geno 3a relapse and 24 vs 48 tx?

[azgrl]

I went to my gastro yesterday expecting to hear that I will do a 24 week tx. (since I knew I was going to treat) However she told me they just switched to doing 48wks for 3a due to many of her 3a's relapsing after the 24 wk tx.  I don't want to do 48 wks but I also don't want to relapse.  I asked if I clear at 12 if we would still be able to do the 24.  She said most of her 3's clear at 12 but it doesn't seem to matter.  Ugh.  I did get scheduled for my biopsy I go on the 13th.  It is US guided.  She was really good.  She actually spent 2 1/2 hrs with me.  Unbelievable.  I took in so many studies and articles and she already knew about the majority of them.  Are there any 3a's on here who relapsed or had to do 48wks?
Thanks
D

[ActingBrandNew]

Hey, this thread is from 2005 so many will ignore it. You have a good question so Id suggest you start a new thread with your topic.

[bbj2856]

Hi so sorry you have to do 48. I was Geno. 3 also . In Jan. 2012 I did 24 weeks . I did first blood work ion week 4 and was UND. I was on Peg. injection 180 mg. and rib. 400 mg. 2 times a day. I stayed Und all during treatment and got SVR in Dec 2012 . I got results of Ultra sound few weeks ago Liver and Spleen was back to normal. Wishing you all the best and God Bless you through this treatment stay strong. There are lots good people here to answer your questions and help you along.

bbj

[muradsq]

Hi There
i am a 26 year male monoinfected with hcv genotype 3a. My viral load was 76000 IU/Ml. I have injected 17 pegylated interferons with daily oral ribavirin 1200 mg. After 12 shots, My viral load became less than 12 IU/Ml. My ultrasoound report is normal. Also my Alt, Ast and platelets are normal.
My question is that how many injections i have to inject more? and am i susceptible to relapse? Please explain
Best Regards

[Dweav]

I

[cuteus]

you might want to check:

janis7hepc.com
http://www.hcvadvocate.org/
natap.org
http://projectsinknowledge.com/

to start with, that should keep you busy for a while.

[FlGuy]

Also in the 3A club with you.  Will treat for 24. No as much damage as Goofy. Was clear at 12 weeks.  But as Goofy pointed out, a concern are those still-present but undetected little buggers that I hope will be the riba targets for the next 10 weeks.

The kind folks here who provide such great stuff to the HCV information hungry have referenced Dr. Cecil.  He has a site 'hepatitisdoctor.com' which is very interesting.  If you go there, find a link 'cure of HCV Improves Fibrosis'.  I think it discusses part of what you were thinking.

Stay well, and get better.  I'm so glad that I found this forum.  We are not alone.

[azgrl]

I just don't know on this one.  She told me that the fatty liver from my ulstrasound is the reason she is insisting on a bx.  There is a lot of talk going on about 3's fatty liver and progression of damage.  I've read some of it but most information seems to have no concrete evidence to back it.  I will see how the biopsy turns out and go from there.  I am leaning more towards the 24 weeks.  It looks like it is back to digging up information again.

I will doing the pegasys copegus therapy.  I'm not sure if either of these are weight based or what the breakdowns are for the weight based.  No overweight issues here though so I don't know if that makes a difference either.

Good news.  She told me not one of her patients has lost all of their hair.  Although she has quite a few that have lost approx. 70% of their hair.  This is my biggest fear.  I know that's awful to fear that but I do.  
D

[azgrl]

Oh also the dosage she said I will be taking of the copegus (riba?) is 4  pills a day 2 in am 2 at night.  What is this dosage?

thanks
D

[cuteus]

I have heard from my NP that a lot of 2's are relapsing also, even those doing 48 wks, she was keeping a log of stats. They can't figure out why. Maybe it is as suggested, biopsies are not being done so the damage to the liver is unknown, and perhaps the theory of hcv in scar tissue is applicable in those cases. I would not consider doing anything below the 24 wks, with the fatty liver isssue. That is only ONE study suggesting less tx time.  It might work in mildly damaged with no complicating conditions folks, but it is still a crapshoot. Listen to your gut and your dr. You are the one who ultimately has to continue living with the virus if you relapse, not us.

