Aa
Sould I seek a second opinion
Coming soon the all important 12 wk viral load. My doc is rec. stopping treatment if not undected. I am type 1, minor liver damage, started 1,700,000, 4 weeks 140,000, 8ks 4800. My doc is GI, I think he is the expect in the office for liver disease. But before I stop I'm thinking about getting a second decision by hepologist. My sense is people can clear later but tend to relapse over the long haul.
Now hold on a minute pcds...
You need to know how rare it is that a doctor will stop treatment at 12 weeks if you are not clear. The benchmark to continue is the old 2-log drop. Your doctor seems to be pretty knowlegable and I think what you need is a good sit-down with him. No one wants to do this treatment more than once. So, if you can do it once, even with extended time, and clear, that is better than twice. Perhaps he just needs a committement from you to extend or up the meds.
He may be concerned because your VL was pretty high at week 4. When I was treating and reading every thread on this forum daily, I was really disappointed not to clear at week 4 . My doctor was delighted with my 2800 VL (he was an SOC kind of guy). By the way, I had to convince him to give me a 4-week VL (SOC says first one is at 12).
So coupled with the fact that you have been given PCRs at 4 weeks and 8 weeks AND that he is not happy with any VL at 12 weeks AND that he orders sensitive PCRs (Heptimax) that tells me that he is ahead of the curve. That is, he must study or research, or just plain care more than other GI's. So, my advice would be to talk with him. I think you may be underdosed with the riba if your VL has not dropped below 11 yet. Perhaps he needs to know that you will commit to more meds or more time.
frijole
You need to know how rare it is that a doctor will stop treatment at 12 weeks if you are not clear. The benchmark to continue is the old 2-log drop. Your doctor seems to be pretty knowlegable and I think what you need is a good sit-down with him. No one wants to do this treatment more than once. So, if you can do it once, even with extended time, and clear, that is better than twice. Perhaps he just needs a committement from you to extend or up the meds.
He may be concerned because your VL was pretty high at week 4. When I was treating and reading every thread on this forum daily, I was really disappointed not to clear at week 4 . My doctor was delighted with my 2800 VL (he was an SOC kind of guy). By the way, I had to convince him to give me a 4-week VL (SOC says first one is at 12).
So coupled with the fact that you have been given PCRs at 4 weeks and 8 weeks AND that he is not happy with any VL at 12 weeks AND that he orders sensitive PCRs (Heptimax) that tells me that he is ahead of the curve. That is, he must study or research, or just plain care more than other GI's. So, my advice would be to talk with him. I think you may be underdosed with the riba if your VL has not dropped below 11 yet. Perhaps he needs to know that you will commit to more meds or more time.
frijole
That's a great thought, but a drop of 2 logs or more does not predict undect at 12 wks. I have asked so many people if it is a predictor, I hear it isn't. I just have to wait and see, and hope. I really, really hope you are right jusjames.
pcds, the two log drop is for SLOW responders.
A 2 log drop by week 12 (in the absence of UND) is to calculate the decision to extend tx to 72 weeks, an option for those who want to take their chances or who don't have the luxury of waiting to see how the stat-c's play out off-trial.
Best regards and my bet is you're UND at week twelve. Keep your spirits up but it's hard, hard to wait and we all know the feeling well.
xoxo
Susan
A 2 log drop by week 12 (in the absence of UND) is to calculate the decision to extend tx to 72 weeks, an option for those who want to take their chances or who don't have the luxury of waiting to see how the stat-c's play out off-trial.
Best regards and my bet is you're UND at week twelve. Keep your spirits up but it's hard, hard to wait and we all know the feeling well.
xoxo
Susan
A 2 log drop at 12 weeks can still mean there is virus present. I think the 2 log thing is for non responders. My understanding undect is what I need to have at the end of 12 weeks. Per MD, studies show if not undec at 12 weeks there is a 5% chance to achieve SVR. My guess is if you clear after week 12, you are more likely to relapse.
I've dropped 2+ logs to 4800 at week 8. If I had 4800, a 2 log drop at week 12, it would not be good news. So the 2log thing seems worthless as it doesn't predict clearing at week 12.
I plan to take my week 12 viral load on the morning of week 13 start.
I've dropped 2+ logs to 4800 at week 8. If I had 4800, a 2 log drop at week 12, it would not be good news. So the 2log thing seems worthless as it doesn't predict clearing at week 12.
I plan to take my week 12 viral load on the morning of week 13 start.
Hi Specta,
Interesting question and I'm only guessing.
I'd say it's to bring uniformity to the decision-making process of whether to continue treatment, i.e., if you're UND or have a two log drop at week twelve. So it's important to establish a consistent point in time for everyone.
What if instead you took the test the day of your week twelve injection and weren't clear but were about to clear in a day or two or have a two log drop? Well, then you'd be dropped from tx, right?
Conversely, if you sneak in an extra injection (the 13th), then you're not clearing with twelve injections. I suppose that it doesn't mean that the science is that precise but simply that there's a clear convention is in place.
And it goes without saying you continue your meds until an official decision is made with your doc!!! :)
Susan
Interesting question and I'm only guessing.
I'd say it's to bring uniformity to the decision-making process of whether to continue treatment, i.e., if you're UND or have a two log drop at week twelve. So it's important to establish a consistent point in time for everyone.
What if instead you took the test the day of your week twelve injection and weren't clear but were about to clear in a day or two or have a two log drop? Well, then you'd be dropped from tx, right?
Conversely, if you sneak in an extra injection (the 13th), then you're not clearing with twelve injections. I suppose that it doesn't mean that the science is that precise but simply that there's a clear convention is in place.
And it goes without saying you continue your meds until an official decision is made with your doc!!! :)
Susan
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If UND, you may still want to get a second opinion from a hepatologist, in case you want to switch to someone more experienced.
With minor liver damage and in today's climate of rapid development with stat-c drugs, I wouldn't hesitate to stop treatment if detected at week twelve; I'd watch and wait under the care of the best hepatologist I could find.
So best wishes on your PCR - the waiting is hard but be sure to tell your nurse to phone you asap and not let the lab report kick around on her desk.
And make sure to get your 12 week PCR done on the day of your thirteenth shot but before you actually do the shot. Or as close to the day as possible.
Regards,
Susan