3a treatment duration

[lolitriqui]

hi all; am type 3a in week 20 out of 24 inter/riba combo; heard several times 3a relapse numbers are higher than published 75/25; anybody going for 48 weeks with 3a???? if so, please powwow me the details..... have no idea what i should believe anymore; treatment is going ok except all the regular complaints; nothing totally intolerable; however, hear that relapsing puts you on an injection a day for a year.... no desire... what can i say!!!!
ciao
Chris

[medicmommy]

Thanks! Such good info and you answered my question perfectly!

[comeagain]

I´m the one that zazza is refering to as her ex.
I just wanna say this there aint no garantis with this hcv, I´ve learned that the hard way.
on my first tx everything seemed just perfect my alt and ast was very low (healthy low not to low).so I was almust certain to clear.

But what a disapointment not to. Ok I´ve got a bit suspected when I found out I was on the same doses as someone who weigted 60 lbs less.
What was really bugging me after relaps was that I did´t feel I`ve got the optimal chance to beat it.
My adwise to you is get a second opinion find a skill hepatologist in your area, was it NY? sure people here can tip U about someone

[CockSparrow]

Last post was meant for you mostly
CS

[CockSparrow]

What VL test did they use in Accelerate?
50IU

But I might not double to 48 under those circumstances. 36 has always seemed like a nice round figure to me

I agree with that. Pity there arent any studies thou

For the record Accelerates G3 SVR rate when non rvr was 39%
A study done in Pakistan or India had a G3 non RVR SVR rate of 44% when detectable at >50iu and 33% when detectable at >600IU at 4 weeks.

CS

[zazza]

I would not put a lot of stock in the fact that lower sensitivity tests might have been used in older studies. It is as Goofy Dad says "courting the devil". There are recent studies which show that for geno 1 the new highly sensitive tests do find the people with a very low viral load at week 12 who are more prone to relapse.

Interestingly enough, my ex - geno 3 - who relapsed after 24 weeks and now is doing weight based 48, got a "borderline" result at week 4 his second round. The first round no week 4 test was taken. Borderline means there is detectable virus, but not enough to give a number in IU/ml. The test was sensitive down to 15 IU/ml. Remember he is a relapser and still got as good a result as this. His nurse cautioned him and said that this result might very well be the reason he relapsed last time.

As you understand, I would not put my bet on the fact that older studies have used tests of lower sensitivity. What I see, I see. If I am detectable, I am.

[zazza]

You want your week 4 viral load test the day before or the same day as but before taking shot # 5. This is because in the beginning of a shot week the interferon might cover up remaining virus in the blood, and by waiting to the end of the shot week instead you get the truest picture possible. Since you are a geno 3, the week 4 test is very important to you! Reschedule if possible!

My hemoglobin fell from 15 to 10, ie 5 points total. I don't know what HCT is. But do check in on the forum with your blood count numbers and ask what people think before any dose reductions, because some doctors are prone to unnecessary reductions. There are rescue drugs to ask for also before retorting to cutting doses.

[cruelworld]

hadnt seen you in a while, i hope your doing well.

a couple of questions.

what was your riba overdose?
was that your idea or did your doc suggest?
how did your hemo hold up?

[mar148]

What was the VL cut off for RVR in the accelerate study?  Does anyone know?

[mar148]

What was the VL cut off for RVR in the accelerate study?  Does anyone know?

[medicmommy]

Does it matter if the first vl response test is done at the start of the 4th week? Or should it be at the end? I'm going for my 1st vl  tomorrow, but it is the start of week 4...Am also a 3a...One more question...HCT suddenly dropped 5 points (HGB dropped 2) at end of week #2...If labs are lower this week (week #3), will the interferon or Riba dose (I'm on 180mcg/800 mg) be lowered or if  critical low, will they try to stop treatment? Are there other options to stopping tx if so?? Thanks...

[GoofyDad]

What VL test did they use in Accelerate? If Loli was 2,000 copies - I thinks that's under 600 IU, which may have qualified as RVR in Accelerate?

Even if - calling that an RVR with knowledge of VL would be courting the Devil. But I might not double to 48 under those circumstances. 36 has always seemed like a nice round figure to me.

As another datapoint - I was 3a, Stage 4, RVR, and SVRed with 26 weeeks. Weight based riba - dosed well to the high side.  

[zazza]

Now you SVR, you hear! We need you as an example of extending tx leading to SVR! :) Great to hear you are getting close to finishing!

