Any chance of SVR if treatment is stopped at 21 weeks?

[AjaLee]

Hello,
I went to the oppthamologist for a  follow up check up  this  week.  He said that there were some changes in the backs of my  eyes. I have to go back in a month , and if they've gotten   worse, he would recommend stopping interferon

That would be 21 weeks into  treatment with inc + SOC

I treated about 10 years ago.  Only had random viral load tests, which were never UND, but was once 35. My (new) doctor said that because the ribavirin was cut so low so often, he would almost consider me  untreated.  

4 week test this  time was <43 (no note whether UND or DET), 8 and 12 week viral loads were UND (hooray!). Dr. said that Quest wasn't  indicating UND or DET at that time (?!?)  Have had pneumonia and a transfusion  and  have had to stop working due to  the SE horrors (I don't know how   you  guys keep working through this!  Kudos)

I am  genotype 1B.

Anyway, not to borrow trouble, but if I find out I have to stop at 21 weeks, is there ANY chance of SVR, and if so, how possible would it be?  

The thought of  going through all of this for nothing is  very depressing.  Thanks for any info.  S.




.

[AjaLee]

Thannks a lot.  Seems it is pretty common and reversible.  That makes it much less of a worry.  Thanks again.  S.

[willbb]

Some degree of cotton -wool; spots are seen in most patients using Inf. therapy and a certain degree of retinopathy has been observed(approx 36%), however rarely to the point of having problems upon cessation of treatment as well as having to stop therapy early.
Seems diabetes and/or high BP plays a role .
Hopefully you will be able to complete your treatment
Best..
Will

http://knol.google.com/k/retinal-complications-of-chronic-hepatitis-c-treatment#

Abstract:
Purpose: to demonstrate the retinal complications of interferon monotherapy and interferon plus ribavirin on patients with chronic hepatitis patients & Methods: 22 patients with chronic hepatitis C diagnosed by PCR were classified in to two groups. Group I which included 13 patients , 8 were not diabetic or hypertensive (Group Ia) and 5 patients were diabetic and/or hypertensive (Group Ib).  Patients of this group were given Interferon alpha2b monotherapy for 24 weeks. Group II included 9 patients, 5 were not diabetic or hypertensive (Group IIa) and 4 patients were diabetic and/or hypertensive (Group IIb). Patients of this group were given interferon alpha2b plus ribavirin for 24 weeks. All patients were assessed at the end of weeks 1, 2, 4, 6, and 8 and every 4 weeks during the treatment. Opthalmological examination were carried out before the start of treatment and every month after initiation of treatment. RT-PCR was done after 24 weeks to detect responders and non responders to treatment.

Results: The ocular examination during treatment period were normal except for the retinopathy. Retinopathy occurred in 8 of 22 patients with an overall percentage of 36%. Non-responders (7/8) were at increased risk of developing retinopathy. Non significant difference were present between interferon monotherapy and interferon plus ribavirin, while patients with diabetes and/or hypertension have shown a high frequency of retinopathy. The cotton wool spots were seen in all patients except one patient in group Ib who developed cotton wool spots and flame shaped haemorrhages at the posterior fundus. The retinopathy developed in some patients as unilateral (5/8) while in others (3/8) patients it was bilateral. All the patients were asymptomatic, and despite the retinopathy, subjective complaints have been uncommon, and visual acuity has not always been impaired. The retinopathy was noted 4 to 16 weeks after initiation of the treatment and disappeared in a 4-11 week period.  The retinopathy disappeared in all patients who continued the treatment except one. At the end of 24 weeks, 4 out of selected patients were negative for HCV RNA by PCR ( 2 in each group).

Conclusion: two weeks to 16 weeks after the start of therapy retinopathy develop in the form of cotton wool spots and retinal haemorrhage.  The retinopathy disappears spontaneously during therapy or rapidly after stopping the therapy.  Despite the retinopathy, most patients have had good visual acuity.  In particular, patients with diabetes mellitus have shown a high frequency of development and progression of retinopathy during treatment. Patients should be examined before starting therapy to look for pre-existing retinopathy.  If any is present, interferon should not be used or the patient should be monitored closely-for example monthly.  If  no retinopathy is present, less frequent examinations might be performed, such as at 3 months, unless the patient notes decreased vision.  

[aj7538]

Same thing happened to me. I had a floater.in my eye, went to dr found out my blood vessels behind the eye were bleeding. Told.me to go back in a month. Just went on thursday, and he said eyes were.much better. to continue tx. I sm in week 22/28 so I know how u feel. Dr toldme 70% of patients.on inteferon get this .it will reverse itself. Good luck

[AjaLee]

I have an appointment with my GI this Tuesday, so I'll see what he says then.  He is  the  one  who sent me to this opthamologist  for a baseline before treatment and everything was OK then, though.  
It's probably nothing - I have lately been having  anxiety over everything, and have neverr been    good at waiting.
Just read your post on the social forum and I  feel silly bringing it up.  You're an amazingly strong person.

[HectorSF]

What does your GI who is treating you say?
An ophthalmologist is no expert of hepatitis C or its treatment. Are they sure it is related to treatment?

I would get another opinion before stopping as you have come to far.

Were you treating for 24 or 48 weeks.

"5.5 Ophthalmologic Disorders

Ribavirin is used in combination therapy with alpha interferons. Decrease or loss of vision, retinopathy including macular edema, retinal artery or vein, thrombosis, retinal hemorrhages and cotton wool spots, optic neuritis, papilledema, and serous retinal detachment are induced or aggravated by treatment with alpha interferons. All patients should receive an eye examination at baseline. Patients with pre-existing ophthalmologic disorders (e.g., diabetic or hypertensive retinopathy) should receive periodic ophthalmologic exams during combination therapy with alpha interferon treatment. Any patient who develops ocular symptoms should receive a prompt and complete eye examination. Combination therapy with alpha interferons should be discontinued in patients who develop new or worsening ophthalmologic disorders."

Good luck.

Hector

[AjaLee]

Oh - similar situations.  Let me know what you find  out.  Good luck.  S.

[working dog]

hi..i'm 1a...had to stop at 19+ weeks..was < 43 at 4 weeks...und 8 and 12 and 19 weeks..now a couple months off tx i just took a vl test...no results back yet...i hope to be und....i had very tough sx during tx...and was stopped because the interferon was causing hemorrhaging in the back of my retinas...we will see ...i was cc..1a...2/2 vl 10 mil to start....never tx before....i feel really good now....my sx are very little...my hgb up to 13.....i will post in a couple days on if i stayed und....good luck.....billy