please help to decide with TX (canada)

[andy_k]

hello,
please help to decide with TX.

i'm 41 yo, gen 1, found out that have hep c last year during blood test for hep A and B.
not sure for how long i have it, feeling constantly tired for 4-5 years

virus load june 2010: 1.6*E6
alt june: 2010 - 71
alt dec:  2010 - 140
alt mar:  2011 - 129

biopcy: apr 2011, scaring 1/4, inflamation 2-3/4

the GI suggesting to start SOC as soon as possible.
he thinks it will help to prevent more liver damage and he is not sure when and how everything will work with new meds (i'm in canada).

he has some involment with clinical trails, but nothing is available at the current moment.

i'm just not sure what to do.

any advise or suggestion is welcome

thanks

[Trish77]

Nowhere am I suggesting in any way shape or form 72 weeks of treatment and you're taking my words out of context.  The data on SVR over 48 weeks of treatment is if DET at 12 weeks and UND at 24 for 48 weeks is simply contained within this study.  THAT is completely relevant to the OP when the discussion is around SVR rates on SOC if not using a PI.

[willbb]

well thats good then    haha lets hope th OP "s doc doesn"t get into 72 weeks data with him....all done on this       as this would not be helpful to  him

[Trish77]

To be more clear...if you read the data in the link....it shows SVR rates for those doing 48 weeks of treatment if still DET at Week 12 and those SVR rates vary depending on whether the log drop was >2 logs or 4 log drop at Week 12, the SVR rate for 48 weeks of treatment IS 50%. Compare that to Week 8 results where a 2 log drop at Week 8 and DET at Week 12 is just over 47% chance of SVR all on 48 weeks of treatment.  It's very useful data for slow responders doing 48 weeks of treatment.

[Trish77]

That's right.  The study shows who would benefit...or not....from extending to 72 weeks if DET at Week 12 and if UND at 24 weeks.  It includes stats on SVR rates for those DET at 12 weeks and UND at 24 weeks - the stats I referred to and those stats are included in this study.  

Because of the PI's, yes...72 weeks is a things of the past for the most part.  My comment was really in reference to the fact that, aside from the advent of the PI's, it was thought that anybody DET at Week 12 needs to do 72 weeks and this study shows it's more granular than that.

Despite what this study's aims are, it includes important data about SVR rates based on log drops at specific intervals and you're completely ignoring that because it also happens to be discussing 72 weeks of treatment compared with 48 weeks.  That doesn't make the SVR data irrelevant.  It only makes the idea of 72 weeks of treatment of little consideration at this point due to the FDA and imminent Canadian approval of PI"s.

Frankly, it's good data.  It shows that SVR rates fluctuate for slow responders depending on log drops and do NOT have the same SVR rates for all people who are DET at Week 12 but that the SVR rate depends on what the log drops were at specific intervals leading up to that 12 weeks.  

[willbb]

that study was to determine who would benefit from extending treament to 72 weeks as a slow responder.  Talking about 72 weeks today is a thing of the past(IMHO) in light of the DAA's   and would not be even discussed with the OP with any doctor who was at all up on new protocols.

As far as your original statement that when going UND between Wk. 12 and 24  the odds of SVR were 40 _50 %  ...I have never read a study confirming that.

[Trish77]

Here is a very granular study that shows what SVR rates are for those that go UND between 12 weeks and 24 weeks and that the SVR rates differ depending on what your viral load decline is leading up to that 12 weeks.  My figures are on the most optimistic side. Yours are on the other end and even a bit optimistic.  Neither are entirely accurate on their own but rather between them represent the range of SVR rates that are entirely dependent on what rate the viral decline was at Week 4, Week 8 and Week 12, if a slow responder that is DET at Week 12 but UND at Week 24.

It also shows that 72 weeks of treatment are not indicated for ALL persons who are DET at 12 weeks across the board, that SVR rates are similar for those who are DET at 12 weeks who had a >2 log drop at Week 4 or Week 8, or a 3-4 log or >4 log drop at Week 12 - so whether one does 72 weeks of treatment is not solely indicated on whether one is DET at Week 12 but how much the viral decline was at specific markers, according to this study.

Makes a case for the validity of an 8 week PCR if still DET at week 4 and if less than a 2 log drop at Week 4 and shows the importance of frequent PCR's for the first 12 weeks.

Interested in your comments on this.

http://www.natap.org/2010/EASL/EASL_55.htm