[jools57]

http://www.hivandhepatitis.com/2007icr/easl/docs/050107_b.html

Here's a link titled "Treatment Duration and Response in Patients with Genotype 2 or 3 HCV Infection". Especially note the second section called "What about Slow Responders?"

I got this link from zazza when I was in week 4, and told I had a 2 log drop. Had it not been for her, I don't think my Dr. would have told me I was a slow responder(thank you zazza!) I decided that I did not want to take any chances, and so fought the insurance co. to extend to 48 weeks. I showed my Dr. this article, and he agreed, better to extend now and see what happens after 48 then to just do 24. I'm in week 42. I had to start procrit last nov. because of low hgb. I won't lie to you, it's been tough, but I felt I had to go for it, and know I did all I could to reach SVR the first time. Time will tell!
Blessings, J

[zazza]

Yes, since you are genotype 3, you are a slow responder, or what is often called a non-RVR responder, since you were not UND by week 4.

You are very wise to consider your situation while still on treatment. Read this link carefully:

http://www.natap.org/2007/DDW/DDW_01.htm

"Conversely, pts without an RVR had an SVR rate of only 49% with 24wks' treatment, suggesting that these pts may benefit from more intensive treatment regimens."

"Conclusions: Genotype 2/3 pts who do not achieve an RVR could receive added benefit if treated for 48wks with a higher dose of RBV (1000/1200mg/d).These results merit further investigation in a prospective controlled study to fully elucidate how treatment customization can benefit pts."

As you can see from the conclusions of this report, additional studies are needed to determine the benefits of extending tx for genotype 2 and 3 non-RVR's. It is pretty accepted nowadays that week 4 is the crucial point for genotype 2 and 3. They need to be UND by then to stand a good chance with 24 weeks. The question is how much are the non-RVR patients helped by doing an additional 24 weeks. This is being studied right now. My ex is a genotype 3 relapser and is right now participating in one of these studies, doing weight based interferon and ribavirin for 48 weeks.

So... if you are a non-RVR, genotype 3, you know your chances are cut down to 50%. You do not know how much or if it will help you to extend to 48 weeks. There are reports pointing in this direction though. I think the question is if you want to wait and see until this theory has been proven right or wrong, or if you want to be one of those who extend in order to find out if extending actually helps you.

Here is a link about another study on extending tx for geno 3's with high viral load:

http://www.hivandhepatitis.com/2007icr/aasld/docs/110907_d.html

If you decide you want extended tx, you might find that it may take some effort on your part to get it approved. Jools might be able to help you with advice here, since she obviously managed to convince her doctor of the benefit of extending tx.

Remember, my ex has already done 24 weeks, is now doing a second round of 48 weeks, which makes a total of 72 weeks. So by extending now, you can actually diminish the total amount of weeks of tx you will have to do.

But, of course, it is your decision. I just want to share the research I have found. Good luck!

Zazza

PS. I think if you look at the entire group of genotype 3's, there might not be that much difference in SVR rates between 24 and 48 weeks, but if you look at the subgroup of non-RVR responders there might. This may explain why older studies do not show much benefit of extending, they have looked at the group as a whole.

[lolitriqui]

thanks for responding; i lowered 2 logs by week 4, however was still at 2000 copies; next test at week 12 was undetectable; does that make me a slow responder???? i thought week 12 is the big one; is there any paperwork on the 50/50 chance if one is not UND by week 4??? i thought i did really well; but then you never know...; i understand there is a greek study out which puts 24/48 week data at pretty much the same SVR; published i can't find anything on the issue; so what do physicians base their timeline on??? many questions, i know....
ciao
chris

[jools57]

Zazza gives good advice.
I'm a geno 3 doing 48 weeks because I'm a slow responder( not und at week 4) on weight based everything.
Wishing you all the best!
J

[zazza]

The question is when did you become undetectable? If you were UND by week 4, you are good to stop after 24 weeks, since you have around 80-90% chance of clearing, can't remember the exact number now. If you were not UND by week 4, you should consider extending treatment to 48 weeks because your rate of success has decreased to 50% if you only do 24 weeks. Also, some geno 3's with cirrhosis do choose to go 48 weeks, just to play it safe.

The "an injection a day for a year" is Infergen. I can't remember hearing about any geno 3 on Infergen. So calm down. Geno 3's do have a good shot at clearing.

Are you on weight based ribavirin? I hope so, since this raises your chances of success yet some.

Best of luck to you!