hepatitisresearcher

[spcecst2]

Your opinion please? Lets say a patient went thru treatment (1b) pegasys/copegus 180/1200 for 48 weeks, starting VL was 10 mil, middle aged male, slight liver damage, still detectable at 600 week 12, clear week 16 (less than 50), relapsed, waited 3 months and started treatment over, VL 500,000, double dose pegasys 4 weeks, 1400 copegus, no VL detected at week 4 using heptimax, did shot every five days from week 4 thru week 12, did 1600 copegus for month and half, waited full seven days at week 12 and got negative heptimax, doing 180/1200 rest of treatment, ast/alt normal at week 12, does this person have the same chance with RVR statistics (as high as 85% SVR) with 48 weeks, or are those RVR statistics only good for someone who does treatment the first time using the SOC? I hope you can understand what I’m asking here?

[burned74]

Hi Spcest2

I was wondering if the increased doses were something that your doctor recommended or is this something that was your idea/ Also do you know if this is a common approach for persons who fail tx the first time?
Is this something that most doctors will agree to or do you have to seek out a doctor  who will treat with this method?

[jmjm530]

Willing: starts to quantify the significance of occasional breakthroughs from high-sensitivity tests during tx. Looks like  breakthrough  is not catastrophic (10/23 still SVRrd) but definitely not good.  Yeah, I know, I know, you already knew all that..
----------------
Well, well, this could be a very boring New Year with nothing to quibble about. No doubt this was the reasoning behind my docs' noting the importance of monthly TMA's after UND.

-- Jim

[mikesimon]

It is always nice to see you here.

Regarding a portion of your post: ". I'm near convinced that most patients never completely eradicate the virus (by the extensive number of studies that  continue to detect it if they look hard enough). Thus SVR represents  a renegotiated equilibrium between virus and host."

I agree with you completely on this and I have a biopsy that seems to support it. It appears that a very "complex truce" is reached once the SVR flag is raised.

Be well,
Mike

[spcecst2]

I hope that my up front hit it hard (double dose) and corresponding RVR, starting lower VL, higher Riba intake first twelve weeks (between 16 and 20 mg/kg) along with **tma negative testing helped me get a ""renegotiated equilibrium between virus and host"" and that I hindered "" the virus' ability to evade"" and that I don't have all the wrong genes!! Maybe it's possible that with geno 1's your gene makeup needs a little extra room to work, reflected by lower SVR rates geno 1's with high starting viral loads, and higher SVR rates with lower starting VL's, so in fact there could be a whole arguement about that!! I am doing the 72 weeks just to give it a little extra room!!

**no transient or persistent reappearance of low levels of HCV RNA in any of the 34 SVR patients wrote H.C. Gelderblom and colleagues using tma

[mremeet]

Not all RVR's are the same. There were several VX950 Provers who took IFN and TVR without ribavirin. Many (or even most) of them achieved RVR, but all of them failed to achieve SVR ("all" that were on this forum at least). Also, there are those who are relatively insensitive to SOC, and would never RVR without the benefit of TVR. Many of those SOC insensitive provers who took SOC (with riba) and TVR together achieved RVR, only to have their initial response peter out and the virus re-emerged by about week 6 or soon afterwards. And technically it's possible for some to go RVR, or even UND in less than 2 weeks using TVR alone as a monotherapy. But the odds they'll go on to achieve SVR later are very small.

So as we can see, a TVR related RVR doesn't *necessarily* carry the same meaning as an "old school" straight SOC RVR. However, on the other hand, based on what I've seen (and experienced) this past year or so, it seems clear that IF the patient is reasonably sensitive to SOC, and TVR is added to the mix, then an RVR is very meaningful. Under those circumstances it appears that if you get the usual UND status within 3 weeks (and usually it happens in no more than 2 weeks), then that definitely bodes well for your future odds of getting an SVR, and perhaps even getting it in much less than 48 weeks too. So within the framework of a patient who is not insensitive to SOC's effects, and TVR is used, it seems clear that RVR (or "super RVR" usually) is a very positive prognosticator for SVR later...almost certainly even moreso than for a purely SOC RVR.

PS>> Cascades VX950 is not hype, it works. But in order for it to work, it has to be dosed with IFN and riba. And you have to be at least reasonably sensitive and responsive to the immunostimulative effects of SOC drugs. If those factors are all in play, I can assure you it ain't hype!

[willing]

have to be careful with using angle brackets or the html-censor strips out the text!  that sentence should have read

this confirms the earlier findings that for 1s with  gt 2 log but detectable at 12, the relapse rate can be significantly cut by extending to 72.  Depending on what your 1st tx VL profile was, this could be a major factor (it would have been for me ...).