Rapid type 3 eradication

[nocomplications]

I am in week 14 of sofosbuvir  / ribavirin treatment for type 3. Results from my first bloodwork at the end of week 4 showed the virus had been eradicated; it was most likely eradicated sooner, perhaps right away - there is no way of knowing because that was my first test.
Before treatment I was asymptomatic and enjoying excellent health.
Has anyone been in a similar situation? Ten weeks at least of 'eradication' -  I  don't want to give this tx more than18 weeks total. I want to stop it in another month.
Is this unreasonable?

[patra_]

Trust me, it is worth being sick on the Meds to reach SVR - sustained viral response (HepC Speak for Cured).  I was reduced to using a walker for 4+ of the 6 months from extreme fatigue due to the anemia brought on by the Riba BUT I remained Undetected at 12 Weeks End of Treatment AND at 24 weeks EOT - which is when  GT3s are recognized as reaching SVR.  I was, like you are, a Gt3.

One study showed that the only people to relapse after 12 weeks EOT, were Gt3s.  Gt3 is a tough nut to crack, so hang in there - keep on keeping on.  You would really hate to stop too soon and relapse.

Blessings and on to SVR!

Pat

[nocomplications]

Can't argue with those data, above posts are much appreciated. I am a sick puppy with these drugs but will try my best to get through.

[pooh55811]

Correction:

In my last post I accidentally left off a "0" (on the 1000 mg)..


The statement that read: "Are you sure you are taking only 400 mg of Ribvirin a day? That is an extremely low dose. Ribavirin is weight based. That means you should be getting either 1200 mg per day or 100 mg per day, depending on your weight."

Should read: "Ribavirin is weight based. That means you should be getting either 1200 mg per day or 1000 mg per day, depending on your weight."

400 mg would be a very low dose.


As hrsepwguy posted the study results for you and I agree with him, "84% SVR rate for 24 wks compared to an SVR rate of 62% for 16 wks would seem to be a really good reason to complete the 24 wk duration as recommended. "

[hrsepwrguy]

84% SVR rate for 24 wks compared to an SVR rate of 62% for 16 wks would seem to be a really good reason to complete the 24 wk duration as recommended.

Have a great day

[hrsepwrguy]

The VALENCE study, which enrolled patients with HCV genotype 2 or 3, assessed the efficacy and safety of sofosbuvir (400 mg daily) plus weight-based RBV for 24 weeks. This trial included 250 treatment-naive (42%) and -experienced (58%) subjects with HCV genotype 3 infection. The overall SVR12 rate was 84% and was higher among treatment-naive than -experienced patients (93% vs 77%, respectively). (Zeuzem, 2014) These results suggest that higher response rates can be achieved with a 24-week regimen of sofosbuvir plus RBV than those reported for HCV genotype 3–infected participants receiving 12- or 16-week regimens in the FISSION (Lawitz, 2013a) (12 weeks, SVR12 rate: 63%), POSITRON, (Jacobson, 2013c) (12 weeks, SVR 12 rate: 61%) and FUSION (12 weeks, SVR12 rate: 30%; 16 weeks, SVR12 rate: 62%) trials. The primary reason for the higher SVR rate with extended therapy among treatment-naive patients was due to a reduction in the relapse rate from 40% to 5%. In a subanalysis, response rates were similarly high among those with (n=45) and without (n=100) cirrhosis (92% and 93%, respectively). These data were confirmed in the randomized controlled BOSON trial as described above. (Foster, 2015) In the BOSON trial, this 24-week regimen had lower SVR rates than the 12-week regimen of sofosbuvir plus PEG-IFN and RBV in treatment-naive patients, regardless of the presence of cirrhosis. Therefore, this is an alternative regimen for patients who cannot take IFN.

http://hcvguidelines.org/full-report/initial-treatment-hcv-infection

[nocomplications]

I weigh 100 lbs, am 5' 2.5".
Really I should have rephrased my question from the beginning
to be "How many weeks/months of 'non-reactive' is sufficient?"
5 months, 6 months, 4.5 months - is thete all that much difference?

[pooh55811]

Good that your liver is healthy. Duke has knowledgeable Hepatologists, which is good.

Are you sure you are taking only 400 mg of Ribvirin a day? That is an extremely low dose. Ribavirin is weight based. That means you should be getting either 1200 mg per day or 100 mg per day, depending on your weight.

From AASLD:

Alternative regimen for treatment-naive patients with HCV genotype 3 infection.

Daily sofosbuvir (400 mg) and weight-based RBV for 24 weeks is an alternative regimen for treatment-naive patients with HCV genotype 3 infection who are IFN-ineligible.

Rating: Class I, Level A


Weight based Ribavirin:

Ribavirin Dosing
Weight(lbs) Total Daily Dosage Dosing Schedule
≤ 165      1,000 mg Daily        (400 mg morning,  600 mg  evening)
> 165      1,200 mg Daily        (600 mg morning,  600 mg evening)

[nocomplications]

Treatment naive, described as "healthy liver" by Duke hepatogist, sofosbuvir 400mg daily, ribavirin 400 mg daily.

[pooh55811]

You do not state if this is your first treatment or if you have treated before. You also do not state what liver fibrosis stage you have.

It appears that you are on the 24 weeks of Sofosbuvir 400 mg and weight based Ribavirin. That is currently one of the AASLD recommended treatment regimens for Genotype 3 treatment naive individuals.

I agree with Can-do. Currently Genotype 3 is the most difficult to treat. Almost everyone becomes Undetectable on Sofosbuvir, but Undetectable is not the same as cure (during treatment).  If one treats for too short of a period of time, that person can relapse and  become Detectable again. Then you would have to treat all over again. You would be wise to follow your doctor's recommendations and treat for the appropriate length of time. They did studies. The people who treated for a shorter length of time had much lower cure rates than those who treat for the recommended length of time.

Here are the current AASLD recommendations for someone with NO Cirrhosis and who has never treated before. You appear to be on the Alternative treatment, the 3rd treatment regimen mentioned:

Recommended regimens for treatment-naive patients with HCV genotype 3 infection. 3 separate regimens:

Daily daclatasvir (60 mg*) and sofosbuvir (400 mg) for 12 weeks (no cirrhosis) or 24 weeks with or without weight-based RBV (cirrhosis) is recommended for treatment-naive patients with HCV genotype 3 infection.

Rating: Class I, Level A (no cirrhosis); Class IIa, Level C (cirrhosis)

Daily sofosbuvir (400 mg) and weight-based RBV plus weekly PEG-IFN for 12 weeks is recommended for IFN-eligible, treatment-naive patients with HCV genotype 3 infection.

Rating: Class I, Level A

Alternative regimen for treatment-naive patients with HCV genotype 3 infection.

Daily sofosbuvir (400 mg) and weight-based RBV for 24 weeks is an alternative regimen for treatment-naive patients with HCV genotype 3 infection who are IFN-ineligible.

Rating: Class I, Level A

Best of luck going forward.

[can-do-man]

Just because one becomes undetectable during treatment doesn't mean there is no virus left in the body. Almost everyone becomes UND while treating and some sadly relapse after stopping treatment.

You have had a very good response so far and you really should treat for as long as the guidelines and your doctor suggest. Genotype 3 as you have has become the most stubborn of types to cure.

Wishing you the best.