Restarting treatment earlier. Is it a mistake?

[Sally01]

Hi, I received my first UND in July and then my Peg/riba treatment was interupted off and on the next few months due to illness.  I am still receiving treatment for an opportunistic lung infection which is apparently very stuborn.  I am post transplant also so my immune system was pretty low.  Also I worked in a hospital in a highly infectious area.  Won't do that again.   Anyway I have had no treatment for the HCV since Sept.  My November VL came back UND.  I was thrilled but a little surprised
      I asked my doctors if I could start the Peg/riba again so as not to loose this opportunity to acheive SVR but they all seem to put the question off or refer it to another doctor for approval.  Final say was to come from the transplant team in Miami.  They don't see me until Dec 12th and was told to wait until I was seen.  My nurse co-ordinator is out ill and no one is responding to my plea for more immediate help.
   I feel better than I have in months.  No doctor has givin me a reason for any kind of interaction with the ribasome I am taking.  Last Wed I had blood drawn and my liver enymes had elevated from 14 to the 50's.  Scared me.  I took the peg and riba on Thanksgiving on my own.  Seemed bad to wait for appointments when the meds are in the fridge.  After about 6 hours I had a bad flu-like reaction but the next day I was better and am continuing to do well.
    Do you think I messed things up> I am planning to take it again on Thursday.  By the time my Dec 12th appointment rolls around I will have taken it 3 weeks. If I feel ok which uspectI will should I tell the

[jmjm530]

Here's a reference to a promising five-year study that cites SVR data between 99.2 per cent and I believe 100 per cent for the combo group. Also discusses the reinfection issue:
http://www.hcvadvocate.org/news/newsLetter/2006/advocate0106.html

Lastly, the study I think I was looking for that goes ten years out  which states in part:

"...All but one patient who achieved SVR (> 99%) still had undetectable HCV viral load after a mean follow-up period of 2.3 years (range 0.3-10.3). The authors concluded that advances in hepatitis C therapy have produced higher sustained response rates in the clinical setting. They also suggested that since this response appears durable, medium and long-term follow-up of patients with SVR is

[jmjm530]

Here's one five-year study:
http://www.natap.org/2004/AASLD/aasld_20.htm

This one goes 9.18 years out:
http://bmc.ub.uni-potsdam.de/1471-2334-5-27/

Here is a compliation of articles on a number of SVR durability studies: http://www.natap.org/2004/HCV/083004_06.htm

I believe there is also another recent study that mentions 10 years which I will post if I can find again.

Also, Dr. Donald Jensen specifically speaks of studies suggesting the durability of SVR "5-10" years out in his video "Doc Eye for the Hep Guy" at the Clinical Options Website. You can fast-forward to the 8 minute mark for this portion of the presentation. I'm sure an email to Jensen from another doctor should produce the studies he's referring to.

Jensen mentions a figure 96% figure which seems to me quite conservative based on both some of the five years studies and what I have read anecdotally from doctors in the field. Perhaps the lower mark -- I've heard the close to 100% figure -- may be due to older studies  initially using less sensitive testing, possibly monotherapy, fixed dose riba, and even HIV co-infection being mixed in -- or the reinfection issue already addressed. Just speculation on my part as I haven't read the full-text, only abstracts. Hope this is helpful.

All the best,

-- Jim

[jmjm530]

No, Jensen did use Pegasys but I'm almost certain the study used by the European Union? was a Peg Intron study but that's for another day.

[jmjm530]

Here's a Ferenci study that has a 77% success rate for short course but it uses Pegasys not Peg Intron as I believe the Jensen study might have. In a similar fashion, studies with selected geno 2's and 3's using Peg Intron have shown similar SVR rates for 12 versus 24 weeks while the Pegasys studies used 16 weeks versus 24.

http://www.natap.org/2006/EASL/EASL_03.htm

Apologies for the fragmented posting but unfortunately I've never saved these studies in an organized manner so I have to look them up from memory.

[jmjm530]

Not sure if this is full-text but a better idea of what the Jensen study stated:
http://www.natap.org/2005/AASLD/aasld_55.htm

There's also that European Union? directive I can't seem to find but will post later if found.

[jmjm530]

In reference to RTS's post below "HR-Question about re-treatment" -- do you give any credence to his supposition that his relapse somewhere between 3 and 6 months post treatment was caused by a dental procedure? Apparently he was VL negative via Heptimax at 3-months post treatment and then positive at six months. Also, how common do you think this is? I've read recently that the 3 month post correlates very closely with the six months so this would put him in a very small group I would think.

Related -- I SVR'd as measured by Heptimax three months ago after 54 weeks of tx and an RVR (via Heptimax) at week 6. In another month or so I'm planning on having a tooth implant which of course requires surgery placing the implant device into bone or sinus. Do you think this might have any negative consequences virus-wise and would you put the procedure off?

All the best,

-- Jim