[rifleman]

I did pegintron.  If I had been on pegasys and had cl'd prior to week 4, I would have had to go 16 weeks instead of 12.  2 weeks until 6 week PCR.
DJL

[cougareyes]

That would be 800mg/day. Riba is based on weight for standard dosing, I'm a genotype 1 and <165lbs=1000mg, >165=1200mg; I know genotype 2 and 3 are prescribed 800mg. This may also go back to your other question, a lower riba dose is also associated with higher relapse. You may want to ask for a higher dose?  Peace

[cougareyes]

I have also been reading about alot of 3a relapsing also. As everything else there are many theories surrounding this, and most are just theories. One being the fact that most 3a's are not getting biopsies, therefore there also hasn't been alot of personalized treatment. I would probably want to dig into the factors that go into making the decision to treat for 48 vs 24 weeks. Because you don't want this poison in your body any longer than you have too. You also don't want to do all this for nothing, or to make it worse. Some believe that unsuccessful treatment may create mutations in the virus that then make it harder to treat. Tough call Good Luck

[mrodriguez112704]

I WAS SO HAPPY TO SEE YOUR POST!  I AM A GENO TYPE 3A ALSO.  I HAVE BEEN WONDERING WHY MY GI HAD PUT ME ON THE 48 WK. TX. INSTEAD OF THE 24/WK.  I THINK YOU ASNSWERED MY QUESTION.  I WENT TO SEE HIM THIS AM BUT I HAD SO MANY QUESTIONS THAT I FORGOT TO ASK HIM 24 VS 48?  I DID REALLY GET SOME GOOD NEWS THOUGH, HE SAID AT MY 4 WK. LABS I WAS UNDETECTABLE.  HE SAID THAT WAS REALLY GOOD NEWS SINCE MOST PEOPLE DO NOT RESPOND TO TX. UNTIL AT LEAST 12 WKS. OR LONGER.  THIS REALLY GAVE ME SOME HOPE AND STRENGTH TO CONTINUE.  I HAVE A PREVIOUS POST ON THIS THREAD FROM LAST WEEK WHEN I WAS READY TO QUIT BECAUSE OF FEELING SO BAD ALL THE TIME AND GETTING WORSE.  I THANK GOD THAT HE GAVE ME THAT GOOD NEWS THIS AM.  THAT HAS GIVEN ME THE INSPIRATION TO CARRY ON!  ALL OF MY BLOOD WORK IS LOOKING REAL GOOD, THERE WAS SOME CONCERN BECAUSE I WAS SO RAN DOWN AND HAVING CHEST PAINS, SHORTNESS OF BREATH BUT ALL LABS ARE OKAY.  I THINK I HAD NOT BEEN DRINKING THE REQUIRED AMOUNT OF WATER.  I WAS IN THE BEGINNING AND I STARTED SLAKING OFF.  YESTERDAY I FORCED MYSELF TO DRINK 90 OZS. OF WATER AND I FEELING MUCH BETTER TODAY.  LAST NIGHT I GOT UP FROM BED 12 TIMES SO GOT VERY LITTLE SLEEP AS USUAL BUT DR. DID WRITE ME A SCRIPT FOR AMBIAN.  HOPEFULLY BETWEEN DRINKING WATER, WATER & MORE WATER AND MAYBE A FULL NIGHT OF SLEEP; I MIGHT FEEL HUMAN AGAIN; WELL SOMEWHAT!  

LOL TO YOU AND YOUR TX.  SINCERELY,  MARSHA

[GoofyDad]

I'm a 3a treating for 48 weeks. I have advanced fibrosis, and that's the major consideration. Longer treatment should have a higher chance at SVR, and even if SVR is not acheived, the longer therapy will give the liver more of a break - hopefully buying more time for more attempts. It's not clear to me whether the interferon itself is theraputic to the fibrosis, or whether it's simply the absence of the virus.  

The Italian study was a large study accross a pretty big population. I think it carries weight. It shows 3s having lower SVR rates, also higher relapses, as compared to 2s.

I had a choice of Pegasys and PI, and chose Pegagsys. I'm interested in rifleman's comments re additional treatement time for Pegasys. As Jim states, the Italian study was with PI. If I had the chance to choose again, I'd likely go with PI. SX were a consideration for me, but I've since learned to fear the riba more than the interferon.

As for insurance, I was approved for meds for 12 mos., no issues. That was w/ United Healthcare.  

