Just got my viral Load of week 12. Not good I think.

[yoyoma123]

Hey guys I just got my viral load of the 12th week and I think its not good news.

I started at 8.6 million with genotype 1a and just got my viral load back at 12 weeks at 8,300.

What does this mean. I am not UND? Does this mean I have to do treatment for 72 weeks?

PLease let me know guys. Thanks

[spectda]

Hi-
Do you know what your genotype is? have you had a liver biopsy to determine the stage of liver disease you are at.

If you do not have advanced liver damage and you are genotype 1,2 or 4 it would probably be best to stop treatment and retreat when telaprevir or boceprevir become available. I know that may take longer in the Dominican Republic then in the US, although I really don't know how your system works in terms of new medications being available. I would guess that these new meds will be available in the us between mid 2011-mid 2012, but we never know for sure. It could be earlier or later.

What type of interferon are you using and how much ribavirin have you been taking? How many kilos are you? If you have advanced liver disease there might be other options depending on how you treated this time.

You had more then a 3 log drop which is good, but you are pretty far from undetectable still which is not a great sign. if for some reason you did continue to treat you would probably extend treatment for 72-96 weeks and if you have been taking pegintron or pegasys you might switch to infergen and increase your riba dosage but more information is needed

Without having more information it is difficult to even guess or offer advice for you to discuss with your doctor.

Take Care,
Dave

[Gordo1977]

I was treated last year but did not respond to peginterferon and ribavarin.My viral count was 575,000. At week 12 while on treatment  my viral count was 4,000.Many had told me that I will not respond if I didn’t show rigorous response at week 12 which I didn’t. Doctor told me to continue but think his interest were on getting paid from pharmaceutical company. After completing treatment my viral count was 165,000. I currently waiting for FDA to approve new drug Telaprevir

My apologies this probably wasn’t what u wanted hear.

[copyman]

I believe you had a 2 log drop which was "old school" protocol to continue treatment.  Check VL weekly and once Undetectable continue for 36 more weeks. Of course stop tx if still a vl at 24 weeks.

I think many Hepatologist like to see Undetectable at 12 weeks now a days.

Not sure what stage fibrosis you are but if you have minimal damage I would stop and wait for the new drugs coming out next year.

Best of luck

[Trinity4]

That's a 3.01 log drop in 12 weeks and no where near UND.  You are responding but not a stellar response to treatment.  Ideally, UND by 12 weeks gives a less than 50 percent cure rate. Not having reached UND by 12 wks, you have lowered the odds to (I think) around 30% even with extending to 72 wks.  You are considered a slow responder and 72 weeks is an option but if you don't become UND by wk 24 stop the treatment or you can stop treatment now and wait for the Protease Inhibitors, liver histology withstanding.

Trinity  

[yoyoma123]

I'm genotype 1a. I don't have liver damage.

Taking 180mg of pegasys and 1200 ribavirin. I weigh 160 punds.

I'm well informed about telaprevir. But it comes out end of 2011-2012. Thats alot of time. I want to get rid of this since I already started. Or maybe I can do a 48 week treatment even of my chances are very low cause one may never know.

My side effects are minimal. Just some bone pains and that it.

Maybe I can do a 48 week treatment while telaprevir gets closer. Or maybe if UND at week 24 do a 60 week treatment.

Cause my question is this one: If i was UND at week 48 thats 36 weeks more. If I'm UND at week 24 why not do the treatment til week 60, 36 weeks more like the 36 weeks more if UND at week 12. Do you understand what I'm saying.

Why if UND at week 12 just 36 weeks more.
Why if UND at week 24 its 48 weeks more and not 36 weeks more?

[spectda]

No liver damage and geno 1a. Any good hepatologist would say wait for new drug. It doesn't make sense to contune. Another 60 plus weeks of soc to give you a low chance of svr or 24 weeks of new pi in a year or two. I don't know why you would consider continuing. I know its difficult to accept, but try to think about the logic.

I wish you the best. Dave.

[spectda]

I am very sorry that you are not und and understand how difficult this is to deal with. Since the disease moves so slowly you are really in no danger by waiting for 1-2 years for better medication. It will be even more depressing if you go another 60 plus weeks and don't svr though.

- Dave

[yoyoma123]

I understand what you are saying but there must be people that achieve SVR by not been UND at week 12 and UND at week 24 doing 60 weeks. Since I'm already into it if I keep going for it and it doesn't work its gonna be around when telaprevir will be coming out. I know its a long shot but what if it works. Cause my side effects are very little. Cause I wanna get this over already and telaprevir is coming out like in 2012 and by that time I would have finished and know if it worked so if it didn't I would start telprevir, but what if it works, I'm done and don't have to wait anymore.

[Trinity4]

" It will be even more depressing if you go another 60 plus weeks and don't svr though."

True statement there yoyoma123 and I can speak first hand about that.  

Trinity

[Trinity4]

So go for it then.  As long as you go into it knowing your odds are considerably lower at achieving SVR even with extending and that you realize just because you feel good now doesn't mean you will down the road.  72 weeks is a long time to be exposed to those very powerful drugs and by the end of my 72 weeks my a-ss was dragging all over the place along with some serious low blood issues.  Maybe you'll breeze though it, who knows, but just be prepared before entering into the zone of the unknown.  

Whatever your decision, I wish you much success.

Trinity

[mikesimon]

Maybe he should ask a question or 2 or 3.

