Aa
New to combination therapy
Hi everyone,
I've just started peg-intron/ribasphere therapy about 7 weeks ago. I had a blood test last week that showed my viral load dropped from 800,000 at the beginning to 81 last week. The doctor seems to think I have a really good chance of being undetectable at the crucial 12 week mark.
The problem is, the therapy is horrendous. I'm afraid I'm going to lose my job and maybe my wife because it has turned me into a serious butthead. Of course I also have 0 energy. My doctor is a competent guy, but he more or less dismisses things that he can't see in a microscope.
So here's my theory. If I'm clear at 12 weeks, and I do maybe 12 more for good measure, would I be making a big mistake to cut therapy at that point? I'm a genotype 1a BTW.
The doctor insists that I must do the full year regardless of how soon I clear. I know he doesn't want to take chances, but man, it would be great to be able to say I'll be done in December rather than next June.
I can't find any studies that talk about this. Anyone have any thoughts.
I've just started peg-intron/ribasphere therapy about 7 weeks ago. I had a blood test last week that showed my viral load dropped from 800,000 at the beginning to 81 last week. The doctor seems to think I have a really good chance of being undetectable at the crucial 12 week mark.
The problem is, the therapy is horrendous. I'm afraid I'm going to lose my job and maybe my wife because it has turned me into a serious butthead. Of course I also have 0 energy. My doctor is a competent guy, but he more or less dismisses things that he can't see in a microscope.
So here's my theory. If I'm clear at 12 weeks, and I do maybe 12 more for good measure, would I be making a big mistake to cut therapy at that point? I'm a genotype 1a BTW.
The doctor insists that I must do the full year regardless of how soon I clear. I know he doesn't want to take chances, but man, it would be great to be able to say I'll be done in December rather than next June.
I can't find any studies that talk about this. Anyone have any thoughts.
revenire is right. do whatever you have to do to make it through this. a year will go by fast.
One most common explanation for the need of full 48 weeks is the hypothetical mechanism of therapy: Interferon and Ribavirin might act in the first line by reducing new infection of healthy cells and this can lead in the case of an EVR (early virological response) in a fast first phase to quick elimination of the virus in serum (this is what VL does mean and PCR does measure).
While this effect could be maintained in a slow second phase (if no brakthrough occurs), you have to wait for dying off all the infected (and infectious) cells and you have to assure that re-emerging of infection does not occur by the virions set free by living and dying infectious cells. The life cycle of liver cells is much longer (could be just about a year long), than the life cycle of the virus (a few hours), and therefore you need to control it that full period by therapy.
There are therefore some half-official considerations to individualize therapy for GT1 patients: continue therapy 48 weeks (or min 36 weeks) from the time getting PCR-negative. You should however stay negative for the whole course of this second period for having good chances of an SVR!
Aiming an SVR at a second course with Non-Responders a full 72 weeks or even 2 full years duration is recommended (off-label, needless to say) by some hepatologists (assuming Response in the first 24 Weeks - otherwise break it up).
But you could have perhaps another options: I experienced tremendous mental problems with Pegintron, too (I had made a full course of 48 Weeks). In the present therapy with Pegysys (I am in the 7. Week) it started subjective much more "pleasant" then all previous Intron- and Pegintron + Riba attempts (it is my 5. attemted therapy!). It seems to me much more tolerable then Pegintron what is the opinion of dr Cecil, too. (www.hepatitisdoctor.com). Could one conceivable option for you be changing interferon brand?
You could consult it perhaps with your doctor.
Greeting: Skepsis
While this effect could be maintained in a slow second phase (if no brakthrough occurs), you have to wait for dying off all the infected (and infectious) cells and you have to assure that re-emerging of infection does not occur by the virions set free by living and dying infectious cells. The life cycle of liver cells is much longer (could be just about a year long), than the life cycle of the virus (a few hours), and therefore you need to control it that full period by therapy.
There are therefore some half-official considerations to individualize therapy for GT1 patients: continue therapy 48 weeks (or min 36 weeks) from the time getting PCR-negative. You should however stay negative for the whole course of this second period for having good chances of an SVR!
Aiming an SVR at a second course with Non-Responders a full 72 weeks or even 2 full years duration is recommended (off-label, needless to say) by some hepatologists (assuming Response in the first 24 Weeks - otherwise break it up).
But you could have perhaps another options: I experienced tremendous mental problems with Pegintron, too (I had made a full course of 48 Weeks). In the present therapy with Pegysys (I am in the 7. Week) it started subjective much more "pleasant" then all previous Intron- and Pegintron + Riba attempts (it is my 5. attemted therapy!). It seems to me much more tolerable then Pegintron what is the opinion of dr Cecil, too. (www.hepatitisdoctor.com). Could one conceivable option for you be changing interferon brand?
