Aa
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???
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
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!
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.
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.
Yes...48 is the proper protocol and to tag on to the good info. pooh has given (as always) if he happens to shorten his tx. and relapse as a result then he may have to wait 3 -5 years to tx. again and with a good chance of slipping in to cirrhosis does not seem at all worth the risk
Good luck to you both....,,.
Will
Good luck to you both....,,.
Will
Well, of course, I understand why your husband is very upset and dissapointed about the 48 weeks.
But I think it would be a good idea for us to focus on some positives
for him: after his 12 weeks of Incivek are over, he will only be doing the Interferon shot and the riba pills. Many people (including myself, I did just those meds, for my first 4 weeks of Tx, as a "lead in" to my Victrelis regiment) find that after the bad side effects of the Incivek wear off, that the Interferon and the ribaviran are fairly easy to live with, in terms of side effects.
I rarely get any ill side-effects, from my Interferon any more, now that I am at 22 weeks. Instead of your husband thinking of a whole year, it might be easier for him to take it one day, and one week, at a time.
But I think it would be a good idea for us to focus on some positives
for him: after his 12 weeks of Incivek are over, he will only be doing the Interferon shot and the riba pills. Many people (including myself, I did just those meds, for my first 4 weeks of Tx, as a "lead in" to my Victrelis regiment) find that after the bad side effects of the Incivek wear off, that the Interferon and the ribaviran are fairly easy to live with, in terms of side effects.
I rarely get any ill side-effects, from my Interferon any more, now that I am at 22 weeks. Instead of your husband thinking of a whole year, it might be easier for him to take it one day, and one week, at a time.
Hi! What a great advise you gave...just to take it one day at a time, a week at a time and so on....
yes - indeed...one day at a time - and one mood at a time I guess. It must be changing all the time
Unfortunately my husband who had ESLD had to stop the treatment after Week 5. Though it was extremely difficult, we were so disappointed that he was unable to continue. Our thoughts were that we needed to do everything we could to get rid of this insidious virus before it caused cancer which would possibly make him ineligible for a transplant. The story does have a happier ending. He remained "unquantifiable" for 8 months after stopping treatment. Though we recently learned the virus is now back, he did get his transplant and is doing great. The fight against the virus will continue someday in the future but at least he will have leveled the playing field now that he has a healthy liver.
So my advice to your husband is hang in there. Complete the treatment however long it takes. SVR will be so worth everything he has gone through. It may prevent him from one day needing a liver transplant or getting liver cancer. Keep your eyes on the prize!
So my advice to your husband is hang in there. Complete the treatment however long it takes. SVR will be so worth everything he has gone through. It may prevent him from one day needing a liver transplant or getting liver cancer. Keep your eyes on the prize!
I agree with the posters above. Many hepatologists are treating stage 3 like stage 4 with regard to length of treatment time with the PIs. So many people with stage 3 are doing 48 weeks instead of 24 weeks anyway, due to the possibility of Cirrhosis. So, he is in it for the long haul, but it is for the best with or without the UND at week 4. Staying on treatment for 48 weeks will increase his chances of SVR. If he were to stop treatment early and then have a relapse, it is likely that he would not be able to treat again with a PI, which would mean he would not be able to treat again until there are new treatment options in 2-5 years. Given that he is already stage 3, he could develop Cirrhosis in that period of time, which is not good.
My advice: do whatever you have to do to keep him on the 48 week course of treatment. Remind him that he is lucky that he is able to treat, as there are many who have exhausted all treatment options and have no choice but to wait. Remind him that he will indeed feel better when he finishes Incivek. Make sure he's drinking plenty of water, and if possible, walking outside for a few minutes every day. If he gets a rash or has signs of anemia, call his doc right away so that these side effects can be managed before they get worse. These are things that will help him stay on treatment for the full 48 weeks.
Advocate1955
My advice: do whatever you have to do to keep him on the 48 week course of treatment. Remind him that he is lucky that he is able to treat, as there are many who have exhausted all treatment options and have no choice but to wait. Remind him that he will indeed feel better when he finishes Incivek. Make sure he's drinking plenty of water, and if possible, walking outside for a few minutes every day. If he gets a rash or has signs of anemia, call his doc right away so that these side effects can be managed before they get worse. These are things that will help him stay on treatment for the full 48 weeks.
Advocate1955
PS: He will very likely be UND with his week 8 results, and that will also help him feel more optimistic.
Advocate1955
Advocate1955
Your husband is just disappointed and that is understandable.
Advocate is correct when he gets his next UND it will motivate him
to keep going. Just don't focus on it too much now and he'll get past the let down of having to go longer.
Reva
Advocate is correct when he gets his next UND it will motivate him
to keep going. Just don't focus on it too much now and he'll get past the let down of having to go longer.
Reva
I'm in the same situation, I extended treatment past 24 weeks (now in my 27th week). I was detectable 44 at 4 weeks, and UND at 8 weeks (it's possible I became UND earlier at 5 weeks, but no test was done).
Some months ago on a website someone posted here I saw that people who are 50 at 4 weeks, extending to 48 weeks is the best option.
Some months ago on a website someone posted here I saw that people who are 50 at 4 weeks, extending to 48 weeks is the best option.
And a count of 25 per millilitre of blood is very low when you consider how incredibly tiny the hep C virus is. When researchers used to call it "not A, not B" they searched for it for over ten years before they finally found it (in the 1980s).
