Genotype 3 PCR check at W 4, 12 ???

[Marcia2202]

I would really like to know, if I have understood this matter correctly.

It is IMPORTANT to have a PCR test to check UND at week 4. It should be a Qualitative PCR test, as it is more sensitive than the Quantitative one.

Question 1.

If one is not UND, should they not also do the Quantitative one, to detect the VL?


Question 2

In which other weeks should the test be performed??

Week 4, .....

Question 3

Would it be a good idea to do PCR at i.e. 2 weeks for geno 3? Would an even earlier RVR not be a good marker to be confident to maybe only have to treat 24 weeks, even though starting with a high viral load. I'm again referring to the Columbia University study suggesting following lengths of tx.

NOT            UND W 4 48 weeks tx
High VL   UND W 4        36 weeks tx
Low VL   UND W 4        24 weeks tx


Marcia

[Marcia2202]

Thanks Eric, I will try to get them to do week 2 and week 4 and if not UND by then maybe 6 and 8 would be an idea?? But as said, it is up to the hepatologist to decide. I'm in Denmark and the treatment is covered by the health care system.

I have made a spread sheet in 'pages' to track all my results, even including blood pressure and  pulse. Am doing the same for my daughter.

Marcia

[Andiamo1]

I agree with Flguy that the more tests you take until undetectable the better.  I understand that money and time can be limiting factors, but the ideal situation is the more often, the better.

There is a test in the us, Heptimax, that is quantitative and is as sensitive as most qualitative tests.

If you should fail to respond or breakthrough, the additional tests will show which of those happened to you and that is very important information as input to future treatment decisions.

Good luck,
Eric

[Marcia2202]

Thanks so much for all your input!!! There is so much interesting stuff there and it is difficult to find it alone. It's great to have so many resources!!


Marcia

[Marcia2202]

Thanks, that so makes sense. The Qualitative shows if there is, and the Quantitative how much virus there is left...

Marcia

[meki]

"Approximately 25% of patientsKidney diet - dialysis patients with genotypes 2 or 3 do not achieve an RVR but later achieve undetectable HCV RNA between Weeks 4 and 12. It is important to recognize that only 49% of patientsKidney diet - dialysis patients with this response achieve an SVR when treated for 24 weeks.
It is therefore rational to assume that prolonging the duration of therapy from 24 to 48 weeks in these slow-to-respond genotype 2 and 3 patientsKidney diet - dialysis patients may reduce relapse and enhance SVR rates, and a retrospective analysis supports this hypothesis. "


WOW --- CS --- you weren't kidding when you said I was one of the very lucky ones.

Dang - I wish I had known that then -- I would have treated longer.

I would have hated every second of it --- because I had a hard time... But - I would have done it - because I was only going to do it ONE time.

Thanks Marcia for the threads - very thoughtful and provoking.

And CS. Thanks for just being you.

Everyone else --- You're amazing folks. Ya know that?

Meki

[lolitriqui]

hi; no dispute there; W4 UND is certainly very important; do you have any more info on the indian study you mentioned??? i have a hard time believing that it is a first grade study; it would be counterindicative and far off any first rate studies; with VL at W4 and UND at W12 you still supposed to have 75% chance of SVR on a W24 SOC tx schedule; however if you have more info please let us know;
ciao

[mar148]

You should have a Qualitative and Quantitative during treatment.  That is my understanding and the strategy I took.  You will need to see how much your viral load has changed, hopefully undetected, but important to know.  mary ellen

[Marcia2202]

Thanks for the input. I have posted two different posts concerning g 3 . One on treatment, which is being discussed on the other thread.

I opened this thread especially not to mix the two...

I wanted to find out when (which weeks)  PCR checks should be made

and

what PCR tests should be used when...


I still did not get any response though to my question nr. 1. Does anyone know?

If at various weeks not UND, should they also perform a Quantitative PCR test??? Or do they do this automatically???

Thanks, Marcia

[CockSparrow]

tx times are not only based on your W4 response; it depends on quite a lot of other factors too;
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I would beg to differ. The week 4 result is what needs to be taken into account.
HVL, Fibrosis can also be considered for extending if UND at week 4 but not being UND at week 4 = lousy svr rate.

In the study below the 49% figure is a combined G2&G3 figure
The G3 non RVR figure is 39% for non RVRs.

There was a study done in India or Pakistan that showed that for G3s being detectable at week 4 with a VL >50IU had an SVR rate of 44%. If detectable at >600IU it was 33%.
In other words the higher your vl at week 4 the lower your svr chances are.

