Does UND stay after the treatment ?

[JCB1606]

I'm geno 2b , 3/3.5 and started my jounrey last Nov for 24 weeks. After a rough -start falling blood levels (procrit and neupogen injections save my treatment) I was UND at 4 weeks and at 12 weeks. Shot 19 today and now was told with my scarring the Drs. are cautious about remission. After being UND for 2 times what are my chances of a relaspe? Final shot and VL  workup on April 30 and wait nervously for results. Still worried.

[Kristina538]

I'm a G3a with bridging fibrosis and probably stage 3 (and is described by my specialists as 'early cirrhosis - small biopsy result made definition hazy).   I was RVR and UND at EOT (24 weeks), and was given my odds as 75-85% chance of SVR maybe higher.

At about Week 18, I asked to extend, and my specialist who said that out of 4 people with exactly the same numbers as mine throughout tx, three would make SVR, which, strangely, sounded better than 75% to me :-)!!   I stopped at 24 weeks, because, as RVR, he said he had no current studies that any extension would benefit an "RVR", and my only option would be to pay for it myself.    I added that advanced fibrosis made me a higher candidate for relapse and he said that IF I did relapse he would tx me again as I was not 'transplant material yet'.

I am, like you, waiting on tenderhooks.   I don't get a PCR until 6 months post but bloodwork to date has looked cautiously promising.   Good luck.

[apache1]

You are in very good shape if you do a full 24 wk tx, and have every reason to expect a SVR.

If the 3 3.5 you mentioned means stage 3 fibrosis, here is a study from the 2008 AASLD meeting that might have some relevance for you.

for the full study:
http://www.clinicaloptions.com/Hepatitis/Conference%20Coverage/AASLD%202008/Tracks/Approved%20HCV%20Agents/Capsules/1239.aspx


    * Current study assessed effect of genotype (2 vs 3) on SVR in patients with advanced fibrosis/cirrhosis receiving peginterferon alfa-2a plus ribavirin for 16 or 24 weeks

Summary of Study Design

       * Retrospective analysis included patients with HCV genotype 2 or genotype 3 infection with advanced fibrosis/cirrhosis at baseline who received peginterferon alfa-2a 180 µg/week plus ribavirin 800 mg/day for 16 or 24 weeks
          o Advanced fibrosis or cirrhosis defined as
                + METAVIR 3-4 or
                + Knodell 3-4 or
                + Ishak 4-6
    * Outcomes and parameters
           RVR: HCV RNA < 50 IU/mL at week 4
          Complete early virologic response (cEVR): HCV RNA ≥ 50 IU/mL at Week 4 but < 50 IU/mL at Week 12
           Partial early virologic response: HCV RNA ≥ 50 IU/mL at Weeks 4 and 12 but ≥ 2 log10 decrease from baseline at Week 12
           End of treatment response: HCV RNA < 50 IU/mL at end of treatment (16 or 24 weeks)
           SVR: HCV RNA < 50 IU/mL at 24 weeks posttreatment
           Relapse: no SVR after end of treatment achieved
           Low baseline HCV RNA: < 400,000 IU/mL
           High baseline HCV RNA: ≥ 400,000 IU/mL
    * Factors associated with SVR identified by multiple logistic regression analyses
           Baseline factors incorporated: sex, age, race, weight, body mass index, HCV RNA, ALT, ALT-ratio, creatinine clearance, albumin, platelets, neutrophils
           On-treatment factors incorporated: assigned duration, RVR, ribavirin plus peginterferon alfa-2a dose (cumulative)

Main Findings

    * Overall 24-week treatment regimen associated with higher SVR rates and lower relapse rates across both genotypes
          

[Myown]

"Lost at Sea" - thats not me. Lost in Space - that's me. ;o)

Thanks for the welcome back, but I sorta - dorta didn't leave, just weening off some. Good to see ya though babeeeeee. Read some of your posts - very Seinfield - funnee ;o)

Take care,
MO

[jmjm530]

Didn't pick up the "scarring" until mentioned by lost-at-sea "MyOwn", welcome back :)
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Could you be more specific? Are you stage 4? Anything less than stage 4 should not affect the numbers I gave you. However, if you're stage 4, a discussion of extended treatment may be in order. The best -- really the only -- person to discuss this with would be a hepatologist (liver specialist). So if you're not seeing one, for example you're seeing a gastro, then ask for a consult with a hepatologist as they are best trained to deal with harder to treat population such as stage 4's. That said, I believe I did read somewhere recent that RVR (which you had) trumps all negative pre-tx indicators such as stage 4, which means 24 weeks should be enough. But frankly I'm just relying on memory plus really not that up on geno 2's nor am I --or anyone else here -- a doctor. Good luck.

-- Jim

[Myown]

Shot 19 today and now was told with my scarring the Drs. are cautious about remission.
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I would ask the doctors what they think about extending treatment - since they are concerned about the odds of SVR due to the scarring.

Good luck,
MO

[jmjm530]

Right now, as Bill suggests your odds of remaining UND are around 80-90%. If you test UND four weeks after stopping the treatment drugs then you have around a 90% chance of staying UND. If you test UND 12 weeks after stopping the drugs, then you chance of staying UND is around 98%. If you test UND one year after stopping the drugs, then your chances of staying UND approach 100%. .

[Bill1954]

I believe your statistical chances for SVR are in excess of 90% as a genotype 2 patient that has successfully completed treatment. That’s assuming there is no cirrhotic involvement; even then, you have an excellent chance of full recovery. I’m not to much up on Genotype 2; perhaps others in here have some more specific answers and possibly links to studies, etc.

Good luck to you, and I hope to hear from you later this summer with good news.

Take care—

Bill