Week16 and still detectable

[Jgolfer123]

I'm a geno 3.  Have cirrhosis.  My viral load went from 1.7 mil to 750+ in 12 weeks.  At 16 weeks the virus is detectable but < 42

I 'm on interferon and rib.  not able to increase dose because of low WBC.  My doc does not like neupogen.
My doc is going to give me options tomorrow.   Initially, wevtalked about:  Quit or continue at current dose. He first suggested I quit.  He will consider neupogen --  I've asked about invocek (sp)' but not sure if it's a good option for geno 3 .

What would you do?

[spectda]

I believe Cando gave you good information. You should probably stop and wait before retrying with a more aggressive approach using ribavirin and interferon, or find a late stage trial using something fairly well proven.
Good luck-Dave


This is what Flguy did his second treatment, he was successful. You would need to find a qualified dr who is willing to be agressive like his was:

http://www.medhelp.org/posts/Hepatitis-C/Looking-for-treatment-advice-for-genotype-3/show/1564917
"FlGuy  
Jul 28, 2011
To: Dave
Yes, kicked it up a notch in treatment #2; pre dose riba, double Peg for 4 weeks.  The goal was UND ASAP and then figure out duration.  It turned out to be 46 weeks which was UND for 44 weeks.  As you suggest, it was all-in since I did not want to do #3.  Kind of unfortunate that McHutchison is no longer at Duke, if even for a consult.  Would have been the best choice for a liverhead.  There another post today for a trial drug with big results for Geno 2/3."

[James10500]

http://hepatitiscresearchandnewsupdates.blogspot.com/2011/06/telaprevir-isnt-useful-for-all-hcv.html

[James10500]

3x therapy has been tested on G2's and G3's it raised SVR rates for both groups.

Just wondering how can your doc perscribe a drug that isn't approved.

[pirate302]

I am a geno 3 also.  Believed My dose of Riba was to low during tx.  Now have a new Dr. who believes in weight base dosing.  I would try and change the dose had I known.  Would have also changed Dr.s  know the second round will give the dragon a run for his money.

[pcds]

No one likes helper drugs like neupogen, but if you need it it works great.  I needed it with SOC and am using it now.   You have some great advice above, push your case, it's your life.  I've had to argue with the geniuses at Mayo and pushed my case.  Why is it always a fight?  With the docs, with the insurance.  Treatment is tough enough.

[joemc34606]

I don't understand why your doc won't give you nuepogen, it is a great drug with no side effects and only makes things better for you. I was on nuepogen for my whole last treatment, I would demand it. Joe

[willbb]

There are currently studies going on treating Geno type 3 with the new drug PSI 7977(polymerase inhibitor) however I believe they are only recruiting for tx. naives.The reason I bring this up is it certainly seems like this drug has had excellent results in trials and it may be something you can treat with when approved.

However having cirrhosis and the drug possibly not being avail for a few years, the timing is certainly not ideal.

Doing SOC slow responders with geno type 3 were shown to have better results with extended therapy past the standard 24 weeks  especially in older patients(your age is not on your profile)

Hopefully your doctor has some ideas..... personally ..because of the cirrhosis I  Might give serious thought to doing everything I could on this go at it to succeed(dosing adjustments as suggested above) and  going to the absolute cutoff point of 24 weeks to see if UND.at that time and if so ,extend to 48 weeks and give this  your best try.

Good luck with whatever you and your doctor decide...
Will

I have included this study  to have a look  at:

.http://www.hivandhepatitis.com/2009icr/ddw/docs/061509_b.html

Based on these findings, the researchers concluded, "Therapy response to interferon-based regimen in patients with HCV genotype 3 infection is negatively affected by increasing age, suggesting that elderly patients (> 50 years old) with genotype 3 infection may need longer duration of therapy."

[desrt]

How low are your various white cell counts?
Why doesn't your doctor want to use neupogen?
Which type of PegIFN are you on?
What dose of PegIFN are you on?
Does your doctor actually have a lot of experience treating cirrhotic HCV patients or does he look like Doogie Howser?
If you have a problem with ribavirin absorbtion, you might be better off with a 1200 mg / day dose.

[lynda607]

There is no compelling study data showing the PI's are effective on genotype 3 but there is plenty of data showing they are not.  Genotype 2 had a somewhat better response but genotype 3 responded poorly.  Besides, the PI's are only approved for geno 1 and most insurance companies will not pay unless the patient is genotype 1.

Because you have cirrhosis, it's very important to discuss all options with your hepatologist, such as odds of SVR or tweaking the current treatment. so you can make the best decision about moving forward.

[Jgolfer123]

I'm seeing a hepatologist.  I did get the standard 800 mg ribavirin.

Do you have any info on the success of the new treatment with 3's?  I've done some searching and can't find anything that looks compelling.

Do you think it's too late for me to add meds and up the dose?

[mykids247]

Hey jgolfer I am geno type 2 and I will be starting triple therapy next week. My dr. explained that it has not been approved for anything or shall I say it had not been tested on anything but geno type 1 but is having GREAT success on others. Are you seeing a hepatologist or GI?

[can-do-man]

What i mean is i would want to make sure i was on weight based dose of ribavirin and not just the 800mg some doctors put geno 3's on, then one might pre dose the ribavirin and maybe add Alinia (nitazoxanide) for a couple of weeks......... Also what lynda said could be an option, one thing you being cirrhotic you need something.

You might send Fl Guy a message, he was also a geno 3 that had to mix things up and went on to svr................. Again only the best to you.

[lynda607]

If your doctor originally planned on treating you for 24 weeks but one of the options he discusses with you is to extend to 48 weeks you may have a chance but the odds are still lower because you are a slow responder.  However, you must be on full dose interferon and weight based ribavirin.  IMO, I would weigh the options very carefully.  If the ANC is low, at or below 500 you're going to need Neupogen to continue.

[Jgolfer123]

What do you mean " spice things up" ?

[can-do-man]

Sorry about your news, no Incivek is only for geno 1......Myself i would quit, regroup and try to spice things up a bit.......... Not being und by week 12 let alone week 16 is not good. The odds are really low now  Whatever you decide i wish you the best.