Aa
What happens now?
Hello All
I am new to posting but have been reading for awhile. I was diagnosed with hep c in Sept 2006.
I am geno 1a, stage 1-2, grade 2 , base line viral load 30,000,000. I started 48 week of Peg and Riba in
March 2007 and reached undetected @ week 14 using Heptimax test. Yesterday I went to doc to get results
of 4 week post treatment viral load test. He told me that the test came back @ 28. He wants me to retest in
30 days to see if it goes up or is undetected. At that point I asked him what my option was if it came back positive.
He told me that retreatment would not benefit me that I would get the same results as the first treatment. I would like to know if there is a chance of this being a false positive or have I relapsed. Could I still reach SVR or should I insist on retreating. I am not sure what to do now.
I am new to posting but have been reading for awhile. I was diagnosed with hep c in Sept 2006.
I am geno 1a, stage 1-2, grade 2 , base line viral load 30,000,000. I started 48 week of Peg and Riba in
March 2007 and reached undetected @ week 14 using Heptimax test. Yesterday I went to doc to get results
of 4 week post treatment viral load test. He told me that the test came back @ 28. He wants me to retest in
30 days to see if it goes up or is undetected. At that point I asked him what my option was if it came back positive.
He told me that retreatment would not benefit me that I would get the same results as the first treatment. I would like to know if there is a chance of this being a false positive or have I relapsed. Could I still reach SVR or should I insist on retreating. I am not sure what to do now.
Let’s hope there was something wrong with the test results!!! Hand in there. Let's hope for the best! I hate to see you having to wait 30 days to get retested. Seems like a long time.
Last VL test came back at 28??? Not sure what that means?
You say you became undetectable at week 14. Seems like a strange week to be tested. At week 12 you where more then 2 log down from your initial VL. Yes? If you became undetectable between weeks 12 & 24 that means you where a “slow responder”. You should have been treated for 72 weeks in order for the meds to keep you undetectable for a long enough time to avoid relapse. The 72 weeks of treatment would improve your chances of achieving SVR. If you do some studying on this topic you find you are a good candidate for retreatment on PEG and Riba for a period of 72 weeks. So you always have options. See the following article...
“15% of genotype 1 patients achieve undetectable HCV RNA between Week 12 and 24 of treatment and have been referred to as “slow to respond.” Virtually no patients will achieve undetectable HCV RNA levels after Week 24 if they have not done so already by that time point, regardless of genotype. Therefore, if a patient has not achieved undetectable HCV RNA by Week 24, treatment should be stopped.
It is critically important to recognize the point at which a patient achieves undetectable HCV RNA during treatment as this is directly related to the likelihood of achieving a SVR.[7] In other words, the later a patient achieves undetectable HCV RNA during treatment, the higher the likelihood that the patient will relapse after treatment is discontinued following the standard duration of therapy (24 weeks for genotypes 2/3 and 48 weeks for genotype 1).[7] Three recent studies have now demonstrated that relapse can be significantly reduced in slow-to-respond genotype 1 patients—those who achieve undetectable HCV RNA after Week 12—by extending the duration of treatment from 48 to 72 weeks.[8-10,20]
***In each of these studies, the relapse rate was reduced from more than 50% to less than 20%.*** Two of these studies suggest that this benefit may be less or nonexistent in patients with higher HCV RNA levels at baseline and at Week 12.[8,9] However, these observations will need to be confirmed in future studies before these patients are not considered for treatment extension. Therefore, for now it appears that prolonging the duration of therapy will increase SVR rates in patients who are slow to respond and should be routinely practiced. By contrast, it does not appear from these studies that extending the duration of therapy beyond 48 weeks in genotype 1 patients who achieve undetectable HCV RNA after Week 4 and before Week 12 will significantly reduce relapse rates. As a result, extending the duration of therapy for this subset of patients is not recommended at this time.”
Patients with a slow virologic response have a high rate of relapse. This is true both for patients with HCV genotype 1 who achieve undetectable HCV RNA more than 12 weeks after the onset of treatment[7] and patients with genotypes 2 or 3 who achieve undetectable HCV RNA after Week 4.[3] Genotype 1 patients with a slow virologic response during their initial course of therapy are excellent candidates for retreatment for a longer duration of 72 weeks. For patients with genotypes 2 or 3 who relapsed after their initial course of treatment, retreatment for a longer duration, from 24-48 weeks, is also a logical approach and supported by a retrospective analysis.[21] However, no prospective data are available to support this approach.
