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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???
I just re-read your post. You said your husband is at Stage 3 fibrosis. In that case, if I was you, I would surely do everything possible to convince him to stay on treatment for the 48 weeks.
There are only 4 stages of fibrosis. The next stage, Stage 4, is cirrhosis. As we age the fibrosis rate tends to pick up speed. No one knows how long it may take him to get to Stage 4. It could be 3 years or it could be 10 years. He may think treatment is bad (and it is), but advancing to Stage 4 and cirrhosis is worse. In addition, the cure rates for people with cirrhosis are considerably lower than for those with lower stages of fibrosis and people with cirrhosis face the possibility of many more complications while treating. He has the opportunity to treat now and hopefully attain a cure. It would be a shame to pass that opportunity up.
Best of luck.
There are only 4 stages of fibrosis. The next stage, Stage 4, is cirrhosis. As we age the fibrosis rate tends to pick up speed. No one knows how long it may take him to get to Stage 4. It could be 3 years or it could be 10 years. He may think treatment is bad (and it is), but advancing to Stage 4 and cirrhosis is worse. In addition, the cure rates for people with cirrhosis are considerably lower than for those with lower stages of fibrosis and people with cirrhosis face the possibility of many more complications while treating. He has the opportunity to treat now and hopefully attain a cure. It would be a shame to pass that opportunity up.
Best of luck.
Thank you and all for the answers...this is very helpfull
Welcome to the forum.
I am sorry that your husband did not reach an Undetectable status by the end of week 4.
Yes, as the others said, if a person does not reach an Undetectable status by week 4 then the person needs to do treatment for 48 weeks instead of 24 weeks.
35 sounds low, but that is 35 per milliliter of blood. When you multiply that by the entire blood volume, there are still many, many virons in the blood stream.
The treatment time frame is based on statistics. Those who did not become Undetectable at 4 weeks had higher cure rates if they did 48 weeks than if they did 24 weeks. In addition,the cure rates for those of us who did not attain UND status at 4 weeks is a bit lower just because we did not attain Undetectable status at 4 weeks. So, those of us who did not attain UND status by week 4 are all doing 48 weeks.
Because I was <43 but still detectable at 4 weeks, I am doing 48 weeks and am on the last 6.5 weeks.There are others on the forum doing 48 weeks. It is doable. I found that I felt better as soon as I finished the Incivek. The other 2 drugs have side effects, but Incivek seems to have a lot more.
I would encourage him to do the 48 weeks if at all possible. If he does 24 weeks and then the virus shows up again he will have done 24 weeks for nothing and he will always wonder if he would have been cured had he done 48 weeks.
From Clinical Care Options:
"Telaprevir. The prescribing information for telaprevir in treatment-naive patients recommends that all patients begin with a 12-week period of triple therapy with telaprevir 750 mg 3 times daily (every 7-9 hours) plus pegIFN/RBV.[53] Telaprevir should be administered with food, specified as standard or high fat (standard-fat meal would be 21 g, such as 2 ounces of cheese or a half cup of nuts). After 12 weeks, telaprevir should be discontinued and pegIFN/RBV continued; for individuals with an eRVR (undetectable HCV RNA at Weeks 4 and 12), pegIFN/RBV should be continued to treatment Week 24. Conversely, for individuals without an eRVR, pegIFN/RBV should be continued through treatment Week 48 (Table 6). As with boceprevir, it is recommended that an HCV RNA assay with a lower limit of quantification of 25 IU/mL be used for evaluating virologic milestones for response-guided therapy. The prescribing information notes that treatment-naive patients with cirrhosis may benefit from receiving the longer duration of 36 weeks of pegIFN/RBV (ie, 48 weeks of total treatment), even if they achieve eRVR.
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. 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
Best of luck and please post again if you have other questions.
I am sorry that your husband did not reach an Undetectable status by the end of week 4.
Yes, as the others said, if a person does not reach an Undetectable status by week 4 then the person needs to do treatment for 48 weeks instead of 24 weeks.
35 sounds low, but that is 35 per milliliter of blood. When you multiply that by the entire blood volume, there are still many, many virons in the blood stream.
The treatment time frame is based on statistics. Those who did not become Undetectable at 4 weeks had higher cure rates if they did 48 weeks than if they did 24 weeks. In addition,the cure rates for those of us who did not attain UND status at 4 weeks is a bit lower just because we did not attain Undetectable status at 4 weeks. So, those of us who did not attain UND status by week 4 are all doing 48 weeks.
Because I was <43 but still detectable at 4 weeks, I am doing 48 weeks and am on the last 6.5 weeks.There are others on the forum doing 48 weeks. It is doable. I found that I felt better as soon as I finished the Incivek. The other 2 drugs have side effects, but Incivek seems to have a lot more.
I would encourage him to do the 48 weeks if at all possible. If he does 24 weeks and then the virus shows up again he will have done 24 weeks for nothing and he will always wonder if he would have been cured had he done 48 weeks.
From Clinical Care Options:
"Telaprevir. The prescribing information for telaprevir in treatment-naive patients recommends that all patients begin with a 12-week period of triple therapy with telaprevir 750 mg 3 times daily (every 7-9 hours) plus pegIFN/RBV.[53] Telaprevir should be administered with food, specified as standard or high fat (standard-fat meal would be 21 g, such as 2 ounces of cheese or a half cup of nuts). After 12 weeks, telaprevir should be discontinued and pegIFN/RBV continued; for individuals with an eRVR (undetectable HCV RNA at Weeks 4 and 12), pegIFN/RBV should be continued to treatment Week 24. Conversely, for individuals without an eRVR, pegIFN/RBV should be continued through treatment Week 48 (Table 6). As with boceprevir, it is recommended that an HCV RNA assay with a lower limit of quantification of 25 IU/mL be used for evaluating virologic milestones for response-guided therapy. The prescribing information notes that treatment-naive patients with cirrhosis may benefit from receiving the longer duration of 36 weeks of pegIFN/RBV (ie, 48 weeks of total treatment), even if they achieve eRVR.
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. 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
Best of luck and please post again if you have other questions.
Sorry he's not undetectible therefore 48 is the right number. Tell him not to feel bad back in the day a bunch of us had to 72 weeks. So, it's better than that!
Your doctor is correct, if one is not und at week 4 then 48 weeks is what they suggest for the best odds of gaining SVR... Good luck
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