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Viral load after the first 4 weeks
Hallo, my husband has hepatitus C 1b, fibrose 3, and is on he triple treatment (with Incivek) and got the results last week from week 4. It as 35. Now the doctor said he would have to do 1 year treatment in stead of 6 months. He is very upset and wants to stop after 6 months. Are there any people that know if 35 is too much? He had many millions before, so it sounds to me very good???
Congratulations to both of you on your husband's Undetectable status at week 8.
As you know, now he will continue treatment for a full 48 weeks. (12 weeks of triple med treatment with Incivek and then another 36 weeks with just Interferon and Riba).
His chances of staying UND are fairly good. His VL was at 35 at week 4 and he is now UND at week 8. Hopefully he will stay UND throughout treatment.
There is a chance that he could have what is called a "viral breakthrough." A viral breakthrough is when he has reached UND status (in his case at 8 weeks) and then the virus reappears later during treatment and starts to increase. This does happen in some cases. It is not common, but it does happen.
If he stays UND throughout the rest of treatment, then his chances are good for cure. There is a chance of relapse after finishing treatment. Relapse is when he is UND at the end of treatment and then the virus reappears after the end of treatment.
He is in the same boat with hrsepwrguy and me and a few others. We were Detectable at week 4 but UND at week 8. Both hrsepwrguy and me have stayed UND throughout the rest of treatment. (Others have also.) I have a week and a half to go. Then all I have to worry about is possible relapse (the rate of which is fairly low).
I have to be honest and tell you that his chance of cure is potentially lower because he was not UND at 4 weeks. Those people, the ones who are UND at 4 weeks, have a very high rate of cure. Those of us who do not become UND until 12 weeks, have a lower chance of cure (but it is still good, about 64%). The studies were based on the 4 week and 12 week viral loads. There are no statistics for those of us who were DET at 4 weeks and UND at 8 weeks.
If he stays UND throughout the rest of treatment, then the relapse rate is about 4%.
http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/ucm256328.htm
Outcome for Subjects without SVR
On-treatment virologic failure a 7% (26/363) 29% (105/361)
Relapse b 4% (11/298) 24% (53/220)
Other c 11% (41/363) 10% (37/361)
a On-treatment failure includes subjects who met a protocol-defined virologic stopping rule or who had detectable HCV-RNA at the time of their last dose of INCIVEK and subjects who had viral breakthrough on peginterferon alfa/ribavirin.
b Relapse rates are calculated with a denominator of subjects with undetectable HCV-RNA at the end of treatment.
c Other includes subjects with detectable HCV-RNA at the time of their last study drug but who did not have viral breakthrough, and subjects with a missing SVR assessment.
Here is the paragraph from Clinical Care Options that discusses the trial results. (See the last sentence of the paragraph.) (eRVR is UND at weeks 4 and 12):
"The response-guided therapy strategy with telaprevir is based on the results of 2 phase III trials in treatment-naive patients. Results from the ADVANCE trial strongly suggested that 24 weeks of therapy is sufficient for patients with eRVR.[29] In the T12PR48 arm of this trial, patients with an eRVR received 12 weeks of triple therapy followed by 12 weeks of pegIFN/RBV, whereas patients without an eRVR received 12 weeks of triple therapy followed by 36 weeks of pegIFN/RBV. Among patients who achieved an eRVR and received 24 total weeks of therapy, the SVR rate was 89%, confirming that this strategy results in a very high SVR rate (Figure 11). The robustness of response-guided therapy was confirmed by the ILLUMINATE trial, in which treatment-naive patients with genotype 1 HCV who achieved eRVR after 12 weeks of telaprevir were randomized to receive either 12 weeks or 36 weeks of pegIFN/RBV, for a total therapy duration of 24 or 48 weeks, respectively (Capsule Summary).[30] Among patients with eRVR, 92% achieved SVR with 24 total weeks of therapy vs 88% with 48 total weeks of therapy. Patients who did not achieve eRVR all continued pegIFN/RBV through Week 48, and 64% attained SVR (Figure 12). "
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%204.aspx
Hang in there. He has a good chance of cure.
As you know, now he will continue treatment for a full 48 weeks. (12 weeks of triple med treatment with Incivek and then another 36 weeks with just Interferon and Riba).
His chances of staying UND are fairly good. His VL was at 35 at week 4 and he is now UND at week 8. Hopefully he will stay UND throughout treatment.
There is a chance that he could have what is called a "viral breakthrough." A viral breakthrough is when he has reached UND status (in his case at 8 weeks) and then the virus reappears later during treatment and starts to increase. This does happen in some cases. It is not common, but it does happen.
If he stays UND throughout the rest of treatment, then his chances are good for cure. There is a chance of relapse after finishing treatment. Relapse is when he is UND at the end of treatment and then the virus reappears after the end of treatment.