[Bali05]

- specifically for your genotype designed Telaprevir is coming out soon
- you have little to no liver damage
- you have no EVR with SOC

Makes no sense to go for a 72 wker to me.
You have little sx now there is no garantee you feel like that in future.
You are risking weakening your system and adverse events for sub
optimal odds.

[sunshines76]

If I were you, I would switch immediately to daily infergen and riba. And then - if you don't get UND by week 8 on infergen, I would stop and wait for newer drugs. You mention that you almost don't have any sx. Are your blood tests pretty normal too? If your hemoglobin is not dropping and other values are still within the norm, it could mean that the drugs you are currently on, simply don't work for you. I had ok CBCs while on pegasys and I didn't respond to it, but on infergen I saw different results.

[copyman]

great advice from everyone that responded. you received some great advice from people that have been on the "front lines" of this disease. probably better advice then your doctor gave you!

by you saying you don't have any side effects is probably why the treatment is not working that well for you. Your doctor probably went by the book and gave you what someone your weight should get, but an up to date doc would have tweeked the dose after seeing no anemia or not being unde at 4 weeks. This disease replicates up to a trillion virons per day! it has to be eradicated from someone quickly for meds to work. This is why being unde by 4 weeks brings the odds way up. This 4 week test is when tx options should be looked at, i.e. increasing meds, etc.

all we can do is offer first hand knowledge here. no one is trying to talk you into stopping tx. that is only a decision you can make. just keep in mind your chances are less then 30% that you will rid your body of this virus. And extending treatment almost gurantees some type of "permanent" side effect.

Waiting one year for the new drugs offer 75% cure, and possibly only 24 weeks of treatment.

Personally I would put down the sworde and live to fight another day

good luck

[Marcia2202]

If I was in your situation, I would stop treatment and wait for the PI's.

[Gordo1977]

I agree with copmen. I carried on a full time job exercised; all with minimal side effects through our entire treatment…I tolerated the drug fairly well but regretfully did not respond. My doctor went by the book as a matter of fact he pulled the book out and began reading it in front of me explaining my options. He did this on several occasions…Folks on this sight have much more valuable information than most docs.

Gordo

[yoyoma123]

maybe I'll just do 48 weeks and see. If i get SVR perfect if not Telaprevir will be almost out. I'm already in week 15.

[FlGuy]

In the absence of anything else, at least you're optimistic. Most people would consider the syringe as half empty.

[spectda]

Good luck! Either way I would not worry about your hcv, If your plan doesn't work new drugs will cure you before you ever get sick from hep c in my opinion. Your lucky to have no damage.

[SusieS2010]

I agree with everyone here as well. Although your statement that no sides mean it isn't working is not really true, We speak to many patients who are fearful of the fact that they feel well but they do respond. Most, if you question them, will tell you that their hemoglobin, platelets and white counts have dropped but not enough to give them side effects.

Another way for yoyoma to look at this is to stay on treatment since there are few sides and it won't make him do less well on telaprevir if he needs it in the future. But if it does work, he won't have to use telaprevir which makes the treatment that much harder with more sides, particularly rash. A 3 log drop would have been celebrated at 8 weeks previously. My question though, is if you are now doing the same exact treatment that didn't work the first time, why are you doing it again. In that case, I would wait for the protease to come out.

[lolitriqui]

I think it's ridiculous to continue Tx in yoyoma's situation. This is poison we are taking. I'm done for close to two years now and I'm still dealing with what I contribute late effects of the Tx. Well it's nothing unbearable, but this medicine has consequences. If you have no organ damage, why not wait for more effective Tx????? All you do in your situation is give the pharmacyticals and your GI money, risking long term consequences for you; with gen1a and your logdrop, 48 weeks probably won't get you there, and the longer you take this poison, the higher the probability that there will be consequences.
Chris

[copyman]

Study after study have shown anemia to be a positive indicator of SVR. If someones HGB doesn't have at least a 2 point drop early on then they are not getting enough Riba.

Not sure I understand, are you saying the original poster should continue tx even if they are still unde at 24 weeks?

I'm sure you are aware that someone still detectable at 24 weeks has less then 2% chance of SVR. And I don't think most doctors will continue tx or insurance will pay for tx if that is the case.

the only way tx will benefit someone that is still detectable after 12 weeks is if they have cirrhosis. Otherwise stopping is the right choice. Risk outweighs benefit in this case.

[SusieS2010]

No, I am not saying that being detected at 24 weeks is reason to stay on...absolutely not. I'm saying over a 3 log drop at 8 weeks, especially when feeling ok, is reason to really give it some thought. Since the patient is feeling well, if he/she clears, it may end up worth it not to have to do a protease.

You are right about the studies showing anemia is a good indicator of response. That wasn't my point either. I think I am not explaining myself too well today. What I am saying is that a lot of people have at least a 2 por 3 point drop in hemoglobin and feel just fine. My first combo treatment, I started with a hemoglobin over 16. It dropped to around 12 and I didn't feel anything concerning. No cough, no out of breath, etc. That's all I meant. I'm really sorry I confused you.

Thanks for your patience

[Bali05]

i don`t think how you "feel" is an indicator of anything on tx
in terms of tx success.
especially with INF impacting your serotonin levels  ect...
Some feel really bad in the beginning only to "level" out
later on , others start easy and get hit with a "truck" later on
it all has no meaning for SVR chances.
I sometimes get great labs feeling like s**t and not so good labs
but feeling great.