3. Shiffman ML, Suter F, Bacon BR, et al. Peginterferon alfa 2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3. N Engl J Med. 2007;357:124 134.
7. Ferenci P, Fried MW, Shiffman ML, et al. Predicting sustained virological responses in chronic hepatitis C patients treated with peginterferon alfa 2a (40 KD)/ribavirin. J Hepatol. 2005;43:425-433.
8. Sanchez Tapias JM, Diago M, Escartìin P, et al. Peginterferon alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology. 2006;131:451 460.
9. Berg T, von Wagner M, Nasser S, et al. Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon alfa 2a plus ribavirin. Gastroenterology. 2006;130:1086 1097.
10. Sanchez-Tapias JM, Ferenci P, Diago M, et al. How can we identify HCV genotype 1 patients who may benefit from an extended treatment duration with peginterferon alfa-2a (40KD) plus RBV? Program and abstracts of the 42nd Annual Meeting of the European Association for the Study of the Liver; April 11-15, 2007; Barcelona, Spain. Abstract 641.
20. Ferenci P, Laferl H, Scherzer TM, et al. Customizing treatment with peginterferon alfa-2a (40KD) (Pegasys) plus ribavirin (Copegus) in patients with HCV genotype 1 or 4 infection: interim results of a prospective randomized trial. Program and abstracts of the 2006 Annual Meeting of the American Association for the Study of Liver Diseases; October 27-31, 2006; Boston, Massachusetts. Abstract 390
21. Willems B, Hadziyannis SJ, Morgan TR, et al. Should treatment with peginterferon plus ribavirin be intensified in patients with HCV genotype 2/3 without a rapid virological response? Program and abstracts of the 42nd Annual European Association for the Study of the Liver; April 11-25, 2007; Barcelona, Spain. Abstract 8.
Hopefully you are still undetectable and won’t have to retreat!!!
Best of luck. Hang in there.
Hector
Last VL test came back at 28??? Not sure what that means?
You say you became undetectable at week 14. Seems like a strange week to be tested. At week 12 you where more then 2 log down from your initial VL. Yes? If you became undetectable between weeks 12 & 24 that means you where a “slow responder”. You should have been treated for 72 weeks in order for the meds to keep you undetectable for a long enough time to avoid relapse. The 72 weeks of treatment would improve your chances of achieving SVR. If you do some studying on this topic you find you are a good candidate for retreatment on PEG and Riba for a period of 72 weeks. So you always have options. See the following article...
“15% of genotype 1 patients achieve undetectable HCV RNA between Week 12 and 24 of treatment and have been referred to as “slow to respond.” Virtually no patients will achieve undetectable HCV RNA levels after Week 24 if they have not done so already by that time point, regardless of genotype. Therefore, if a patient has not achieved undetectable HCV RNA by Week 24, treatment should be stopped.
It is critically important to recognize the point at which a patient achieves undetectable HCV RNA during treatment as this is directly related to the likelihood of achieving a SVR.[7] In other words, the later a patient achieves undetectable HCV RNA during treatment, the higher the likelihood that the patient will relapse after treatment is discontinued following the standard duration of therapy (24 weeks for genotypes 2/3 and 48 weeks for genotype 1).[7] Three recent studies have now demonstrated that relapse can be significantly reduced in slow-to-respond genotype 1 patients—those who achieve undetectable HCV RNA after Week 12—by extending the duration of treatment from 48 to 72 weeks.[8-10,20]
***In each of these studies, the relapse rate was reduced from more than 50% to less than 20%.*** Two of these studies suggest that this benefit may be less or nonexistent in patients with higher HCV RNA levels at baseline and at Week 12.[8,9] However, these observations will need to be confirmed in future studies before these patients are not considered for treatment extension. Therefore, for now it appears that prolonging the duration of therapy will increase SVR rates in patients who are slow to respond and should be routinely practiced. By contrast, it does not appear from these studies that extending the duration of therapy beyond 48 weeks in genotype 1 patients who achieve undetectable HCV RNA after Week 4 and before Week 12 will significantly reduce relapse rates. As a result, extending the duration of therapy for this subset of patients is not recommended at this time.”
