Big decision on new hep c treatments

[raymondk]

I relapsed after 72 week treatment and it was a real bummer. I was undetectable for most of the time and
my liver went fron f4 to f2 and my platelets went up anyway. Needless to say I have a second chance at this
so the big question is and I sure it’s all over this board is:

Which is the best triple regimine for relapsers that had a small amount of RNA at 12 weeks with standard treatment
(I went for 900k IU to 70 Iu). I was undetectable at 13 weeks with sensativity of 5IU. Also does the genetic test for treatment really work this is HCV GenoSure NS3/4a

Thanks I hope it works for everybody this time!!!!

[pommes]

I got this from my hepatologist this morning.    Seems totally reasonable.

NS3/4: I have thought more about this and I believe this is absolutely an unimportant clinical test because resistance mutations likely preexist in all infected persons (which is why you read about them) due to the genetic diversity of the quasispecies, and this is why resistance is selected so quickly when pts are treated with protease inhibitors as monotherapy. Even if the tests were done and negative, it does not mean the mutations are not there but rather that they are not fit enough to compete with wild type virus. They are then enriched if one treats with a protease inhibitor which gets rid of the wild type and allows the mutant strains to flourish. This is why we give combination therapy.  There would thus be nothing reassuring about pre-testing and if anything any result will almost certainly contribute nothing to your care or lead to poor clinical decision making. Regardless, I checked and there is no test commercially approved test.

[pommes]

I asked my hepatologist today about the NS3/4A test.   His response was that he will try to order it, but he doesn't know if it is commercially available, and if it is, it'll be jawdroppingly expensive.   Insurance companies probably won't be covering it for some time.     Thing is that for treatment-naive patients, it is not likely to be particularly useful (since the percentage of pre-existing resistant variants is estimated to be less than 5% at baseline).   So it will only be after there is a significant number of triple combo failures that the medical community and patients will be asking for it and the insurance companies will come on board.    And maybe it won't ever happen, depending on what other drug treatments come down the line.

As to whether it works, there is some qsn as to the limits of detection for the test, but I have no idea whether that is clinically relevant for you.

Good luck.   72 weeks and then relapse...   you are definitely due for SVR.

[joemc34606]

I did 6months of interferon then a year of infergen in 2007, was clear the whole time on infergen to relapse after 3 months post. So I guess were in the same boat. I started triple therapy with incevik 7weeks ago and was und at 4 weeks, sides are about the same as the first time around, but it definetly worked quicker this time. I don't know a lot about victrellis but I chose the incevik because it's only a 12 week program of incevik and 12 more weeks of interferon and RIBA. Good luck. Joe

[crossroadsec]

Good question n thnx for the response. This triple therapy may just be the trick for you! Good luck Karen :)

[hondapatches]

I have done the treatment twice already and I know I was clear the second time for 10 months and after I stopped the treatment my hcv came back. My last treatment was 4 years ago now I am going to do the new treatment but the doctor told me if I didn't clear in 4 weeks that I was not going to clear the virus with the new meds, My doctor was one of the one's that got the medication approved by the FDA. So im hoping he knows what's going on..