HCV: should i begin treatment, or wait for VX-950?

[niceguy2007]

hi everyone,

i got my test results back...

This time, ALT was 103, but AST was 28, virus load is 12,000 IU/ml.

A month ago, ALT was 24, AST was 18, virus load was 13,000 IU/ml.

i'm 25 years old...probably got virus within 4 years ago.

Now the doctor is pressing me for treatment, but i'm considering waiting till the VX-950 comes in.

What do you guys say?

[jmjm530]

I believe the initial strategy was to trial geno 1's since that is the predominant and hardest to treat genotype here. How effective it will be with geno 2's and 3's is only speculation, as is projected treatment time with Vertex for any of the genotypes. By the end of next year we should definitely have a better idea regarding tx time and efficacy for geno 1's. You might want to contact the company and inquire about their plans for geno 2's and 3's.

-- Jim

[niceguy2007]

plz plz everyone give ur comments! thanks :)

[Bill1954]

You've gotten some good advice above. If were in your shoes, however, it would be a no-brainer; treat. I feel that with genotype 3, and age in your favor, you stand a 70%+ chance for SVR. Treat and watch your viral load closely for the first 90 days, and make Tx duration decisions based upon personal response. Odds are this HCV ordeal will be in your rear-view mirror before you know it. The vast majority of people survive current Tx in one piece; just look at the numbers and I think the decision is there for you.

Take care,

Bill

[GrandOak]

I agree with Jim.  I believe the trials are focused on G1's because of them being the most difficult.  I also seem to recall that initial mono-therapy trial was on all geno's.

As for tx'ing or not.  I might suggest getting a biopsy to see what grade and stage your at.  Enzymes and VL's don't really mean much as far as liver is concerned other than to indicate something is going on and whether tx is slaying the dragon.

[mremeet]

I would wait under the following conditions: (1) your liver is minimally affected at F1 or F0. You need a biopsy to find out, but at 25 with only 4 years infection you probably are in this ballpark...unless you're one of the rare/unlucky ones where the virus is moving quickly (most people take 30 years or more before they approach cirrhosis). (2)You live cleanly, don't drink, don't drug and take care of yourself. (3) Keep close tabs on your health with 1 or 2 visits a year with your hepatologist.

Then I would simply wait and see what us guinea pigs discover on this current VX-950 trial. Within a short year or two, much more will be known. And if all goes well, we will end up with a treatment that is more humane w/less side effects, will require a shorter duration of treatment, and will be much more effective (i.e. likely to cure you). They haven't tested VX950 on non-genotype 1's yet, but non-1's are still strains of HCV just like type 1 is. So I would be willing to lay a fair wager VX950 (or some other PI) will kill genotype 3 just fine when they get around to testing it.

Lastly, you should know that your young age, your very low VL of 12,000 IU/ml, and the fact that you have a non-type 1 genotype is very good (other than having HCV at all). These factors very significantly make it more likely you will successfully respond to current treatment, and require less time on treatment to do so. And if your liver is in good shape (which it probably is), you're not overweight and otherwise healthy, then these factors also make it more likely you will respond to current treatment. Since you have most or all of this going for you (really I can't think of a better scenario to be in for an HCV patient), you would probably respond very well to current treatment (which would be about 85% effective based on your stats). And since at least some part of the current therapy will be incorporated into one of the upcoming protease inhibitor treatment schemes, then that could mean your future course of therapy could be ~3-6 months in duration with a greater margin of likelihood for SVR-ing (which is already ~85%!). Plus the possibility exists for lower side effects, especially if it's determined ribavirin is not required.

So considering all of these factors, IMHO I think waiting another year or two to see how these PI's pan out is a good idea. And again, most people take 30 years or more to get to cirrhosis. If you take care of yourself and keep in touch with your doctor, another year or two on top of your 4 years so far shouldn't be too much to worry about. Good luck with whatever decision you make.

[amommy]

Well, if I were in your situation, I would probably treat, with conditions.  I would be looking to do short course treatment.  So, I would treat insisting on a PCR test every week of treatment to determine when you clear.  If I was not clear at week 4, I would probably stop tx and wait on the vx 950 or other new treatment.  If I was clear at week four, I'd stick it out to 16 weeks and call it quits.  

I am 29, f, geno 2.  I was underdosed on riba at the start, but still cleared at week 4.  I opted to split the difference since I had been underdosed and complete 20 weeks of treatment.  I will find out within 2 weeks or so if I am still clear at 3 months post.  I suppose those results could easily change my opinion on this matter.