the throat thing going on not too far back but all in all, not too bad.  The doc did decrease shot to 135 when I continued to have the throat thing.

I do go to a hepatologist at John Hopkins University. supposed to be one of the best and not at all doubting that.

Any studies out there that show 24 wks as opposed to 48 with the above factors?  I guess Ive been thinking and I realize that the next 6 months I will be terrified that I will relapse.  Who in their right mind wouldnt?  

Anything that I should be concerned about?

Thanks for the input!
Shari

[jmjm530]

Not sure about some of those options without study data to back them up.

Option 1 and 6 do have study data (not sure about the Tahiti part).

Not sure the point of option 2, unless you're having problems with anemia.

Option 3 I've never seen documented but that doesn't mean it isn't.

Option 4 I don't like at all because reducing the Peg has been associated with lower odds of SVR.

Sam with option 5. No reason to lower the Peg unless your blood tests and/or medical treatment warrant.

Going back to the Tahiti part -- that makes the most sense to me, whether you take the shorter 24 week course or the standard 48 week course. You're certainly a candidate for the shorter course given your week 2 UND and very low pre-tx viral load.

How sensitive is the test they used at week 2? Ideally you should be UND using as sensitive a test as possible. You say your doc is at J. H. and is one of the best -- maybe that's why he agrees with me.on the shorter course. But seriously, search your heart and do what you feel is right.

All the best,

-- Jim

[alagirl]

Here's another option.  There is some evidence that six months of interferon after the combo therapy is helpful in RVR.  So if you wanted to toss the riba at this point, doing interferon for the remainder of the time might be helpful.  1a is not as resistant as 1b, but still - it's in genotype 1 and the standard of care for genotype 1 is 48 weeks.

You DID start out at a low viral load though and go UND quickly, all good prognosticators for success.  I would discuss this further with your doctor.  Pull the studies and go in and talk to your docs with the studies.  Get a second opinion too.  Toss around the different options with the specialists which as I see it are as follows:

1) Continue the current combo therapy to 48 weeks
2) Continue the current interferon level but reduce the ribavirin for the remaining time until 48 weeks
3) Continue the current interferon level but stop the ribavirin for the remaining time until 48 weeks
4) Reduce both the interferon and the riba for the remaining time until 48 weeks
5) Reduce the interferon and stop the riba for the remaining time until 48 weeks
6) Stop treatment after 24 weeks and go to Tahiti for two weeks

And yeah... I know who I am LOL ;))

[CJ807]

I was thinking about this today when I came across this thread.

Check this article:
http://www.hivandhepatitis.com/hep_c/news/2005/ad/121605_b.html

Good luck to you.

CJ

[goldenrule]

what did your ALT/AST enzymes look like last blood work??

[chevyelcam79]

Yes!  tonight and next friday!

[wyntre9]

First, congrats on your great news.

Second,  as a IA on extended TX, I agree with NYgirl that I'd think long and hard about whether to do the 48 week SOC.

1A is a very resistent genotype.

best of luck whatever you decide,

wyntre