Thank you all for all your answers. Moods are better here now - the docter promised to look into it and have him also tested at 2 months again - and he does the accupunction, which really helps - I can recommend it to all. No real side effects untill now except tiredness. Usually we go for a week fasting and colon cleaning in a wellnesscentre, in august - but I think now this would be to much, does anybody know that? I also think that coloncleaning could reduce the effect of telepravir? The doctor said that fasting (with juices) would be fine, only ofcourse the medicine has to be taken with some fat. And I just realised about the coloncleaning - think its not wise?
If it was me, I would skip the fasting and colon cleansing in August.
First, the Teleprevir has to be taken with at least 20 grams of fat, and preferably with some solid food or very thick food. You do not want the Teleprevir going through the colon to fast. And it needs the fat for absorption.
Even without the Teleprevir, I would skip the fasting and colon cleansing until off treatment. In my opinion, the body does not need anything else going on or happening to it (in addition to the harsh meds). Plus, luckily the side effects are mild so far. That does not mean they will stay that way. (Hopefully they will stay mild, but one cannot count on it.) If he starts getting nauseated he has to eat. The nausea is worsened by having no food in the stomach. Eating helps a lot of the side effects.
In addition, fasting is not easy on the body (I do not mean it is not beneficial, just that, at the time, it is not easy on the body). His body is already compromised with the Hep C and the harsh meds. Another change from "regular" could add more stress, which is not good while on Tx.
In reality, he would not be fasting anyway. He has to eat at least 3 meals a day with 20 grams of fat each. He also has to eat with the Ribavirin. So there is no way he could fast anyway.
I do not know what is involved in colon cleansing, but you do not want anything to interfere with medication absorption.
I would save the colon cleansing until after treatment is over.
First, the Teleprevir has to be taken with at least 20 grams of fat, and preferably with some solid food or very thick food. You do not want the Teleprevir going through the colon to fast. And it needs the fat for absorption.
Even without the Teleprevir, I would skip the fasting and colon cleansing until off treatment. In my opinion, the body does not need anything else going on or happening to it (in addition to the harsh meds). Plus, luckily the side effects are mild so far. That does not mean they will stay that way. (Hopefully they will stay mild, but one cannot count on it.) If he starts getting nauseated he has to eat. The nausea is worsened by having no food in the stomach. Eating helps a lot of the side effects.
In addition, fasting is not easy on the body (I do not mean it is not beneficial, just that, at the time, it is not easy on the body). His body is already compromised with the Hep C and the harsh meds. Another change from "regular" could add more stress, which is not good while on Tx.
In reality, he would not be fasting anyway. He has to eat at least 3 meals a day with 20 grams of fat each. He also has to eat with the Ribavirin. So there is no way he could fast anyway.
I do not know what is involved in colon cleansing, but you do not want anything to interfere with medication absorption.
I would save the colon cleansing until after treatment is over.
I agree. Colon cleansing is difficult on the body. It can be dehydrating, it can upset the balance in the gastrointestinal system, and can irritate the bowels even further. I think it would just be too much while on this important treatment. Glad to hear that the mood is better at your house! :)
Advocate1955
Advocate1955
Hi, I have another question - my husband is not drinking any alcohol now for 2 months - but the doctor said that a beer avery now and then is not bad. What is your opinion about it? His ALAT and ASAT are fine now, but I think it might be harmfull for the treatment?In his depressed days he would like a beer sometimes!
whoa - a beer every now and then? Not a good idea, especially while still on treatment. If he just quit drinking 2 months ago he has had a lot of changes in his life in a short time.
My hepatologist said guardedly after treatment that an occasional drink for a birthday or holiday would be okay. But that is after you are clear. He also said he has had disasterous results telling people the can drink after tx. It is an addiction and has a nasty little habit of taking charge. Please find something else for his depression.
frijole
My hepatologist said guardedly after treatment that an occasional drink for a birthday or holiday would be okay. But that is after you are clear. He also said he has had disasterous results telling people the can drink after tx. It is an addiction and has a nasty little habit of taking charge. Please find something else for his depression.
frijole
but the doctor said that a beer avery now and then is not bad
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Your doctor is correct ,for anyone who has a beer now and then ,this is not harmful, however the fact you mentioned that he has not had a drink in 2 months leads to believe possibly he has a problem with alcohol and I concur fully with frijole ,,if that is the case too not indulge .
In his depressed days he would like a beer sometimes!
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There is little that will fuel depression greater than alcohol for those that use this method to try and relieve such...
Good luck to you both going forward with tx....
.
Will
.
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Your doctor is correct ,for anyone who has a beer now and then ,this is not harmful, however the fact you mentioned that he has not had a drink in 2 months leads to believe possibly he has a problem with alcohol and I concur fully with frijole ,,if that is the case too not indulge .
In his depressed days he would like a beer sometimes!
-----------------------------------------------------------------------
There is little that will fuel depression greater than alcohol for those that use this method to try and relieve such...
Good luck to you both going forward with tx....
.
Will
.
if your husband feels like drinking a beer while on tx i would say the drugs aren't working as well as they should...is he eating the right amount of fat? lots of folks on tx have a tough time just drinking enough water....my doctor wouldn't even see anyone that drank alcohol...i think it was at least 6 months before tx.. having hep c and still drinking is really not a good idea.....good luck...billy
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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