Aa
Dropping out of Tx at 8 weeks...
I just got my 7th week VL result: 2.6 million. Given that I started with 13.7 million, a 0.72 drop. Well below the 1 log that I had agreed with my doc as a stopcriterion. Hence, I stop, right here, right now. It was a horrible 8 weeks, and I can only say I'm happy the result is black or white (albeit black in this case) and not grey.
Hopefully, I'll be me old self again soon. And even more hopefully, my liver will last until the new meds come out.
Thank you guys for all the support you have given me the past weeks. I'll try to reciprocate.
VB
Hopefully, I'll be me old self again soon. And even more hopefully, my liver will last until the new meds come out.
Thank you guys for all the support you have given me the past weeks. I'll try to reciprocate.
VB
Your CD4 count is a signficant factor. It's already dropped a signficant amount and you would have had a ways to go to get through treatment. Not sure your CD4 count would have held out. My CD4 count dropped to 109 at it's lowest before they yanked me off treatment.
It's a tough decision you're making and sounds like you're doing it with eyes wide open. Some trials will take you if you're six months off of treatment so hopefully you won't have too long to wait for a good trial to come along. In the meantime, keep investigating IR and whatever other reasons you may not have responded to treatment. And, please, keep a good eye on your liver damage.
You just may have to go at this again without new drugs sooner than later. If you do, I would suggest you investigate planning to incorporate neupogen for your white counts and procrit for your hemoglobin to counteract the impact that the interferon and the ribavirin have on both respectively. I would suggest you look into both of them and see if it makes sense to include them as part of your treatment plan. Many people take them to allow them to adhere to the treatment and reduce the adverse effects at the same time.
Good luck to you.
Trish
It's a tough decision you're making and sounds like you're doing it with eyes wide open. Some trials will take you if you're six months off of treatment so hopefully you won't have too long to wait for a good trial to come along. In the meantime, keep investigating IR and whatever other reasons you may not have responded to treatment. And, please, keep a good eye on your liver damage.
You just may have to go at this again without new drugs sooner than later. If you do, I would suggest you investigate planning to incorporate neupogen for your white counts and procrit for your hemoglobin to counteract the impact that the interferon and the ribavirin have on both respectively. I would suggest you look into both of them and see if it makes sense to include them as part of your treatment plan. Many people take them to allow them to adhere to the treatment and reduce the adverse effects at the same time.
Good luck to you.
Trish
As someone who stopped treatment at 24 weeks with geno 1b, I am firmly convinced that we do have to take a long term approach to our treatment options. There are new drugs around the corner and I think 72 weeks in the current circumstances is far too long for some of us to have to treat. I had been monitoring treatment options for 7 years before I decided to treat.
Good decision, I think. The current treatment times are so long and potentially toxic. I think practitioners do not like to work outside SOC for their own safety. Research clearly indicates a greater range of options than current SOC.
Have a great holiday.
Jim,
We're certainly no experts on HIV/HCV co-infection. Pearlman specializes in co-infection too. When I visited him in October, he gave me a handbook he had written for all his patients. It deals with many issues including co-infection. Even though it's not a study, there are specifics. This is from the chapter on co-infection
Patients with HIV are treated with the same medications as HIV negative patients with hepatitis C (interferon and ribavirin). The response rates are lower in co-infected patients, about 14-20% for genotype 1 and about 40-50% for genotypes 2 and 3. Often, a liver biopsy is obtained to help decide how urgently treatment should be considered. Since HCV progresses faster in co-infected patients, your health care provider may recommend treatment at an earlier time than in HIV negative patients. Medicines for HCV do not work as well in patients with low CD4 counts. All persons co-infected with HCV and HIV should be seen by physicians knowledgeable about both HCV and HIV.
It appears VB is under the care of a top notch staff even though he had to debate ending early and they did see the logic.
VB has low CD4 counts so an additional 5 weeks on the medication may not prove beneficial towards a 2 log drop or even UND at any point.
We're certainly no experts on HIV/HCV co-infection. Pearlman specializes in co-infection too. When I visited him in October, he gave me a handbook he had written for all his patients. It deals with many issues including co-infection. Even though it's not a study, there are specifics. This is from the chapter on co-infection
Patients with HIV are treated with the same medications as HIV negative patients with hepatitis C (interferon and ribavirin). The response rates are lower in co-infected patients, about 14-20% for genotype 1 and about 40-50% for genotypes 2 and 3. Often, a liver biopsy is obtained to help decide how urgently treatment should be considered. Since HCV progresses faster in co-infected patients, your health care provider may recommend treatment at an earlier time than in HIV negative patients. Medicines for HCV do not work as well in patients with low CD4 counts. All persons co-infected with HCV and HIV should be seen by physicians knowledgeable about both HCV and HIV.
It appears VB is under the care of a top notch staff even though he had to debate ending early and they did see the logic.
VB has low CD4 counts so an additional 5 weeks on the medication may not prove beneficial towards a 2 log drop or even UND at any point.
Sorry, my previous post was transposed incorrectly. Should read:
62% SVR rate if <600 IU/ml by week 12
17% SVR rate if greater than 2 log drop by week 12 but still detectible.
