Hep c back after first bloodwork post tx

[Chrisann144]

Hi everyone! The reason om writing is my boyfriend has hep c and yesterday we found out it came back he had the bloodwork two weeks after tx! He is a genotype 2! The dr was very surprised by this! My bf is just starting to feel better. The last six months was hell for him as well as for me! His viral load is 17000 now! So question do we treat sooner or later? Any input would be appreciated!

[Fnzol]

What were his PCR results during treatment?  How did his red and white cell counts change?

[Bill1954]

Most of the research focus on these new protease/polymerase inhibitor drugs has indeed been on GT-1; however there has been significant study on other strains as well.

For your info, these new drugs are collectively referred to as either ‘STAT-C’ (Specifically Targeted Antiviral Therapy) or ‘DAA’ drugs (Direct Acting Antivirals).

Here’s a brief overview of how these might affect future therapy; this again focuses on GT-1, but I imagine GT-2 will eventually benefit as well:

http://www.hivandhepatitis.com/hep_c/news/2011/0325_2011_a.html

This link helps with the acronyms used in here:

http://www.medhelp.org/health_pages/Hepatitis/Common-Hepatitis-C-Acronyms/show/3?cid=64

Good luck-

Bill

[willbb]

   Bill"s link above was a study for  Geno 2 and Telaprevir.

[Chrisann144]

Thank you all for all the info I will look into telaprevir but from what I know isn't that drug for geno type 1? I will have to bring this up to bf and his dr!

[spectda]

I am very sorry to hear of the relapse. What kind of drop in Hemoglobin (hgb) did your BF have during tx. This can often be a good indicator of whether he was absorbing enough ribavirin.

What week did he first become undetectable? Being und by week 4 of treatment is pretty common with geno 2 and usually a very good indicator of the potential for svr.

If he was und by week four and didn't want to wait for new drugs to be released, I would guess that increasing the riba and length of treatment would have the most effect in the future. Changing the interferon and dose would also be a good idea as others have mentioned, perhaps to daily infergen rather then peg-interferon.

Good to hear you stood by him during tx. My wife really helped get me through the toughest times I experienced during treatment even when I started turning into a bit of an ahole after many months.

Take care and good luck in the future,
- dave

[Bill1954]

Clearly worth discussing with his doctor. Some data on Telaprevir and genotype 2 patients; from this 2009 study, it appears GT-2 patients received very robust response:

“In this study genotype 2 treatment naive patients achieved a mean 4 log reduction in viral load after 6 days on monotherapy with telaprevir. The triple combination of telaprevir + peg/RBV achieved a mean 5.3 log reduction in viral load at day 16. But genotype 3 patients only achieved a -.80 reduction in viral load so therapy for genotype 3 won't be pursued.”

http://www.natap.org/2009/EASL/EASL_13.htm

--Bill

[Bali05]

I am pretty sure Telaprevir showed good response in Geno 2 .
Something to check out.

[willbb]

  Yes....when on tx. that is indeed when he needed you most  and will again... He is lucky to have such good support.

Hope it works out for him on the next go at it .

WILL

[Chrisann144]

Thank you all for your input!!!! We both are in recovery almost 17 years for me and almost 9 for him!!!! So no drinking! The dr told us it could hide I just didn't think it would be so quick!!!!! He wants to take his time considering he is only five weeks post tx! He had terrible stomach problems while on the meds so having a endoscopy at the end of the month! I am a nurse but my speciality is hospice so the sad part I get the end stage from this disease so I am not familiar with all txs that are available! I also couldn't believe how many peoples partners leave during tx! I know I don't have to stay but when he was on those meds that was when he needed me the most! I promised him I wasn't going anywhere if and when he choses to do tx again! Thank you all for listening and any other thoughts are appreciated!

[willbb]

  Sorry to hear about your b/f relapse. As nygirl and FIGUY have stated ,possibly a different approach to treatment or if he is mild or moderate stage fibrosis,he may want to speak with his DR.about looking into the new DAA meds that are currently in clinical trials for Geno type 2 and 3. Here is an excerpt from one trial going on and to view others go to ;;;www.clinical trials .gov.

Good luck

WILL





PSI-7977 Polymerase Inhibitor  Pharmasset  Jan 6, 2011  
Comments:

AASLD 2010: PSI-7977, a polymerase inhibitor, dosed once a day (100, 200 and 400 mg) combined with pegylated interferon plus ribavirin for 28 days produced 4 week RVRs of 88 to 94% compared to 21% in the pegylated interferon plus ribavirin group (without PSI-7977). At week 12 the cEVR (complete early virological response) was highest in the 200 mg QD (94%) and 400 (87%) compared to 64% cEVR in the pegylated interferon plus ribavirin (placebo) group. Based on these results a 12 week study is being planned. In addition PSI-7977 appears to work against different genotypes.

On December 14, Pharmasset announced the commencement of an exploratory study. The trial will evaluate PSI-7977 400mg QD in combination with ribavirin , with 0, 4, 8, or 12 weeks of pegylated interferon alfa 2a in treatment-naive patients infected with HCV genotype 2 or 3. About 40 patients infected with HCV genotype 2 or 3, not been previously treated are expected to be enrolled. The primary endpoint of the trial will be the assessment of safety and tolerability of PSI-7977 400mg QD and RBV for 12 weeks, administered with or without pegylated interferon in treatment naïve patients with HCV genotypes 2 or 3.

On January 6, 2011 Pharmasset announced preliminary results of a trial of 24 HCV genotype 2 and 3 patients who received PSI-7977 (with pegylated interferon plus ribavirin) for 12 weeks—total treatment duration. All patients were HCV RNA negative at the end of the treatment period and are being followed to assess SVR12 and SVR 24.

PSI 79-77 BMS 790052 is also being studied in combination with BMS 790052 (see DAA combination above)

[nygirl7]

I'm so sorry for you guys. The odds of clearing with geno2 are 80% which always makes people call it the 'lucky' geno but if you are in the other 20% then not such a lucky thing.

I agree with FLGuy that next time 48 weeks and more meds will be necessary. The other option to add to is to change interferons.....if he took Pegasys he could try PegIntron and vice versa.  There really isn't too much difference but sometimes in the past it has worked for others.

Best of luck.

[FlGuy]

It might not be unreasonable to try treatment again, longer and stronger.  The longer being for up to 12 months, depending on initial response and how quickly he gets to zero the second time.  In addition, the doc could enhance the doses of the meds to include more, or more frequent Peg and maybe kicking up the riba a notch - depending again on response and other blood level indicators.

What was the stage/grade of the biopsy?  Maybe he has time to sit around for a while.  What about the drinking?

[Chrisann144]

He had a biopsy before tx and he did a full six months of the peginterferon and he took 6 pills of the RIBA!!!!! His doc usually has great results he seemed disappointed as well! Just the thought of him going thru six months of hell *****!!!!

[FlGuy]

Did he have a biopsy? Results?  Did he take all the meds on schedule for the full 6 months?  How much riba did he take each day? Does he drink?