TOPIC: Question to Dr. Freeman - treatment length

Hello HCV mates,
my name is Artur. I live in Poland. I belive I was HCV infected in hospital because of drip. It happened in 2008. I was dehydrated and physician sent me to hospital. In this time in Poland were cases of sepsis. I was HCV diagnosed in 2009.

Anyway, after the visit in the hospital I was graduating high school and I was preparing to military technical university. One of the recrutation steps are helth tests. Everything was fine, except anti-HCV test. This one was positive. Few weeks before matura exam military physician sent me to the loboratory to get HCV-RNA test. The viral load was 4.05 IU/ml in logarymic scale. After two months, in June, I had another HCV-RNA test and the result was about 40.000 IU/ml. So, the VL rised from 12.000 to 40.000 in really short time. All liver tests were fine. In December my VL was about 200.000 IU/ml. In September I had biopsy and the liver was compleatly fine, no fibrosis.

Hopfully I have been sent to treatement with PegInterferon and RBV. I started this adventure in the end of 2010. Before the threatement my VL was 250.000 IU/ml. In the EOT I have achieved UND HCV-RNA, but I haven't achieved SVR24.
This year I have made fibroscan. The result was F2 (9.1 kPa). The VL was 1.230.000 IU/ml. BTW I don’t drink, smoke, I have never had to do anything with drugs or high risk sexual behaviours. In Poland are avaiable interferon free therapies, but only for people with all other genotypes then GT3. Now I have drugs from India (SoviHep+DaciHep). I have made HCV RNA test after 17 days of treatment and I am undetected (test sensitivity was 21 IU/ml).

On our polish forum we have discussion about treatement lenght. I have decided to be treated for 24 weeks, but some other people say I should have 12 weeks treatement, because of recomendations. In my opinion recomendations are mostly based on economical point of view.

My question is: should I take the medicine for 12 or 24 weeks? Does the treatement length have the influence on SVR?

Yes SVR rates improve with longer treatment and duration is in part an economic decision.

If I was F2 and GT2 and a past treatment failure I would take 24 weeks.

In GT1, which has better SVR rates but also better statistics, your SVR rate would be 94% with 12 weeks treatment and 99% with 24. For a government paying double for and extra 5% does not make good economic sense but for you.....

In GT3 SVR rates are lower - around 90% so you need all the help you can get.

OK. Thanks for help. I don't have any other doubts and I am going to follow my primal idea- 24 weeks on SOF+DAC. My GT3 must be defeated.

Yes. I went 16 weeks (gen 3) and relapsed. I wish I had gone the 24.

I have just started treatment 16 days ago, I'm GT 3a
I got 12 weeks supply.
So glad I read this post "thank you for posting"
I have decided to get another 12 weeks so that I can have the best chance of clearing this virus.
I'm still in shock really as I had a raised ALT level 66%
So in April asked for a full liver test.
Did not expect the news I was positive.
Hope to get clear with this treatment
I'm F2
My nurse just emailed and said the ally-3 study shows G3. 12 week treatment non cirrhosis 96% achieved svr

Am a little confused now with all the different information.

It seems the real world figures for g3's isn't quite as good as 96% but given that the current meds are still relatively new it may take time for treatment regimes to be perfected.

Ally-3 trial participant numbers were fairly low. As Paul says with more people having treated over time the real world rates have been lower for Gt3s so longer or stronger treatment is a good option for us.

Thanks Gaj, Paul and Split, Donna I have tried to answer you other post re your path for you in the other blog you wrote, friends, Dr J, you may wish to check on that.
With all my empathy,
Ariel

Today I got my lab tests. I don't understand one thing.
Before treatement my ALAT was equal 28, in the beginning of 5th week of treatement was 9.9 and now, in the beginning of 9th week of treatement is 5.9. ASPAT also dropped from 18 before treatement to about 10 now.

I don't know why people mostly have these two chemical parameters rised (in my case they were ok even before treatement)? I want to add that my liver fibrosis is/was F2 (9.1 kPa)...

ALT and AST are released from damaged cells. Everyone has some levels as part of the wear and tear of daily life but most people with HCV have raised levels although the amount they are raised varies depending on the damage occurring when the test was done. Even though your levels were within the average normal range prior to treatment you still had raised levels compared with your normal as shown by them decreasing x2 and x4 during treatment.

Excellent explanation. Liver functions - at least the liver enzymes - are not about function. They are about damage and how much dead liver stuff is floating around in your blood.

For you that was not much at the start, and even less now. About 5% of people have normal enzymes with their HCV. These people often have high viral loads, so it probably means their immune system is not doing much about the HCV (ie killing the liver cells it has infected).

As Gaj says the normal range simply represents where you find the values for 95% of the people. 2.5% of "normal" will by definition have lower levels, 2.5% will have higher levels and while most people will be in the mid range, some will be low normal and some high normal.

That's normal which is probably why it's called a normal distrubution - the shape of the curve with most in the middle, and a tail out each side is called "the bell curve" for pretty obvious reasons.

I wonder... maybe that 's also genetycly detremined. For example my brother's liver parameters are: ALT arround 10 and ASPAT arround 15. And he is HCV free. So mine, when I will be healthy, supposed to be similar.

They say age is just a number.

Not sure who they are or if I agree but ALT is just a number, one that hits the thousands with acute Hep C then drifts along, usually a bit over normal.

What we want is not a number. You can't feel that. What we want is all the good stuff that happens with having no viral load.

Dr Freeman I have Geno Type 3a and my Fibroscan was Stage 3 I have toenail fungus they count give me the oral meds and the topical doesn't work.I was diagnosed in 2004 but believe I contracted it in 1994.Im treatment naive,High blood pressure ,diabetes2.Which treatment and the length of treatment would you suggest.I have 900,000,000 viral load.

Is your viral load really 900 million?