what is a null Vs a partial responder?

[1oftheclub222]

My partner ahd done treatment a few years ago...he was UND at 4, 8 12 and 24 weeks.  when he went back for the 6 month check up, he had a viral load again.  Is that a partial responder?  he is type 1, would those type have a better chance with the new triple therapy?

[1oftheclub222]

yeah, he is type 1, I am a 2 B, just by dumb luck that we both have it...I know lots of people who have it, but my best guess now that I have all my information, is I probably got it from some other random way and not from anyone I know

[frijole]

I just stay confused.....
   I guess you are a 2 and he is a geno 1.  duh

[frijole]

I agree with the folks here that your partner was a relapser.  He respondeed very well to treatment.  I saw in your profile that he is a 2b.  The chances of SVR are so good with 2s for 24 week therapy, especially those that clear at week 4.  I wonder what happened.  Do you remember the sensitivity of the test?  I wonder if he had low levels of virus, under the level of the test.


I guess I am confused.  This thread says he is a type 1.

[1oftheclub222]

thank you, I will check it out and show it to my guy.

[spectda]

Maybe he can get into a late phase trial for relapsers. If he is truly stage 3 it would be important to stop the virus from continuing to damage his liver. You can check at http://www.clinicaltrials.gov/

If you have trouble negotiating the site let us know where you live and someone may be able to help you.
Good luck,
Dave

[1oftheclub222]

He did the interferon and the ribavarin.  He didn't have another biopsy, just the fibro blood test thingy.  I don't know about any of the blood test results, it was about 2 years ago when he was last tested, he doesn't remember what the other results were, but doesn't remember the doc saying anything negative about them, so he wasn't too concerned.

Treatment right a way isn't really an option as he doesn't have any insurance and has been out of work for a while.  He knows once he goes back to work, he thinks it wouldn't be so great to start treatment right away and be sick right off the bat at a new job.

if we could only win the lotto!

[spectda]

Ribavirin was approved for treatment of hep c on june 3rd 1998. Did he treat with ribavirin also? He would have been taking pills with every day in addition to the interferon.

For several years before triple tx became available which was this year treatment for genotype 1 (does he have sub type a or b?) has been interferon and ribavirin for 48 weeks. Interferon is now pegylated (time released) and only has to be injected once per week.

If your partner responded as well as he did to either interferon alone, or to interferon and ribavirin for only 24 weeks with genotype 1 then he responded very well and has an excellent chance of success as others have mentioned with the new treatment. More sever liver fibrosis can make it more difficult to be successful, but his response to interferon was excellent.

A biopsy is the best diagnostic tool for knowing the condition of his liver, Did he have a biopsy 2 years ago in addition to the blood work? How are his blood platelet levels? Personally if it was me with his past response and current liver condition I would treat with one of the triple therapies ASAP.

-Dave

[1oftheclub222]

It sounds like he only treated for 24 weeks from what he has said, it was back in 98 or 99 maybe.  He had a hard time with treatment, had to do the shots 3 times a week and is not so keen on treating again.  He has no insurance right now, has been out of work for a little while.  His liver was at stage 3 last time he checked with the blood test 2 yrs ago.  I know he doesn't have a bunch of time to wait anymore.  He eats well, doesn't drink, tries to take care of his liver.  I think it makes me more nervous then it makes him, I know it's his decision, but I wish I could make it for him....

[spectda]

Did he treat for 48 weeks total?  If so was he und at 48 weeks (end of treatment) was his only post tx viral load test done at 6 months post?

[Advocate1955]

He would be considered a prior relapser.  His chances for SVR using triple therapy with Incivek would be 86% chance of SVR.
Thank you to willbb for the information below:

http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/ucm256328.htm

Treatment Outcome All T12/PR48a  
SVR rate      
Prior relapsers 86%
Prior partial responders 59%
Prior null responders 32%

Advocate1955

[JasmineT]

He is la relapser http://www.thebody.com/content/art46371.html

He would likely be a good candidate for triple therapy.  You can do some research on stats from the trials by searching the internet on the terms boceprevir and teleprevir.  These were the trial names for the new protease inhibitors used on triple therapy.  They are now approved by the FDA and are called incivek and victrelis.  Here is a link to a comparison in case thatbhelps.  
http://www.natap.org/2011/PDF/NurseMary.pdf

Here is some info on the trials from incivek.  http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/ucm256328.htm

Others may have more information.

[willbb]

He would be classified as a relapser( someone who goes UND. during treatment and then at the end of tx. viral load appears again.
Being UND early art week 4 is a good predictor of success..surprised he relapsed. And yes relapsers do very will on the triple therapy..

Best
Will



http://www.medscape.com/viewarticle/713174_2

Definition of Relapse and Nonresponse
Relapse and nonresponse are defined on the basis of the virological response to treatment (Fig. 1). A patient is said to have experienced a virological relapse if HCV RNA decreases and remains below the limit of detection (<50 IU/mL) during treatment but becomes detectable after cessation of treatment. If HCV RNA rebounds and becomes detectable in such a patient before treatment is completed, this is referred to as virological breakthrough. Virological nonresponse is evident when the serum HCV RNA level remains above the limit of detection throughout treatment and is formally defined as less than 2 log10 decline in HCV RNA between baseline and week 12. A patient who has less than 1 log10 reduction in serum HCV RNA at week 12 of treatment is said to have had a null response.