HR - Question about retreatment

[returntosender]

HR, if you have finished digesting your Thanksgiving turkey, I have something to ask you.  I am a male, 56, 300lbs, 6'4 Geno 1a, Biopsy, is 2-3 - completed treatment on June 1, 06 after 48 weeks of Peg 180 and Riba 1200.  Cleared at 4 weeks, and stayed clear througout tx including clear on Heptimax on Sept 1.  PCR on 11/17/06 indicated a HCV RNA of 66,200.  All other blood levels within normal limits.  During tx had some reduction of Hgb but not treated for anemia.  No rescue drugs at all.  Most blood tests were OK during tx.  Doc says to lose weight, down to 200 or so and retreat for 72 weeks using same protocol.

My first question, is it possible that this result is in error? Am I wrong to want this confirmed by another test?  My doc thinks so.  Is it possible that this is a spike that the immune system could handle? In other words, is it possible that these small spikes occur but are handled by the immune system or is this amount (66000) an indication that the battle is lost?  Have you ever seen a viral load at the end of tx that goes back to undet without tx?

As to retx, losing weight is going to take a while for sure.  My thought is that I would like to go back after this thing while its down.  I dont like the idea of letting virus do more damage and making me harder to treat. Seems like it would offset the weight loss. Upping the Riba is not popular because of toxicity.  What about using same amount for longer period of time but start it now?  Is that a resonable way to approach this?  Any thoughts, ideas would be most welcome.

[returntosender]

Thanks for your analysis - my 4 week PCR was a Quant Real Time PCR using Roche COBAS Taqman Analyte Specific Regeant which I believe measures to 75 copies.  To summarize your comments, I think you are saying that if another PCR is positive then retreatment may be indicated and that weight loss alone cannot justify the wait and that I should be looking for a doc who is willing to be more aggressive escpecially in the beginning of treatment but not so aggresive with the SOC that I will be damaged for life but more aggressive in terms of adding some of the newer safer regimes that are out there. However in order to get a doc to do this I have to have him in my family. Thats sounds pretty straightforward. LOL.   At any rate, thank you very much for the well thought out response.  You are such a great addition to this forum.  It is absolutely a blessing to have you around. Thanks again.

[cuteus]

this list needs a bit updating, but it is a good summary, there might be another one out there and someone might have it bookmarked, but until then, this will do:
http://www.hivandhepatitis.com/hep_c/news/2005/ad/102605_a.html

[jmjm530]

You might want to reaccess your liver damage with a good hepatoloigst before making any decisions -- be it needle biopsy, fibroscan, fibrosure or some combination.

If you liver damage hasn't progressed, taking a year or two to get down to your ideal weight has a number of advantages. First, a lower BMI (body mass index) is associated with better SVR outcomes, as well as a slower progression of Fibrosis. But perhaps more important, if you're actually 100 pounds over your ideal weight, the health consequences of not losing that weight may be more serious at this point than the virus itself. Another reason to wait -- again assuming no fibrosis progression -- is to factor in the SVR trial data from VX-950 which will be flowing in all throughout 2007.

The alternative seems to be what some are calling the "sludgehammer " approach, be it high-dose riba, more extended SOC, infergen, something more experimental, or some combination. Perhaps if you weren't an RVR -- as HR suggested, check the sensitiviy of those tests -- the path might be clearer. But assuming you were an RVR, to me a future path is less clear.


All the best in whatever you decide.

-- Jim

[cuteus]

I meant to address your theories for relapse; dental work, pain killers, bad diet, etc  Not likely, your brain is telling you, and you know it is correct!
If I would have relapsed I would have been blaming the CTS release surgery, the dental work, the antibiotics, the champagne at daughter's wedding or the mojito, stress at work, driving too fast, flipping the finger too much, etc.  It does not work that way and you know it.  
HCV was still there, probably held back by some powerful t cells or something.  What finally let the dogs out, it is anybodys guess, most likely the super powers exhibited by hcv. But, it responds to tx, and that is the plus side. You know, since you are so unique, you could end up like pharoah, another member here.  Like you, negative through tx and at eot, negative also.  Post tx, he had two PCRs that showed a positive vl.  Then, the next PCR was negative and have been for two yrs.  What the heck happened in that case? another hcv puzzle.

[sfbaygirl]

I noticed you have the same exact PCR I did. Pretty poor! 75IU is like 200 copies, so you really don't know if you were UND to a low amt. with that test. I was fooled as well. HR mentions another good test, not sure my ins. will cover it, but I plan on getting one, even though I may have to pay. HEre PCR's are $250. Not sure about the most sensitive....

Also, I know that dental work can release bacteria and maybe virus. My x had to take antibiotics when he went to the dentist after having a heart valve infections years earlier.

[returntosender]

Thanks for the help.  I always thought I was special and now I know it! LOL.  This is not quite the special I envisioned as it does not involve applause and shiny trophies.  Ya know, I just was reading Dr. Cecils thread - because he is so pro tx - and he said that once you get 3 months post tx negative you have 95% chance of success.  What the heck was it that happened to lose this thing.  I did have some major gum work after that 3 month PCR.  I wonder if all that blood somehow contained some active virus that worked its way back into the bloodstream?  Sounds crazy when I say it though.  

I also must admit that I wasnt living the healthiest lifestyle basically eating anything I wanted without a care at all.  Lost 40 pounds on tx and was working it back on.  Perhaps this stressed out the liver or immune system somehow.  Also, had some serious back problems for which I was given percocet and popped a fair amount of those - maybe Tylenol stressed liver and virus reemerged.  Find all that kind of hard to buy though because I didnt get the impression that SVR was all that finicky.  

At any rate,  I really really thank you guys for your thoughts.  I am ready to retreat tonight if I could.  My selective memory has all but blocked out my previous tx.  At stage 2-3 though I am somewhat reluctant to jump in too fast.  The first thing I am going to do is get another PCR.  The second is get a doctor who knows a bit more about using Riba on fat guys.  The third is to - well I dont know the third yet but I will soon - maybe it will involve that research team - that sounds good - I need a team working on this one. Perhaps its the fact the my second toe is longer than my big toe - I always thought that was a problem. LOL