44 weeks versus 48- what do u think?

[Believer7777]

I have a question. I have Gt 1a, original viral load was 340,000, dropped to 200 at week 4 and was UND at week 12 (dr thinks I prob cleared at week 5).

I have a huge trip coming up 4 weeks prior to end of treatment and I wanted thoughts on going to 44 weeks versus 48. Since I've been on treatment for so long, does anyone think it will greatly limit my success for SVR?

I do not want to go this far and stope early,  but wanted to get opinions to see if anyone has done this and then SVR'd.

Thanks!

[joemc34606]

I agree with everyone else, is it worth the chance you came a long to quit now. I no everyone here is looking for the best possible chance to clear so they won't take any short cuts. Good luck
Joe

[oceanblue701]

I thank you for the congratulations. I never told anyone but my husband about the dx and of course he was here for the treatment and the svr news, but, it is so good to have someone else know I succeeded and congratulate me.
I got through it by being extremely positive and continually paying as little attention as possible to how i felt while doing everything I could to stay healthy and avoid side effects by covering every base I could think of ahead of time.
This forum really helps people cover their bases and keep up their courage.  
I visit this forum from time to time because I feel a kinship with everyone who has faced the diagnosis and the treatment of hepatitis c. The diagnosis is scary and isolating and the treatment required my full attention and effort to finish. This is prompting me to reach out to others.
So many posts by many people really made the difference for me.

[flcyclist]

THAT was a wonderful story.  Thanks so much for sharing and congrats to you for SVR!  

[oceanblue701]

I have never posted here but was a frequent visitor about a year ago when I really started crashing with side effects that were overwhelming to me as I dragged through the last 8 weeks of 48 wks of INF/RIBA treatment.
Diagnosed a 1a with 150,000 viral load. I was treated with 1200mg riba daily /180 inf weekly. Found to be und on a Monday at  the beginning of wk5 by blood test and also again later at the 12 week. SVR this past April 2011. I finished  tx last week of Sept 2010.
I was desperate to be done and had soldiered through lots of SE's with a positive outlook and a get up and get going every day approach which worked very well for me for a long time. But the physical side effects really deepened over time and I developed claustrophobia too. My doctor, who was very good, put me on an anti anxiety agent as needed and told me I could half the riba for the last four weeks when she saw me near the end. I had lost 30 lbs since the last visit and I really considered tapering or even stopping as I was not doing well. I planned to go on vacation the day after my last shot.
I visited this forum and read for days the many many intelligent and caring comments posted by the members here over time and I decided to continue the Riba  at full dose . You all lifted me up and SAVED me. Thank-You.
I do not know if I would have achieved SVR if I had stopped early. I just felt I needed to complete the entire tx, and then, if I didn't SVR, I wouldn't be blaming myself for giving up too early with the end almost right around the corner .
I never had any rescue drugs other than the anxiety med which I did not need anymore within a few weeks of finishing tx as the claustrophobia pretty much resolved. I did not feel really good until this summer. I had  continuing GI stuff and lumps and sore joints. But, most of this has resolved now, and I am 59 years old and I do not have hepatitis c anymore.
I'm worried for you to stop early believer and that is all I am writing to say.
I know all the great stats on RVR . However, I have read here where a person or two with a lower viral load than I started with, finished tx and then did not SVR. This made me not want to take ANY chances. Good Luck to you whatever you decide.

[spectda]

http://www.hivandhepatitis.com/hep_c/news/2011/0111_2010_a.html
Results

865 participants (28.6%) developed anemia during treatment.
449 of these patients (51.9%) used ESAs, usually after ribavirin dose reduction.
Patients who developed anemia were significantly more likely to achieve sustained virological response.
SVR rates were associated with magnitude of hemoglobin decline:
Drop of > 3 g/dL: SVR 43.7%;
Drop of < 3 g/dL: 29.9%.
Participants who reduced their ribavirin dose were not significantly less likely to achieve SVR.
Among patients with early-onset anemia (through week 8 of treatment), those who used ESAs had a significantly higher SVR rate than those who did not (45.0% vs 25.9%).
People with early anemia who used ESAs were also significantly less likely to discontinue treatment due to adverse events (12.6% vs 30.1%, respectively).
However, ESA use did not affect SVR or treatment discontinuation rates among patients who developed anemia after 8 weeks.

[spectda]

http://onlinelibrary.wiley.com/doi/10.1002/hep.24180/abstract
"Abstract
Anemia may increase the likelihood of achieving a sustained virological response (SVR) during pegylated interferon and ribavirin treatment of hepatitis C virus (HCV) infection. To determine whether hemoglobin decline is associated with SVR, we retrospectively evaluated the CHARIOT study of 871 treatment-naïve HCV genotype 1 patients. Anemia (serum hemoglobin 30g/L from baseline occurred in 76% of patients overall, including 526 patients who did not become anemic. Virological responses were higher in anemic patients compared with those who did not develop anemia (end of treatment, 80% versus 65%, P = 0.003; SVR, 61% versus 50%, P = 0.02); these differences remained significant when patients receiving erythropoietin were excluded from analysis. SVR was also higher in patients with hemoglobin decline >30 g/L compared with patients without a similar decline. In multiple logistic regression analyses with treatment group and baseline characteristics, the odds ratio for SVR was 1.97 (95% confidence interval, 1.08-3.62) for anemia and 2.17 (95% confidence interval, 1.31-3.62) for hemoglobin decline >30 g/L. Patients who first developed a hemoglobin decline >30 g/L during weeks 5-12 and 13-48 were more likely to achieve SVR than those who first developed such changes in weeks 0-4 or who never experienced them. Conclusion: Patients with HCV genotype 1 infection who develop anemia or experience a hemoglobin decline >30 g/L during weeks 5-48 of therapy achieve higher virological responses to pegylated interferon and ribavirin therapy that are unrelated to erythropoietin use. (Hepatology 2011;)"

