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TOPIC: 8 weeks versus 12 weeks Harvoni

8 weeks versus 12 weeks Harvoni 2 weeks 5 days ago #24395

For patients who are all of

  • GT1
  • Treatment naive
  • No cirrhosis
  • Taking Harvoni
  • Viral load < 6,000,000

The guidelines suggest 8 weeks treatment is ok. But is it really?

In this VA study of 4,365 patients they concluded:

Conclusions: In this real-world cohort, SVR rateswith LDV/SOF6RBV nearly matched the rates reported in clinical trials and were consistently high across all sub-groups; those without cirrhosis but with HCV RNA<6,000,000 IU/mL were less likely to achieve SVR with 8 weeks compared to 12 weeks of therapy, although the numeric difference in SVR rates was small.

www.researchgate.net/publication/3016714..._C_Infected_Patients

Hmm, small. What's small?

Small is 96.6% SVR at 12 weeks compared to 93.2% at 8 weeks.

Putting that in failure terms:

3.4% failure at 12 weeks compared to 6.8% failure at 8 weeks.

So if you fit the criteria, and only do 8 weeks you have DOUBLE the failure rate.

DOUBLE is not small to me. Double is big.

I don't know about you, but I would be wanting that extra 3.4%

Also note this. The same study shows (as did we with generics) that patients who are detectable at the 4 week test (that's detectable at all and includes <15 detected) are 2.5 times more likely to fail, compared to patients who are undetected at this point.

So the only reason that I personally would do only 8 weeks would be if that was all I could get. If I was still detected at the 4 week mark I would be very nervous.

If you are female, if you have low fibrosis, if you are undetected at 4 weeks these are all good, but still - DOUBLE THE FAILURE RATE

Double is not small.
YMMV
Last Edit: 2 weeks 5 days ago by James-Freeman-facebook.
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8 weeks versus 12 weeks Harvoni 2 weeks 5 days ago #24396

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Unlike fertilizer, more is better.
No place to cut corners here.
Go the 12 week route.
m
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forums.delphiforums.com/generichcvtx

G 1a F-1
Started tx 10/23/15 (Meso sof & led) ALT 48 AST 28 v/l 1.6 mil
11/17/15 4 wk lab ALT 17 AST 16 <15
11/18/15 Started Harvoni
12/16/15 8 wk lab ALT: 15 AST: 13 V/l UND
1/14/16 Fin. Tx
7/07/16 UND SVR 24
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8 weeks versus 12 weeks Harvoni 4 days 12 hours ago #24508

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In my case <15 was undetected. The doctor told me that <15 detected was not what I wanted, but since mine was undetected he had it that I would most likely not relapse.
So again "undecided <15" is good if your laboratory can only go down to <15. But if you have "<15 decteded", yes this is reason to start thinking retreat.

Dr Freeman if this is so why don't they develop better testing to go all the way to zero undetected? The labs here in the US mostly are <15, undetected or detected, why?
Contracted HCV 1980's
Geno Type 1a
F3 ( doc says once treated I'll be F2 maybe F1)
Meds shipped 6/17/2016 arrived early 7/2016

Viral count - 3,471,080

4 week quantitative bloods: August 17, 2016. I have been diagnosed as <15 (told undetected)

8 week quantitative bloods: September 14th. I have been diagnosed as <15 (told undetected)

11 week PCR RNA Qualitative bloods: September 26th 2016 - Undetected

December 19th 2016: Cured!
Viral count: zero!!!
Last Edit: 4 days 12 hours ago by Sven. Reason: Grammar
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8 weeks versus 12 weeks Harvoni 4 days 11 hours ago #24512

.
HCV RNA consists of 9600 bases. Each weighs about 650 Daltons and 1 Dalton is 1.67 x 10-24grams so you could multiply all those together and get a really small number - about 10-17 grams.

That's really really really really really really really really really really really really really really really really really small.

0.00000000000000001 g

We use the process PCR - which is Polymerase Chain Reaction like this. We add some blood that may have RNA in it to a chemical soup of RNA duplicators. We incubate it to make lots of RNA, and only now do we have enough to count.

So that is problem 1.

Problem 2 is that it only takes about 10 Hep C virions (viuses) to cause infection.

If these were all in your blood, and there were only 10, and you have 5 litres of blood (you do) then we would need to draw off 500 ml to have a chance of getting 1 virus. We only take 5 ml.

And of course most of the HCV is NOT in your blood - it is in liver and other cells.

So while it would be great to measure down to zero it is fundamentally impossible to do so because:
  1. We can't measure small enough
  2. We can't take enough blood, you would die
  3. And there is more virus not in the blood that we simply can't get at - we would have to homogenise at least 10% of you in a blender per test
YMMV
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8 weeks versus 12 weeks Harvoni 3 days 17 hours ago #24520

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Take 12 weeks!
m
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G 1a F-1
Started tx 10/23/15 (Meso sof & led) ALT 48 AST 28 v/l 1.6 mil
11/17/15 4 wk lab ALT 17 AST 16 <15
11/18/15 Started Harvoni
12/16/15 8 wk lab ALT: 15 AST: 13 V/l UND
1/14/16 Fin. Tx
7/07/16 UND SVR 24
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8 weeks versus 12 weeks Harvoni 3 days 10 hours ago #24525

Take 12 weeks!
m

What he said!
YMMV
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8 weeks versus 12 weeks Harvoni 2 days 21 hours ago #24533

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  • Vindecat de HCV cu med. generice. Cured with generics HCV drugs.
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in my case I chose 12 weeks ( had to..... ), however I would not put my bet on the 8 weeks.
In fiecare an HCV ucide peste 500000 oameni.Medicamentele generice pentru hepatita C functioneaza. Nu deveni statistica! Cauta pe Google “medicamente generice pentru hepatita C”. Transmite aceasta informatie pentru a salva viata cuiva.
HCV kills more than 500000 people every year. HCV generic drugs work. Don't become a statistic.Google for "generic hep c medication". Share this knowledge to save someone’s life.
My TX: HEPCVIR-L[generic Harvoni]-India
GT 1b.VL before TX:2.5m
Wk4, EOT: VL UND
SVR12! - VL UND
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8 weeks versus 12 weeks Harvoni 2 days 18 hours ago #24535

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Go for 12 weeks, it's such a small price to pay for a big advantage :cheer: :+1:
Gt 1a, F0, VL 6.5 million, AST 59, ALT 62
Started Twinvir 1/15/16
6 wk. labs, VL UND, AST 27, ALT 20
EOT labs, VL UND, AST 23, ALT 19
SVR 16, VL UND, AST 28, ALT 17
SVR 24, VL UND, 10/8/16
Last Edit: 2 days 18 hours ago by Greedfighter.
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