I'm down to 85 kg now. Does that improve my chance of SVR?

[Peter2012]

When I started treatment I was 95 kg. I remember reading that the chances of SVR are better if you weigh 85 kg or less. Now, nearing the end of my 13th week, my weight is down to about 85 kg (as of this morning).

I wonder if the weight loss help my chances of SVR? I'm on a 24 week treatment so I have another 10 weeks to go.

Also, is the weight loss during treatment good for my health even if I don't attain SVR? I'm only 5'8", so at 85 kg I'm still about 10 kg overweight (my ideal weight is about 75 kg).  Now I realize because of inactivity, the weight loss will include a loss of muscle, but my belly is smaller now so obviously I've lost some fat.

I've had high blood pressure, which is related to being overweight. I tested it this week and it's now 124/73, well within the normal range for the first time in many years. The lowest the top number had been in recent years is about 140, the highest is 190.  

[Peter2012]

Thanks for the kind words, can-do-man.

You're right, all I can do is play by the rules they set out, and hope for the best.

I believe if I continue to follow the treatment plan diligently, I have perhaps a 50% chance of SVR. Even if I don't attain SVR, I'm going to try very hard to keep the weight I lost off, so I'll at least have one health benefit from this treatment.

[Peter2012]

"congratulations on your weight loss. That is a big accomplishment."

Hector, it's not an "accomplishment". The weight loss just a side effect of the pegatron. We're you being sarcastic?

"Odds of successful hepatitis C are very different between stage 3 and stage 4, which is why we encourage anyone who has stage 3 liver disease to treat before they progress to Stage 4, cirrhosis."

Thank you Hector for telling me about this. Since I'm at stage 4 as I mentioned above, reading that really made my day.

[Peter2012]

Hector, that information is rather depressing, because as I mentioned above, my doctor said they cannot extend the length of treatment from 24 weeks to a longer period.

It seems too inflexible, but here in British Columbia, there are probably certain guidelines for treatment they must abide by.  

[HectorSF]

FYI:  A study done with 414 genotype 3 patients showed that treatment for 36 weeks had higher SVR then 24 weeks of treatment for those who were not undetectable by week 4. (though you came very close to undetectable by week 4). Though this is not a standard protocol and is up to each individual doctor's practice.

http://www.ncbi.nlm.nih.gov/pubmed/20843575

J Hepatol. 2010 Dec;53(6):1000-5. Epub 2010 Aug 4.
"Individualized treatment with combination of Peg-interferon alpha 2b and ribavirin in patients infected with HCV genotype 3."

Source
Liver Unit, IRCCS, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy. a.***@****

Abstract

BACKGROUND & AIMS:
The benefit of individualizing treatment for patients with genotype 3 HCV infection on the basis of viral clearance at week 4 (wk4-R) has not been firmly established.

METHODS:
Four hundred and fourteen patients received Peg-interferon alpha-2b plus 1000-1200 mg of ribavirin daily according with body weight > or <75 kg. Patients were randomized to standard 24 weeks (Std24) or to a 12 or 36 weeks variable treatment duration (Var12/36). In the variable treatment arm, patients with or without wk4-R were allocated to either 12 or 36 weeks duration.

RESULTS:
At treatment week 4, HCV RNA was undetectable in 262 patients (63.3%), 136 in the Std24, and 126 in the Var12/36 group (p=0.41). In patients with wk4-R, end-of-treatment (EOT) responses were 80.4% (CI 85.4-95.3) and 97.6% (CI 94.9-99.9) in the two arms, respectively (p=0.019). In patients without wk4-R, corresponding rates were 61.9% (50.6-73.2) and 75.3% (CI 65.9-84.6) (p=0.08). SVR was attained in 302 patients, 71.4% (CI 65.3-77.6) in the St24 group and 74.3% (CI 58.4-80.3) in the variable 12/36 arm. Among patients with wk4-R, SVR was 81.6% (CI 75.1-88.1) and 82.5% (75.9-89.1), respectively. In patients without wk4-R, SVR amounted to 52.1% (CI 40.4-63.7) and 61.7 (CI 51.1-72.3) in the two arms (p=0.25).

CONCLUSIONS:
HCV genotype 3 patients with week4-R may be treated safely with 12 weeks of therapy, provided that sufficiently high doses of ribavirin are administered. For patients still viremic at treatment week 4, SVR rates were numerically higher after 36 weeks of treatment than after the currently recommended 24 weeks.

Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

[HectorSF]

That your viral load was undetectable at 8 weeks is great. So you probably became undetectable somewhere between weeks 4 and 8. That is the biggest factor in the success of treatment, even beyond cirrhosis. It is the viral load kinetics that matters the most. So things look very good. Remember to stay compliant with your drugs and hopefully you won't need to reduce your dosages. When taking only two drugs for treatment dose reductions or stoppage, as in your previous treatment, can allow the virus to return.

Odds of successful hepatitis C are very different between stage 3 and stage 4, which is why we encourage anyone who has stage 3 liver disease to treat before they progress to Stage 4, cirrhosis.

Best of luck with your treatment!

Hector

[Peter2012]

The doctor thinks 24 weeks will be okay because I stopped treatment for a time in 2003 due to severe fatigue and being unable to function at work.

However, I think 30 weeks would be better. For people with genotype 3 who have cirrhosis, it takes a few weeks longer to attain SVR.

I've seen the results of studies/trials that show with genotype 3 and cirrhosis stage 3/4, the SVR rate is very low after 16 weeks, but for people with no cirrhosis about 75%-80% not much different than for 24 weeks.

But those trials showed there's a BIG difference in SVR rates between treatment of 16 and of 24 weeks for people with genotype 3 and cirrhosis stage 3/4 (although still much lower than the SVR rates for people with no cirrhosis).

So that may imply although I might not need 48 weeks (which would be impossible anyway because I'll need to work) 30 weeks might be better than 24 weeks.  I've asked about this but they say they cannot extend treatment for 4 more weeks.

[Dee1956]

So glad to hear that you can stay home with this tx.  It is tough. I also had dry mouth and used all the Biotene products, also sour candy helped with the bad taste, wishing you the best.
Dee

[Peter2012]

This time I've taken time off work until the end of treatment.  My 24 weeks will be completed by the time the really warm weather arrives in late June and July.  

I'm finding the fatigue and other side effects (such as dry mouth and headache) much easier to deal with since I'm relaxing at home rather than trying to function and keep up with the others at work.

[nygirl7]

I'm a little bit confused, usually a 3 will do SOC for 48 weeks if they relapsed...regardless of why.  You know 3 can be as tough sometimes as a geno1, right?

[Peter2012]

I'm genotype 3a.

Although I relapsed after rebetron in 2003, it may have been because I temporarily stopping the treatment (interferon for a week, ribivirin for several weeks) at about the 15th or 16th week - because I could not function at work during an unusually hot summer with the severe fatigue.

I went from UND at 12 weeks (they didn't test at 4 or 8 weeks) to "positive" at about 18 weeks. After resuming the ribivirin, I was UND again at 24 weeks and then the virus was detected again 4 weeks after end of treatment.  

[can-do-man]

Sorry meant 24 week treatment.

[can-do-man]

May I ask what genotype you are and since your a prior relapser on SOC how they came up with a 34 week treatment?

I was Dx in 2005 with cirrhosis, relapsed but now SVR so yes it can be done............ Best to you.

[Peter2012]

The last time I had my viral load tested before treatment, it was at about 2,400,000.

My viral load was down to 44 after 4 weeks, and "negative" or UND after 8 weeks.

I have been at stage 4 cirrhosis since 2004, it is compensated and hasn't seemed to become any worse since then. The chances of SVR are of course reduced because of my cirrhosis, but I have seen on this forum people who were at stage 3 and 4 who attained SVR, so I'm still hopeful.

[HectorSF]

First, congratulations on your weight loss. That is a big accomplishment.

Unfortunately weight is not a major pre-treatment factor in the treatment of hepatitis C with persons with cirrhosis unless you have fatty liver disease also. The stage of liver disease is THE most impact of any factor in the ability to achieve SVR. Which is why it is so difficult for persons with cirrhosis to achieve SVR.

Of course reduction of viral load over time is the largest on treatment predictor of SVR. The quicker you become undetectable the better the odds of SVR. Your viral load dropped over 2 log so you have responded well to the treatment. When did your viral load become undetectable? Week 8 or week 12?

Let me encourage your weight loss success. The healthier you are generally the better you will be able to handle all of your health issues including the progression of your liver disease and should you achieve SVR the healing of whatever hepatocytes are still remaining in your liver. I believe you are still "compensated", which is excellent, and you should want to stay compensated as long as possible. It sounds like you are taking care of yourself and are living a healthy lifestyle. Glad to hear you have been able loss that extra weight. I'm sure you feel better physically now too except for treatment side effects.


Best of luck with your treatment!
Hang in there.

Hector

[Idyllic]

I am not certain about the weight loss but I just want to congratulate you for getting your BP under control. This is likely one of the more stressful events you will probably experience in your life yet you have managed to obtain a very healthy BP. That is not an easy thing to do so my hat is off to you.