Should I continue or stop the treatment?

[azmiracle]

I am in the week 56/72 of double treatment Riba+Interferon. The Riba dose was reduced to 600mg for 2 months already due to low WBC & HGB + cirrosis. The virus has been UND since last November. Last blood data was hgb 9.2 and WBC 2. 2... My concern is: should I continue to finish this treatment? Because I have been feeling so weak, and so low hgb, and continious UND over 6 months?? Doctor says that it is OK to stop now, but I hate that virus gets back again because it happend once already 2 years ago when I finished the 72 week treatment and virus was back in 2 months..... What are your advices??

Thanks

[frijole]

Your mother could add a protease inhibitor now, if one is available, but it will bring her HGB lower.  It will probably not have an impact on her WBC - which is about what mine is after 40 weeks of treatment.  Mostly my WBC has been under 2.0.  If she were to start a PI, could she get any resuce drugs prescribed (epogen or procrit?).

Have you compared the viral loads from her first treatment to this one?  If they are parallel, I do not see the purpose of continuing, but I think Hector is correct.  She has very little chance to achieve SVR.  Is her liver compensated?

best of luck with hard decisions
frijole

[HectorSF]

You say your mother has cirrhosis, correct? I am sorry because that makes her situation particularly difficult being outside of the US with limited medical resources.

The biggest factor in terms of treatment is when the virus became undetectable. At what week was the virus undetectable? That will tell you the chance for SVR.

If my calculation is correct you are saying that your mother has only been undetectable for the last 24 weeks. So you are saying that your mother still had a viral load for the first 32 weeks of treatment? If that is the cause, unfortunately she she has no chance of clearing the virus. The longer it take to get to a undetectable viral load, the less change of SVR. Being cirrhotic makes success even more unlikely. If she didn't become undetectable by week 12 I would say the odds of SVR are pretty much close to zero. Even if she had no viral load at week 12 the chances of SRV with cirrhosis is about 10% with two drug therapy. I could get the exact numbers for you if you want them. But not becoming undetectable until week 32 if that is the case she has no chance of success and will relapse when treatment is stopped as she did before unfortunately.

Since she is being treated outside the country and doesn't have access to a doctor who understands how to treat patients with hepatitis C I understand she is in a very difficult situation. Even in the US treating cirrhotics is problematic as the SVR rates even with triple treatment are very low compared to others with less liver damage.

I would consult with a hepatologist first before deciding what to tell your mother. Who is Tarek Hanasim? Is he a hepatologist or gastroenterologist experienced in treating cirrhotics with hepatitis C? If he is I would talk to him. Otherwise try to get a consult with a doc at a transplant center. Of course even they will have a hard time guessing at all the facts about your mother's true health condition.

Good luck.
I hope think work out for your mother.

Hector

[azmiracle]

Thanks Dee and NYGirl for your post. I am actually not the patient, the patient is my mom. I am in California. My mom is not in US.  She used same treatment with previous because we didn't know the incevik at the time when she started to 2nd time treatment. We knew Incevik around half year ago, at time, I was asking the doctor, Tarek Hanasim, who is supposed to be good in southern california. And he said that I don't need to change to incevik as long as interferon + riba works.

Dee, what do you mean 'how much damage you have?'

[Dee1956]

I agree with NYGirl, are you doing the same medication as the last time?
Did you think about trying Incivek or Victrellis?  
I see that you are in CA. Is this doctor the same one that you had when you treated the last time?
I am sure others will be a long very soon.  I am sorry I don't know enough to advise you, just wanted to say you are not alone.
Do you know how much damage you have?

[nygirl7]

Why are they doing the exact same treatment on you that previously failed?  Are you not in the US? Unfortunately there is no hard data that I am aware of that doing 56 weeks is any better than doing 48.  The only old studies were 48 vs. 72.

I did 72 and know how long it is and how grueling it can be.  Is there a reason your doctor will not prescribe Procrit to get your hemo up?

I'm sorry I wish I could be more helpful but there is no way to predict the success for any hcv patient.