You could consult it perhaps with your doctor.
Greeting: Skepsis
studies after studies, both domestic and international, have re inforced a minimum of 48 wks of therapy for geno 1 in order to give yourself the best shot at SVR. Relapse will bring even longer therapy so why try "cheating"? Insist that your GI assist you with the sides that are affecting your QOL.
http://hopkins-id.edu/diseases/hepatitis/hep_sulk_1.html
http://hopkins-id.edu/diseases/hepatitis/hep_sulk_1.html
SOORY BUT YOU WILL LOOSE YOUR JOB AND YOUR WIFE IF YOU DO NTO TAKE CARE OF THIS PROBLEM. I START TREATMENT IN SEPT AND AM FEARFUL OF SIDE AFFECTS BUT WILL GO TO THE MAX TO BEAT THIS. GOOD LUCK. HANG IN THERE!
For being a serious butthead/losing your job: check w/your dr. I believe an antidepressant may be of help to you. A tough guy or two on this forum went all the way thru treatment making their family miserable, and when they finished treating and their mind was clear again, they realized that they should have taken an AD. They just thought of themselves as being mentally tough, "I can get thru this" not thinking of their family and how hard it was on them! My husband will be going thru treatment soon and I just know I'll have this to deal with this ...
I took Lexapro during treatment, and it helped me considerably.
Keep an eye on your hemoglobin. You're going to be tired, but there is procrit for if you start having symptoms of anemia. Make sure your dr will prescribe it if needed, and ask at what point he would consider it necessary. It seems to me I read somewhere in this forum that for guys over 50, it's not good to let it drop too quickly. I believe drs intervene with procrit if it drops below 10, but if you have symptoms of anemia that are making you disfunctional, then may intervene sooner.
I took Lexapro during treatment, and it helped me considerably.
Keep an eye on your hemoglobin. You're going to be tired, but there is procrit for if you start having symptoms of anemia. Make sure your dr will prescribe it if needed, and ask at what point he would consider it necessary. It seems to me I read somewhere in this forum that for guys over 50, it's not good to let it drop too quickly. I believe drs intervene with procrit if it drops below 10, but if you have symptoms of anemia that are making you disfunctional, then may intervene sooner.
Your doctor is 100% correct.You really do have to do 48 weeks.
There is a wealth of data proving that 24 weeks for type ones leads to high relapse rates.
That's why the protocol was changed to 48 weeks.
Hang in !!!!!!!!!!!!!!
There is a wealth of data proving that 24 weeks for type ones leads to high relapse rates.
That's why the protocol was changed to 48 weeks.
Hang in !!!!!!!!!!!!!!
I understand your desire to cut treatment short.
One study does offer a "short course" tx of 24 weeks for genotype 1's. However, the short course was only recommended to those that were non-detectible at week 4 week 4 with a pre-treatment viral load of <600,000. You don't fall into either category.
Assuming your non-detectible by week 12, you'll need to treat 48 weeks in order to have a decent chance at SVR. If you're still detectible at week 12, or if you have significant liver damage (stage 3 or 4) then you should consider extended treatment beyond the 48 weeks.
The good news is you've had almost a 4-log drop in seven weeks. Hopefully others can help you with your domestic problems. This is a big issue with many married couples. You may need some sedatives and/or anti-depressants to help with the sides. I live alone but flew off the handle frequently with friends/relatives for the first three months. It has gotten better. You gotta talk to your wife and make her a partner in this thing. Good luck.
So...it looks like 48 weeks. :)
Jim.
One study does offer a "short course" tx of 24 weeks for genotype 1's. However, the short course was only recommended to those that were non-detectible at week 4 week 4 with a pre-treatment viral load of <600,000. You don't fall into either category.
Assuming your non-detectible by week 12, you'll need to treat 48 weeks in order to have a decent chance at SVR. If you're still detectible at week 12, or if you have significant liver damage (stage 3 or 4) then you should consider extended treatment beyond the 48 weeks.
The good news is you've had almost a 4-log drop in seven weeks. Hopefully others can help you with your domestic problems. This is a big issue with many married couples. You may need some sedatives and/or anti-depressants to help with the sides. I live alone but flew off the handle frequently with friends/relatives for the first three months. It has gotten better. You gotta talk to your wife and make her a partner in this thing. Good luck.
So...it looks like 48 weeks. :)
Jim.
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