He is in the same boat with hrsepwrguy and me and a few others. We were Detectable at week 4 but UND at week 8. Both hrsepwrguy and me have stayed UND throughout the rest of treatment. (Others have also.) I have a week and a half to go. Then all I have to worry about is possible relapse (the rate of which is fairly low).
I have to be honest and tell you that his chance of cure is potentially lower because he was not UND at 4 weeks. Those people, the ones who are UND at 4 weeks, have a very high rate of cure. Those of us who do not become UND until 12 weeks, have a lower chance of cure (but it is still good, about 64%). The studies were based on the 4 week and 12 week viral loads. There are no statistics for those of us who were DET at 4 weeks and UND at 8 weeks.
If he stays UND throughout the rest of treatment, then the relapse rate is about 4%.
http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/ucm256328.htm
Outcome for Subjects without SVR
On-treatment virologic failure a 7% (26/363) 29% (105/361)
Relapse b 4% (11/298) 24% (53/220)
Other c 11% (41/363) 10% (37/361)
a On-treatment failure includes subjects who met a protocol-defined virologic stopping rule or who had detectable HCV-RNA at the time of their last dose of INCIVEK and subjects who had viral breakthrough on peginterferon alfa/ribavirin.
b Relapse rates are calculated with a denominator of subjects with undetectable HCV-RNA at the end of treatment.
c Other includes subjects with detectable HCV-RNA at the time of their last study drug but who did not have viral breakthrough, and subjects with a missing SVR assessment.
Here is the paragraph from Clinical Care Options that discusses the trial results. (See the last sentence of the paragraph.) (eRVR is UND at weeks 4 and 12):
"The response-guided therapy strategy with telaprevir is based on the results of 2 phase III trials in treatment-naive patients. Results from the ADVANCE trial strongly suggested that 24 weeks of therapy is sufficient for patients with eRVR.[29] In the T12PR48 arm of this trial, patients with an eRVR received 12 weeks of triple therapy followed by 12 weeks of pegIFN/RBV, whereas patients without an eRVR received 12 weeks of triple therapy followed by 36 weeks of pegIFN/RBV. Among patients who achieved an eRVR and received 24 total weeks of therapy, the SVR rate was 89%, confirming that this strategy results in a very high SVR rate (Figure 11). The robustness of response-guided therapy was confirmed by the ILLUMINATE trial, in which treatment-naive patients with genotype 1 HCV who achieved eRVR after 12 weeks of telaprevir were randomized to receive either 12 weeks or 36 weeks of pegIFN/RBV, for a total therapy duration of 24 or 48 weeks, respectively (Capsule Summary).[30] Among patients with eRVR, 92% achieved SVR with 24 total weeks of therapy vs 88% with 48 total weeks of therapy. Patients who did not achieve eRVR all continued pegIFN/RBV through Week 48, and 64% attained SVR (Figure 12). "
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%204.aspx
Hang in there. He has a good chance of cure.
Thanks - yes I understand that after completing the treatment it can come back - but a relapse means taht it comes back during treatment?
Congratulations to you and your husband on reaching UND. This increases his chances of clearing Hep C significantly. I am assuming this is his week 8 test, so at least now you know that if he remains UND, he will be able to continue treatment.
Not everyone remains UND. Some people have a viral breakthrough, which means that the virus bounces back to a detected level during treatment and they have to discontinue treatment. Some people have a relapse, which means that the virus comes back to a detected level after completing treatment.
Hopefully neither of these things will happen to your husband and he will remain UND. Hopefully he won't be too nervous every month, now that he has reached UND, but yes, unfortunately, it is not a 100% sure thing. His chances are good, so he should persevere and be happy about his UND results.
Advocate1955
Not everyone remains UND. Some people have a viral breakthrough, which means that the virus bounces back to a detected level during treatment and they have to discontinue treatment. Some people have a relapse, which means that the virus comes back to a detected level after completing treatment.
Hopefully neither of these things will happen to your husband and he will remain UND. Hopefully he won't be too nervous every month, now that he has reached UND, but yes, unfortunately, it is not a 100% sure thing. His chances are good, so he should persevere and be happy about his UND results.
Advocate1955
YES!! he is no UND, we are so happy. But now another question - does this mean that one stays UND usually during the whole treatment - and then after you have stopped it might come back? Or does it fluctuate also during the treatment - so we have to be so nervous every month???
A beer or two every once in awhile will not effect is treatment, studies have shown it has no effect on the outcome of treatment. Alcohol does not cause Hep-C or prevent someone from being cured... The problem begins when one or two leads to several on a regular bases and further damages is liver....... Is it a good ideal way to treat depression?..Nope
He is not having a problem with alcohol, he is just asking himself why it would be bad. I agree with the fact that its not a good idea, but why would it affect more then anti depressive pills or sleepingpills? For the drinking of water: he drinks loads of water and tea and lemonade and 0% beer - no problems with drinking liquids only food gets more difficult. The fat he takes enough.
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