Patients with a slow virologic response have a high rate of relapse. This is true both for patients with HCV genotype 1 who achieve undetectable HCV RNA more than 12 weeks after the onset of treatment[7] and patients with genotypes 2 or 3 who achieve undetectable HCV RNA after Week 4.[3] Genotype 1 patients with a slow virologic response during their initial course of therapy are excellent candidates for retreatment for a longer duration of 72 weeks. For patients with genotypes 2 or 3 who relapsed after their initial course of treatment, retreatment for a longer duration, from 24-48 weeks, is also a logical approach and supported by a retrospective analysis.[21] However, no prospective data are available to support this approach.
3. Shiffman ML, Suter F, Bacon BR, et al. Peginterferon alfa 2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3. N Engl J Med. 2007;357:124 134.
7. Ferenci P, Fried MW, Shiffman ML, et al. Predicting sustained virological responses in chronic hepatitis C patients treated with peginterferon alfa 2a (40 KD)/ribavirin. J Hepatol. 2005;43:425-433.
8. Sanchez Tapias JM, Diago M, Escartìin P, et al. Peginterferon alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology. 2006;131:451 460.
9. Berg T, von Wagner M, Nasser S, et al. Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon alfa 2a plus ribavirin. Gastroenterology. 2006;130:1086 1097.
10. Sanchez-Tapias JM, Ferenci P, Diago M, et al. How can we identify HCV genotype 1 patients who may benefit from an extended treatment duration with peginterferon alfa-2a (40KD) plus RBV? Program and abstracts of the 42nd Annual Meeting of the European Association for the Study of the Liver; April 11-15, 2007; Barcelona, Spain. Abstract 641.
20. Ferenci P, Laferl H, Scherzer TM, et al. Customizing treatment with peginterferon alfa-2a (40KD) (Pegasys) plus ribavirin (Copegus) in patients with HCV genotype 1 or 4 infection: interim results of a prospective randomized trial. Program and abstracts of the 2006 Annual Meeting of the American Association for the Study of Liver Diseases; October 27-31, 2006; Boston, Massachusetts. Abstract 390
21. Willems B, Hadziyannis SJ, Morgan TR, et al. Should treatment with peginterferon plus ribavirin be intensified in patients with HCV genotype 2/3 without a rapid virological response? Program and abstracts of the 42nd Annual European Association for the Study of the Liver; April 11-25, 2007; Barcelona, Spain. Abstract 8.
Hopefully you are still undetectable and won’t have to retreat!!!
Best of luck. Hang in there.
Hector
I have heard of a couple of false positives on Heptimax. They were due to contamination of the sample. All three patients had very low/odd numbers come back and future tests were all undetected. I hope this is what happens for you.
A false positive is a possiblity, but certainly not a probability..
"He told me that retreatment would not benefit me that I would get the same results as the treatment" IMO, your doctor should have choosen his words a bit better. I agree retreatment with the same protocol would probably not benefit you, but retreatment with a different protocol could
(ie., different dosages of soc, different duration of soc, or retreatment with a trial protease or polymerase inhibitors-or approved down the road
pro)
"He told me that retreatment would not benefit me that I would get the same results as the treatment" IMO, your doctor should have choosen his words a bit better. I agree retreatment with the same protocol would probably not benefit you, but retreatment with a different protocol could
(ie., different dosages of soc, different duration of soc, or retreatment with a trial protease or polymerase inhibitors-or approved down the road
pro)
I've never heard of a false pos on a Heptimax.... BUT THAT DOESN"T MEAN THERE IS NOT...
28 is a number I've also NEVER seen ---- unless you're talking 28 thousand or million.
Retest --- and ONLY you can decide if taking the TX is worth it for you.
Look to Andiamo1's posts --- and Susan400.
I think there are others on this board that will be able to answer your questions better... Specifically jmjm (Jim) or CockSparrow...
So good luck to ya -- and much hope!
Meki
28 is a number I've also NEVER seen ---- unless you're talking 28 thousand or million.
Retest --- and ONLY you can decide if taking the TX is worth it for you.
Look to Andiamo1's posts --- and Susan400.
I think there are others on this board that will be able to answer your questions better... Specifically jmjm (Jim) or CockSparrow...
So good luck to ya -- and much hope!
Meki
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.