As for Riba, it seems some protocols call for 800 for 2s & 3s, where others go weight based ( > 165 lbs = 1,200). I'm right at 165, and I'm on 1,200. I do think 800 would be a whole lot easier, but I'm also interested in blasting this bug with all I got.

Good luck.

[azgrl]

There is so much information out there it is just crazy.  I am so happy for this forum and the ability to talk with people who are or have or are going to go through tx.  

I'm a total believer in give it all you got as much as you can take the first time...and hope it's the only time.

My doc says she will do the Procrit thing when my CBC (?) drops to 10.  She said that is the stopping point.  Would it be wise to ask for a high dose of riba?  I'm reading about it right now but would like your thoughts?

Mrodriguiz - I am glad to see other 3s as well.  I hope when I start I don't have such bad sx.  I am keeping my fingers crossed and am already drinking at least 1 gal a day of water but I live in Arizona and it is kind of necessary anyway.

Goofydad did you have a fatty liver also?  My big fear right now is that fatty liver is going to be the indication of damage to my liver.  I'll see what the biopsy says.  How long have you had this disease and does that play a role in the amount of damage in your case?

and one last question...what the best site to find the latest studies.  I have just kind of been doing the shotgun approach and see what comes up.  Is there any university sites that display their studies?

Thanks
D

[GoofyDad]

No fatty liver.

I've had this 25 years. I saw a GI for a long time who was very lukewarm to tx. I was comfortable with his assessment that I'd be in the majority who wouldn't develop significant damage. An obvious miscalculation.

[rifleman]

Well, my doc told me that him and his colleagues were treating geno 2 for 12 weeks if and only if pegintron was the drug of choice and there was an undetectable viral load (<10)at week 4.  He also told me that there is a study going on (it may have recently finished)that was trying to determine whether 16 weeks was enough if you used pegasys and were cl's at 4 weeks.  My guess is that the pegasys takes a while to build up in your system whereas pegintron (as anyone who has used it can likely attest) hits you like a semi a few hours after the first shot.  It seems that the consensus is that pegintron is a more powerful drug than pegasys, which still works well but is more "user friendly."  We didn't talk about treatment protocols for type 3's.  We had no reason to.
DJL

[cougareyes]

I have also been reading about alot of 3a relapsing also. As everything else there are many theories surrounding this, and most are just theories. One being the fact that most 3a's are not getting biopsies, therefore there also hasn't been alot of personalized treatment. I would probably want to dig into the factors that go into making the decision to treat for 48 vs 24 weeks. Because you don't want this poison in your body any longer than you have too. You also don't want to do all this for nothing, or to make it worse. Some believe that unsuccessful treatment may create mutations in the virus that then make it harder to treat. Tough call Good Luck

[bunkywoo]

I'm a "former" 3A - been SVR for 2-1/2 years. My personal opinion is to do the 24 weeks - get tested along the way and tested again 6 months post-tx. If clear throughout, I wouldn't do the additional 24 weeks. After getting tested every 6 months for 2 years, I am now going to wait 5 years for my next retest.

Good luck - tx will go by faster than you think. I still can't believe I've been done for so long now. Scary how fast time actually does go by!

Laurie

[FlGuy]

AZGirl's situation brings up a question I've wondered about.  In her situation the treatment may call for 24 weeks.  The doc decides longer is better for whatever reasons.  Generally, how do insurance co. look at this?  Do they generally go with the doc's recommendation or do they pull out a chart and say something like 'we'll cover the treatment for 24, not 48'  Anyone have experience with this situation?

[friole]

That is unbelievable - that your doc spent 2 1/2 hours with you.  I am impressed.  The least you can to is stay the course for the 24 and if it is not too bad, continue for the 48.  I am a 1a, but your doc really seems to be on top of it.  I am glad you are getting the biopsy.

[jmjm530]

You might ask for a week 4 PCR. The Italian study shows 12 weeks tx as effective as 24 weeks for geno 2's and 3's who are non-detectible at week #4. You might also ask your doctor how many patients her reluctance to treat 24 weeks is based on, and were they're any dose reductions.

If I were to follow the Italian study I'd consider taking Peg Intron as did the study group, especially if I were overweight (Peg Inron is weight based.)  Rifleman, one of our members, recently completed the 12-week course. Not sure if he was on Pegasys or Peg Intron but we're all pulling for him.

-- Jim