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3140551 tn?1343255037

Three Doses Missed of Ribavirin...with a back story

Monday, my husband had his 24-week visit with his GI doc, who told us that while his viral load was technically undetectable it was still detected. The lab sheet showed <43 detected. Oh, he is/was on triple therapy with Incevik for the first 12 weeks. There was never a more faithful taker of medication in all the history of the world. But, the doc said to stop the treatment and said he needed to go to a hepatologist and perhaps the hepatologist would go with Victrelis next time.  

In the meantime, we have chatted with a research facility in the metroplex and she seemed to think perhaps the treatment shouldn't have been stopped, or paused at all.  My question is whether or not he could continue to take the ribavirin, as God knows we have plenty of it in stock, while we try and figure out what is next. It was my understanding that treatment experienced patients go for the 48 weeks, so I was puzzled at the stoppage myself. We are just frantic and everything I read only addresses one missed dose.  ANY, and I do mean any information would be greatly appreciated.

thanks!
17 Responses
Avatar universal
Well I agree treatment should not of been stopped as 48 weeks is whats called for if not und at week 4, missing only 3 doses should not be a huge deal... If you still have the riba and interferon I would get back on it and get into a hepa asap......... Good luck
1747881 tn?1546179478
First I would request a retest then go from there, if indeed he is detectable even <43 IU/ml he is technically detectable and the doc is following proper protocol stopping all treatment

2.3 Discontinuation of Dosing
Patients with inadequate viral response are unlikely to achieve SVR, and may develop treatment-emergent resistance substitutions [see Microbiology (12.4)]. Discontinuation of therapy is recommended in all patients with (1) HCV-RNA levels of greater than 1000 IU/mL at Treatment Week 4 or 12; or (2) confirmed detectable HCV-RNA levels at Treatment Week 24 (see Table 2).

Table 2: Treatment Futility Rules: All Patients
HCV RNA - Week 24: Detectable
Action - Discontinue peginterferon alfa and ribavirin

http://pi.vrtx.com/files/uspi_telaprevir.pdf

Ribavirin monotherapy is not effective for the treatment of chronic hepatitis C virus infection and should not be used alone for this indication.

http://www.drugs.com/pro/ribavirin.html
Avatar universal
Opps, keith is right, I was thinking not und at week 4 and you wrote week 24.
1747881 tn?1546179478
Hey can-do :)
1815939 tn?1377995399
Welcome to the forum.

I am very sorry that your husband is still Detectable at week 24. I know it must be devastating to have to stop treatment.

However, if I was you, I would request another VL test to be certain there was no lab error and I would continue treatment until the results of that lab test are known (with your doctor's knowledge and okay, of course).

You do not state what happened the last time your husband treated. Did he ever clear the virus? Did he Relapse? Or did he not respond well (either a non-responder or a partial responder? His response to his last treatment would be a factor in determining how long he treated. If he relapsed, he would treat for 24 weeks. If he was a partial responder or a non-responder then he would do 48 weeks. Also, if he has cirrhosis he would do 48 weeks.

Also, was he ever Undetectable while on this 24 week treatment?

As far as viral load goes, he is either Detectable or Undetectable.  There is no "technically undetected" status. If his VL showed  1000 IU/mL at Wk 4 or 12: stop all 3 drugs
2. HCV RNA detectable at Wk 24: stop all treatment

http://www.clinicaloptions.com/inPractice/Hepatology/Hepatology/ch8_Mgmt_of_Hep_C_Infection/Supporting%20Assets.aspx



3140551 tn?1343255037
I guess it was the undetectable but detectable thing that threw me and then when this research person questioned it, it just had me a little frantic.  Thanks for the input!
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