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How long to wait before retreatment 7 years 8 months ago #20366
Hi Meg, After your comment about the percentages I went back and did some research as previously I took your comment of 95% for 8 weeks and compared that to the overall 12 week results for F0-1 1b's of 99% per the combined ION trials.
hcvadvocate.org/hepatitis/factsheets_pdf/GT1_Harvoni.pdf And the eight week treatment doesn't actually increase the risk of resistance as such. However doing 12 weeks Tx means there will be a better chance of SVR and if you SVR then you can't develop resistance. G3a since '78 - Dx '12 - F4 (2xHCC) 24wk Tx - PEG/Riba/Dac 2013 relapsed 24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed 16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof SVR7 - 22/06/17 UND SRV12 - 27/07/17 UND SVR24 - 26/10/17 UND | |
How long to wait before retreatment 7 years 8 months ago #20369
Hi Gaj I hear you! Blood transfusion in 1992 - Diagnosed in 2007 Tx naive -G1b - F1 VL 2.270.000 ALT 40 Start tx June 4th/2016 with DAAs - Sof/Led from India Bloods on two weeks of tx (June 18th) AST 17 - ALT 10 - GGT 19 Virus UND Bloods on six weeks of tx (July 16th) AST 17 - ALT 8 - GGT 12 Virus UND EOT on August 8th (did 9 weeks and 3 days) SVR 4 Virus UND (September 7th) AST 13 - ALT 5 SVR 14 Virus UND (November 12th) | |
How long to wait before retreatment 7 years 8 months ago #20370
Hi again! Going back to the original topic I just saw on a facebook Hep C forum that someone who thought had relapsed at SVR12 is now UND at SVR24! Blood transfusion in 1992 - Diagnosed in 2007 Tx naive -G1b - F1 VL 2.270.000 ALT 40 Start tx June 4th/2016 with DAAs - Sof/Led from India Bloods on two weeks of tx (June 18th) AST 17 - ALT 10 - GGT 19 Virus UND Bloods on six weeks of tx (July 16th) AST 17 - ALT 8 - GGT 12 Virus UND EOT on August 8th (did 9 weeks and 3 days) SVR 4 Virus UND (September 7th) AST 13 - ALT 5 SVR 14 Virus UND (November 12th) | |
How long to wait before retreatment 7 years 5 months ago #22776
Many NS3 RAVs resulting from treatment generally disappear by themselves in about more than 1 year. Ns5b sofosbuvir-emergent RAVs - in about less than 1 year. However, acquired NS5A RAVs persist, requiring retreatment with drugs having considerably different resistance profile/mechanism of action/high bareer to resistance. Results from a small 3-year follow-up study (presented at AASLD 2016). www.natap.org/2016/AASLD/AASLD_61.htm There are drugs in development that target not the virus, but host proteins, and were shown to work in early trials. However, different direct acting antiviral drug combinations were also shown to be effective for retreatment in many cases. Gen 1b VL pre treatment 29000 ME/ml AST 32 ALT 94, F0 Started treatment 13 January 2017 Generic sofosbuvir/velpatasvir (Incepta) VL 9 days into treatment <300 (undetected) AST 13.8 ALT 22 Side effects: mild dehydration, not a problem at all if I drink water at night, nothing to worry about Diet and gastric ph are very important with velpatasvir. One must think what and when to eat to keep gastric pH low. Side effects disappeared 2 weeks after, unless I ate anything < 4hrs before the pill. SVR60. The following user(s) said Thank You: Meg | |
How long to wait before retreatment 7 years 5 months ago #22802
I find the whole "wait for the RAVs to become un-measureable" logic flawed. Accepting the observation that some RAVs become unmeasurable over time, to me the question is "does that matter?" Go with me on this. Say you have no measurable RAVs at baseline, and treat, but fail. What does this mean? It means you MUST HAVE HAD RAVs at baseline, despite the fact we could not measure them, and this is why you failed. Post treatment we may be able to see the RAVs (because we have killed just about everything else) but we need about a 10% population to see them. Now consider this: Starting viral load 1,000,000 Limit of detection 10 Almost all patients become undetectable (99.5%) but 5-10% fail to SVR. It follows that when they are undetectable they have < 10 RAVs, or to put it another way from that initial population of 1,000,000 there were only 0.001% RAVs Conjecture - generally RAVs are at such low levels we can't measure them, despite the fact they exist. Now with biological systems we see decay in terms of 1/2 life - the time taken for something to fall by 1/2. If it takes say 1 month for RAVs to fall by 1/2 it will take 2 to fall to 1/4, 3 to fall to 1/8. Even at this rapid rate it will take 20 months for 1 million RAVs to decay to 1 RAV (2**20 == 1 million). To me one of the best reasons to delay retreatment is to wait for better, more potent drugs and particularly triple and quadruple regimens. If this was HIV nobody would suggest waiting to RAVs to decay before changing regimens but prices are different and there are more options about that. The first of my originator Harvoni failures are coming through at SVR12 and 24 following 24 weeks generic Sof+Dac+[Simeprevir or Asunaprevir]+Ribavirin. The Simeprevir was originator out of Egypt, and the Asunaprevir originator out of Russia The combinations of Viekira-pak+Sofosbuvir and Zepatier+Sofosbuvir, both +/- Ribavirin are also looking good with patients in the USA using originator V-pak/Zepatier and generic Sofosbuvir. www.aidsmap.com/Treatment-intensificatio...atment/page/3014995/ YMMV | |
How long to wait before retreatment 7 years 5 months ago #22803
Thank you. Does this mean I should do an SVR24 test? Genotype 1a Diagnosed in 2004, had HCV for all my adult life. Until 2016!!!! Harvoni treatment, started 19 March 2016 4 week results Bilirubin 12 down from 14 pre treatment, Gamma 25 down from 52, ALT 19 down from 63, AST 19 down from 47, VL <15 down from a lazy 6 million or so EOT Results Bilirubin 10, GGT 18, ALT 19, AST 21, VL UND 12 Weeks post EOT Bilirubin 11, GGT 16, ALT 22, AST 20, VL UND Cured baby The following user(s) said Thank You: fitz | |
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