62% SVR rate if <600 IU/ml by week 12
17% SVR rate if greater than 2 log drop by week 12 but still detectible.
OK. The figures I have are for HCV/HIV Coinfected doing 72 weeks are:
62% SVR rate if 2 log drop by week 12 but still detectible.
My point is that Trinity had a somewhat similar response and I believe ended up with a two-log drop by week 12, so maybe you would as well.
72-week Extended Treatment
R. Chung and colleagues (abstract 103LB) reported the latest data from the SLAM-C trial (ACTG A5178), designed to look at interferon maintenance therapy and extended combination therapy in HIV/HCV coinfected patients (standard duration for coinfected patients is 48 weeks regardless of genotype). Initially, 329 coinfected individuals were treated with 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 1000-1200 mg/day weight-adjusted ribavirin for 12 weeks. At that point, participants who did not achieve early virological response (EVR) – at least a 2-log drop in HCV RNA – stopped ribavirin and continued on pegylated interferon alone (as reported at last year’s Retrovirus conference, maintenance therapy essentially demonstrated no benefit).
Of the 183 participants who achieved EVR, 169 opted to continue the combination regimen for a total duration of 72 weeks (data were available for 146); 78% had HCV genotypes 1 or 4, 29% had prior interferon experience, and 9% had cirrhosis. Overall, 51% of patients who achieved EVR went on to achieve sustained virological response (SVR) 24 weeks after completing therapy. But patients who achieved complete EVR – undetectable HCV RNA (< 600 IU/mL) at week 12 – were almost four times as likely to achieve SVR (62%) than partial early responders who had a 2-log drop but still detectable HCV viral load (17%). Overall, African-Americans had a lower SVR rate than non-black patients (38% vs. 57%). Among complete early responders, however, SVR rates no longer differed significantly according to race (65% for whites vs. 54% for blacks). About one-third of study participants stopped treatment before 72 weeks, with a majority of early discontinuations and dose reductions occurring during the final 24 weeks. The researchers concluded that patients who achieve complete EVR “do very well,” whereas those with partial EVR have “very limited responses.”
http://www.hcvadvocate.org/news/newsLetter/2009/advocate0309.html#1
62% SVR rate if 2 log drop by week 12 but still detectible.
My point is that Trinity had a somewhat similar response and I believe ended up with a two-log drop by week 12, so maybe you would as well.
72-week Extended Treatment
R. Chung and colleagues (abstract 103LB) reported the latest data from the SLAM-C trial (ACTG A5178), designed to look at interferon maintenance therapy and extended combination therapy in HIV/HCV coinfected patients (standard duration for coinfected patients is 48 weeks regardless of genotype). Initially, 329 coinfected individuals were treated with 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 1000-1200 mg/day weight-adjusted ribavirin for 12 weeks. At that point, participants who did not achieve early virological response (EVR) – at least a 2-log drop in HCV RNA – stopped ribavirin and continued on pegylated interferon alone (as reported at last year’s Retrovirus conference, maintenance therapy essentially demonstrated no benefit).
Of the 183 participants who achieved EVR, 169 opted to continue the combination regimen for a total duration of 72 weeks (data were available for 146); 78% had HCV genotypes 1 or 4, 29% had prior interferon experience, and 9% had cirrhosis. Overall, 51% of patients who achieved EVR went on to achieve sustained virological response (SVR) 24 weeks after completing therapy. But patients who achieved complete EVR – undetectable HCV RNA (< 600 IU/mL) at week 12 – were almost four times as likely to achieve SVR (62%) than partial early responders who had a 2-log drop but still detectable HCV viral load (17%). Overall, African-Americans had a lower SVR rate than non-black patients (38% vs. 57%). Among complete early responders, however, SVR rates no longer differed significantly according to race (65% for whites vs. 54% for blacks). About one-third of study participants stopped treatment before 72 weeks, with a majority of early discontinuations and dose reductions occurring during the final 24 weeks. The researchers concluded that patients who achieve complete EVR “do very well,” whereas those with partial EVR have “very limited responses.”
http://www.hcvadvocate.org/news/newsLetter/2009/advocate0309.html#1
"bottom of page 6 second paragraph from the bottom says 2%, right from Roch/Pegasy
http://www.rocheusa.com/products/copegus/pi.pdf "
Isn't that for a 48 week treatment? I would go for 72 weeks, and I expect the success rate to be higher then, indeed.
"New drugs right around the corner are looking better every study I read."
Indeed, that's what I look out for now. I hope not to have to wait two years. But instead, to be able to participate in a trail of HIV-HCV co-infected. The trails for treatement-native patients are coming to a conclusion. Hence, soon they will want to move on to people like me. ;-)
http://www.rocheusa.com/products/copegus/pi.pdf "
Isn't that for a 48 week treatment? I would go for 72 weeks, and I expect the success rate to be higher then, indeed.
"New drugs right around the corner are looking better every study I read."
Indeed, that's what I look out for now. I hope not to have to wait two years. But instead, to be able to participate in a trail of HIV-HCV co-infected. The trails for treatement-native patients are coming to a conclusion. Hence, soon they will want to move on to people like me. ;-)
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