Below is by ML Shiffman and is from
Understanding HCV Nonresponse and Identifying Candidates for Retreatment
http://clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20Nonresponders/Module/Shiffman/Pages/Page%201.aspx

It is critically important to recognize the point at which a patient achieves undetectable HCV RNA during treatment as this is directly related to the likelihood of achieving a SVR.

In other words, the later a patient achieves undetectable HCV RNA during treatment, the higher the likelihood that the patient will relapse after treatment is discontinued following the standard duration of therapy (24 weeks for genotypes 2/3 and 48 weeks for genotype 1)

Approximately 25% of patients with genotypes 2 or 3 do not achieve an RVR but later achieve undetectable HCV RNA between Weeks 4 and 12. It is important to recognize that only 49% of patients with this response achieve an SVR when treated for 24 weeks.
It is therefore rational to assume that prolonging the duration of therapy from 24 to 48 weeks in these slow-to-respond genotype 2 and 3 patients may reduce relapse and enhance SVR rates, and a retrospective analysis supports this hypothesis.
Unfortunately, no prospective studies have yet addressed this important issue.

All the Best
CS

[Marcia2202]

To sum up the answers to my questions.

Qualitative PCR test, preferably Taqman <15 IU/ml, as it is very sensitive...

At weeks 2, 4, 12, 24

I'm not going into length of treatment, as it has already been discussed on my other thread.

I did not get any response though to my question nr. 1.

If at various weeks not UND, should they also perform a Quantitative PCR test??? Or do they do this automatically???

Thanks, Marcia

[Marcia2202]

Thank you for refreshing my mind. I have been turning the threads and trying to google up this study, in vain. I had copied the 'formula' onto my 'Ask the doctor list' and could just not remember where I got it from. Now everything is back... You had lunch with this MD who told you this.

Yes, I will have one of the viral hepatologists from the university hospital here in copenhagen take care of me. Actually it's DK's main hospital and they also take care of all the most difficult cases from all over DK and transplants, too.
This is how it works here in DK. You get referred to a hospital, where the experts will take care of you, discussing the cases together as a team. According to the 'formula', I should treat 36 weeks, as I have a high VL. Am going to ask them, if they think it would be a good idea to predose on the riba. Anyway, we have discussed this on another thread which is still here. So I don't want to get into this again, boring every one, with the same discussion.

Marcia

[Marcia2202]

Thank you for the valuable information. I will try to get them to do it! Who knows, they might agree to it. I just have this feeling,  as it is the university hospital, they might agree to do some experiments.

Marcia

[lolitriqui]

hello! i think i put out these numbers, having talked to the columbia MD; but i would like to add, tx times are not only based on your W4 response; it depends on quite a lot of other factors too; if you decide to do tx, you should think in terms of w24 soc; you have the option to extend if things look like it might be beneficial to achive SVR; however i would not extend tx just for one indicator; make sure your doc knows hepc; best is if your doc doesn't treat anything else but hepc; the disease has a lot of things only a real specialist knows; they have the best feeling for it and they know you individually; hope your liver is in good shape, that is apparently also important with gt3's; good luck ciao

[Marcia2202]

Thanks for your feed back. I did not get the subtype through the tests my GP got back. :-(  I have an appointment scheduled at the hospital, and they will run all necessary tests. They are keeping me there the whole day. I will ask the hepatologist, if they will run a test on the subtype again. One of my twin daughters just was dxed. Maybe she will get the subtype, when she gets her geno back. If we have the same geno, which I suppose we do, than I could assume we have the same subtype, too. I live in Denmark, so everything is taken care of by the health care system. I'm not sure when they do the PCR. I have read that they initially take weekly blood tests to keep and eye on possible anemia, neutropenia and thrombocytopenia. But I have not found anything on the time lines of PCR testing in Denmark. I will ask the hepatologist. In the end it will be the doctor who decides as the state is paying for these, but I can always suggest it to him/her.

Thanks again, Marcia

[FlGuy]

It would be good to do the pcr after week 2 (the morning of shot 3) and then every 2 weeks until undetectable. Beyond undetecable, at every 6th week or so.

[comeagain]

If you can get them to give you a test at week 2 I think would be good.
In Sweden we use Taqman <15iuml that is just as good as the others< 5 <2 .

Perhaps they use that test in Denmark to?

I think you can get problem by getting one earlier then w 4 though, since that seems to be the new protocol for geno3. you can always go to a privat md and order one in Sweden that test cost between 200-250$

Take care
ca

[desrt]

Do you know what subtype of geno 3 you are? I wouldn't bother with a qualitative test except possibly at the end of treatment. Unless you can't get a quantitative that goes down to <2/<5 IU/copies. If it were me, and money weren't an issue, 2 wk, 4 wk, 12 wk, 24 wk, then if I were extending 36 and 48. If not UND by 12, I would not push on, but that's just me.