[spectda]

Unfortunately our treatment does not include testing plasma concentration of ribavirin. Weight based dosing was a step in the right direction, but as Willing pointed out to me during my tx since the riba is mostly processed through the kidneys, kidney function may be a bigger factor in absorption and of course is different in each individual. In the absence plasma concentration testing Hgb decline has been used and studied as a method of judging riba absorption since riba destroys RBC and HGB along with it. There are many studies that show the SVR rates are higher in people who have early hgb declines. That does not mean that all who do not have a good hgb decline relapse, but the rate of relapse is certainly higher.

http://jac.oxfordjournals.org/content/62/6/1174.full
"Ribavirin exposure and SVR
Persistently negative serum HCV-RNA beyond 24 weeks upon completion of HCV therapy defines SVR. All studies that have assessed a relationship between ribavirin plasma concentrations and SVR found an association. Jen et al.34 found an SVR rate of 49% when ribavirin plasma concentrations at week 4 were 3.5–4 mg/L. This figure increased to 62.5% when ribavirin plasma concentrations were >4 mg/L. The same authors noted that HCV genotype 1 required higher ribavirin plasma concentrations than genotypes 2 and 3 to reach the same response rate. Based in part on these results, Lindahl et al.55 performed a prospective study in 10 patients infected with HCV genotype 1 to evaluate the safety and tolerance of a high dose of ribavirin that was selected and adjusted to achieve a steady-state ribavirin concentration of ≥3.66 mg/L. Nine of the 10 patients achieved SVR, despite the fact that side effects were more frequent and serious than using standard ribavirin doses. Tsubota et al.56 found an SVR rate of 100% in patients infected with HCV-1b when ribavirin plasma concentrations were 2.5–3 and >3 mg/L at weeks 4 and 8, respectively. Similar results were obtained by Arase et al.40 and Maynard et al.57 at weeks 8 and 4, respectively. Interestingly, Loustaud-Ratti et al.58 evaluated the relationship between early ribavirin exposure and virological response and found that the area under the curve interdose (AUC0–12) and an abbreviated AUC0–4 after the first dose of ribavirin, but not the AUC at week 12, were correlated with SVR. Two cut-offs were established for AUC0–12 and AUC0–4 of 3014 µg/h/L with a sensitivity of 91% and a specificity of 61% and 1755 µg/h/L with a sensitivity of 72% and a specificity of 85%, respectively."

[Believer7777]

Dave, are you saying there is a direct correlation with low HGB to absorption of RIBA?

My HGB levels have been pretty normal, however I've lost much hair and itched severely in the winter time.

[Trish77]

Without knowing your viral load between Week 4 and Week 12, you're rolling the dice, as it's been aptly put.  There are too many cases of viral load holding between those weeks and you're potentially wasting 44 weeks of treatment on a "probably".   I'm sure you can get an example of people who had to stop early and SVR'd but would they have stopped early if they had a choice is the question.  Even if you stopped at Week 44, chances are you're not going to bounce back immediately after stopping.  It's not like you stop the drugs and immediately you're a new person.  So if your reason for stopping is so that you'll feel better for your trip...you won't necessarily.  I'm sure by now you've learned strategies to deal with your side effects.  I had to work a couple of weeks of 14 hour days while on treatment for a crisis situation at work and I was amazed that I was pulling it off at the time.  Good luck with your treatment results and I hope the trip goes well, whatever you decide.

Trish

[spectda]

How much of a decline in HGB did you have? Riba is very important in preventing relapse and our only way guessing how much you absorbed is by HGB decline?

Willing added Victrelis at week 30 I believe because he was waiting for it's approval. I Don't know if it's worth considering adding it now until the end of tx but maybe. Hopefully he and other's will chime in.

Good luck and hopefully you will be done with HCV for good,
-Dave

[flcyclist]

Is it really worth rolling the dice for 4 weeks?  And will you feel that much better 4 weeks after stopping due to the long half-life of riba?  As mentioned above, when did you really clear the virus.  I'd have a long talk with the doc before making that decision.  

Best luck as you finish and hope you have a great trip.

[Believer7777]

Great feedback guys- I am on INF and RIBA- old school treatment. 1200 mg of RIBA a day- never decreased dosage and I'm not anemic ( issues with wBC) and have been on nuepogen.

I am finishing week 36 today.

[spectda]

I would have thought that bali would have asked how sensitive the pcr was that was used at week 12. being und with a pcr to sensitive to 43 iu/ml is very different then being un with a pcr sensitive to 2 iu/ml

[Bali05]

Do you feel lucky ?
My viral load was 234k baseline and 170 @ wk4
I was still detectable @ wk8

b

[spectda]

I would complete the 48 weeks since you did not do a pcr between week 4 and 12. You're doctor can guess but there is not guarantee that you were und at week 5. As an example in my victrelis trial my vl was 246 at week 6, 274 at week 8 and und at week 10, detected  <25 at week 12, and und from week 14 onward so you never know.

Are you using triple therapy with victrelis or incivek? How many weeks are you into treatment? Have you had any dose reductions? How much ribavirin per weight are you taking? Have you become anemic?

-Dave

[desrt]

"(dr thinks I prob cleared at week 5)."
Based on what?

Is your doctor sure enough about 'probably clearing' at 5 weeks to OK shortening tx? I'm all for doing the minimum amount of IFN possible to get a sustained response, but it seems you've got a lot of time invested in this to base tx protocol on a guess.