First, congratulations on your biopsy result. Stage 1 is considered minimal liver damage.
I don't know your complete stats/history, nor are any of us doctors here.
But in a very general sense -- you have minimal liver damage with the hardest to treat genotype. Newer drug treatments like Telaprevir/Peg/Riba are showing very good premliminary results that may be able to treat genotype 1's like yourself in half the time with twice the cure rate. If all goes well, Telaprevir is projected to be on the market in '09. Further down the line -- maybe 5-10 years -- there may be even better therapies available, possibly without interferon.
So, if it were me, I would not treat now, but keep a liver-healthy lifestyle and keep tabs on my liver via periodic doctor visit's, tests, etc. In any event you have plenty of time to make your decision, so whatever you do, make use of that time to learn as much as possible about the pro's and con's of treating in your individual situation.
All the best,
To add to the above, the cure rate for geno 1's is around 40-50% with 48 weeks of treatment. Whether this is "really good" odds as your nurse suggests, is debatable, but something you might discuss with her. Preliminary Telaprevir triple-therapy data appears to promise 80% SVR with 24 weeks of treatment, although the data presented so far is incomplete and the complete story probably won't be available until end of year. Lastly, there are some other things you can do both to help your liver, and your chances of treatment in the future. Stop smoking (tobacco and pot), lose weight if necessary (high BMI is a negative predictor for SVR), and either entirely eliminate or indulge in Alcohol only to the limits acceptable to your liver specialist.
Should have added an appropriate/sensible aerobic exercise program preferably combined with some resistance training plus a good nutritional program, possibly including supplements approved by your liver specialist. Do not take any vitamins or supplements with iron in them unless your doctor tells you to and has a good reason.
With JodyLynn's VL and liver damage, if she were to RVR wouldnt that give her similar odds. Even with 24 weeks.
Cause Jody would have to RVR first.
AT what point would you treat? Im aware this is just your opinion. Ive heard after 50 , and being in menopause progression is faster. I know whether to tx is a personal decision but would like to hear your opinion...when would you treat? Not easy living with it and not treating I find it to be a monkey on your back.
Thanks for your knowledge & opinion!
I think her VL would have to be <600,000 IU/ml to qualify for the shorter course, at least according to the European Union Protocol from last year. And, yes, she would have to be non-detectible by week 4, which would be less than 50/50 I think.
But as long as you bring this up, one reasonable strategy for those geno 1's with qualifying viral loads, is to impose a 4-week stop rule. In other words, if non-detectible by week 4, then continue on to 24 weeks. If detectible at week 4, then stop treatment. Problem is that unless the setting is controlled (like the Vertex trials where I believe they do use a similar 4-week stop rule) -- or unless they had a doctor very much onboard -- most people would find it hard to stop at week 4, especially if they had some sort of response. Just too much prepartation -- physical and mental -- that go into beginning treatment and making the decision to start. In any event, and this again is my personal take for me, if I were a stage 1, not sure I'd even want to treat for 24 weeks with 80% odds, but might want to wait a few years to see what the newer treatments bring.
Yes, your points are good, and that is why I answered in a general sense. As to what point would *I* treat, I best way to answer this is to tell you when I actually treated.
I treated three years after I thought my doctor told me I was between stage 3 and 4 (I was actually stage 3 but that wasn't made clear to me.)
Am I suggesting everyone wait that long? H*ll no. I pushed it to the very limit, for a number of reasons (an acute flare pushed it off a year or so) but the primary reason was what I had heard about interferon treatment.
Would I have treated earlier if newer/shorter/less toxic treatments were hypothetically available at that time? I'm sure I would have taken that into serious consideration.
I am one that decided to treat and did qualify as RVR. I had no liver damage . I did 36 weeks of 48. I am glad I treated. There are alot of thing that factor into treatment and response. For me, being a mother of 2 small children, i was sooooo afraid of them getting ahold of my toothbrush, or whatever and passing it to them. All i wanted was the disease out of my body, NOW!!!!! When I found out I had hep c, i was devestaed and not to mention uninsured. I had to FIGHT to get the medicine, iin no way wanted any part of waiting for tx. However, i had little knowledge about all of the studies that suggest that shorter treatment can be possible for RVR's. I would make sure you learn AS MUCH as possible and make the deceision that is RIGHT FOR YOU. You will have a peace that surpasses all understanding and that will be how you know its the RIGHT deceision.
RESEARCH, RESEARCH, RESEARCH!!!!!!!!
Darn now i dont know what to do again lol. Thank yall so much for all your help....dont know what id do without this place, makes me feel better and not be as scared. (smile) Before i found this site i was a crazy person with all of this on my mind. I come here everyday and read, still have alot to learn, but im doing my best. I am thankful for all of you here.
Slow Friday I guess and not too many people have chimed in on your situation. But from past threads of this sort, it generally runs around 50-50 in terms of whether someone like yourself should treat now, in fact probably the majority here would think you should, but of course keep in mind that the folks here have in most cases already made a decision to treat therefore may have some bias. I don't think anyone would argue, however, that you do have choices and you do have the time to think about those choices.
All the best,
Oops read the VL as copies not IUs.
The VL would probably need to be <400K to do the short course.
I do like the idea of the 4 or 12 week stop rule though.
It would give you a much better chance the second time round.
Would have to be better than booking yourself in for 72 weeks as well.
I agree that it would be hard to stop as we tend to be in fight mode when on Tx.
Congrats on your mininmal liver damage...Thats good! Wish you good luck on whatever decision you make. I know its a tough one!!