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862235 tn?1336060295

good drop?

My wife is beginning triple TX with a viral load of 6,000,000 copies and enzymes perfectly normal. At her 4 week viral load count what would be an acceptable number of copies. Obviously we're hoping for zero. Also she is native American. Does this mean she would be considered Asian and have a better chance of success?
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862235 tn?1336060295
In my readings, unfortunately, Hispanics and African Americans are less likely to achieve SVR and are about equal to one another in this regard.
Helpful - 0
2062453 tn?1350332942
Hi Chuck:  Thanks for the link. My wife is Asian so this topic is interesting to me. You indicated your wife will be taking Incivek. Later on, I'll Google for potential study results pertaining to Incivek & Asians. My experience with Incivek is the viral load drops so dramatically that being Asian may not have an advantage over Caucasians (not sure about Hispanics and African Americans). My VL dropped 99.99% during the first week of Incivek therapy. I estimated Pooh's VL dropped 99.6% during her first week of Incivek therapy (I'm not sure what Pooh's ethnicity is). Just two data points, but very encouraging! Cheers, GB
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862235 tn?1336060295
I'm sorry I meant UND, which, if I am correct means that no virus was detected in the test or zero copies. I realize this does not mean that there is zero virus present otherwise we could stop treating at week 4. It means that the lab was unable to detect any virus with the means of testing available.
As for the favourable outcome for Asians treating, a google search will reveal several articles in this regard. One might be read here.
http://www.nature.com/ajg/journal/v105/n5/full/ajg2009635a.html
Although there does not appear to be a large difference along racial lines, there seems to be one none-the-less
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1747881 tn?1546175878
Thank you for your response, I am familiar with the math involved with curve prediction, by profession I am a directional driller.

Thanks again and have a great day

HPG
Helpful - 0
2062453 tn?1350332942
Hi HPG: Your data set is interesting. It seems your viral load stayed between 43 and 7.1 for a full 3 weeks (i.e., weeks 4, 5 & 6).

Reference your question about when you became UND. Using the model, I would have predicted you became UND at five and a half weeks. Since we know you were detectable at week 6, you must have become UND right after your week 6 test.

Reference your question about when you reached zero. Technically, a Y=AX^b power function (where b is a negative exponent) becomes asymptotic to the axis (i.e., it never reaches zero). Using the model, when you stop treatment after 48 weeks your viral load will be 0.6 units per LITER. I think the idea is that your body will eradicate on it's own the little bit of virus that's left.

HPG, your data set is similar to Pooh's. You may want to read the note I left for her earlier today. If you are fascinated by this concept, I can upload your prediction table as a photo on my personal page -- just let me know.

If you want to learn more about Y-AX^b improvement curves, you can go to https://acc.dau.mil/CommunityBrowser.aspx?id=379493. This site is affiliated with the Department of Defense so you may get some warning messages you'll need to click past. If you are not comfortable clicking past the warning messages you can Google, "Y=AX^b DAU" and look for the result titled, "Ch 7 - Improvement Curves".

For all of the people reading this post, I'm just another patient ..... with some knowledge of improvement curves. I'm still experimenting with applying the Y=AX^b concept to the decrease in viral loads during treatment. This should not be considered controlled formal research. If you like the concept, just use it as an interesting tool. I'll continue making improvements to the model as I get more data and perform more analysis.

Cheers, GB
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1747881 tn?1546175878
Also UND at wks 16 and 20 same test at wk 24 UND LLOD of 5
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1747881 tn?1546175878
"Let me know if you want me to elaborate on this point."

I would, my starting VL was 14.2 mill, didn't test again until wk 4, was det below limit of quantification at wks 4, 5 and 6 (LLOQ 43 LLOD 7.1) didn't test again until wk 12 was UND same test.

When did I go UND and when did I reach zero ?

Currently in the middle of wk 34.
Helpful - 0
2062453 tn?1350332942
Hi Chuckles:

Reference your question about whether or not a native American would be considered Asian. Since native Americans are generally considered to have crossed the Bearing Strait from Asia, I would say that yes, she could be considered of Asian origin. That said, with Incivek I don't know whether or not there is a statistical difference in the SVR rate for the Asians population.

Reference your question about what is an acceptable number of copies at treatment week 4. It is not clear to me how you personally define "acceptable" so I'll make two different assumptions, as follows:

1. If you define acceptable as being able to continue on with treatment at week 4 then the answer would be "less than 1,000."

2. If you define acceptable as potentially qualifying for 24 weeks of therapy (versus 48 weeks) then the answer would be "Undetectable". I use the word "potentially" because more goes into a decision to treat for 48 weeks than just the viral load test result at week 4.

I'd like to address one of your statements, which was, "Obviously we are hoping for zero." I hope you understand there is potentially a BIG difference between "Undetectable" and "Zero". May of us Incivek triple therapy patients are "undetectable" by week 4, but we stay on treatment for 24 or 48 weeks because it takes much longer to reach "zero." If you assume the eradication of the HCV virus is logarithmic, you can estimate when you are likely getting close to "zero" with just a starting VL and an assumed slope. Let me know if you want me to elaborate on this point. Cheers, GB
Helpful - 0
1747881 tn?1546175878
INCIVEK must be administered with both peginterferon alfa and ribavirin for all patients for 12 weeks, followed by a response-guided regimen of either 12 or 36 additional weeks of peginterferon alfa and ribavirin depending on viral response and prior response status.

http://pi.vrtx.com/files/uspi_telaprevir.pdf
Helpful - 0
Avatar universal
That's 2 drugs, which is the 3rd?
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1747881 tn?1546175878
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 or equal to 1000 IU/mL at Treatment Week 4 or 12; or (2) confirmed detectable HCV-RNA levels at Treatment Week 24 (see Table 2).

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

2.7.1 Duration of Treatment in Treatment-Naive Subjects
In subjects who have had no previous treatment for HCV (treatment-naive), treatment with telaprevir must be initiated in combination with Peg-IFN and RBV and administered for 12 weeks.
• Subjects with undetectable HCV RNA at Weeks 4 and 12 receive an additional 12 weeks of Peg-IFN and RBV alone for a total treatment duration of 24 weeks
• Subjects with detectable HCV RNA at either Weeks 4 or 12 receive an additional 36 weeks of Peg-IFN and RBV alone for a total treatment duration of 48 weeks HCV-RNA levels should be monitored at Weeks 4 and 12 to determine treatment duration.
Treatment with telaprevir should be discontinued in subjects who do not have an adequate viral response during treatment.

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252562
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862235 tn?1336060295
Incivek & Pegasys
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1747881 tn?1546175878
Which triple will she be doing ?
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