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Understanding SVR - Why don't we call it cure? 8 years 3 months ago #13685
SVR means Sustained Viral Response. When we stop the medications if there is no virus left you will remain undetected and this is SVR. Undetected at 4 weeks post finishing - SVR4 - predicts a 96% chance of permanent cure Undetected at 12 weeks post finishing - SVR12 - predicts a 99% chance of permanent cure Undetected at 24 weeks post finishing - SVR24 - predicts a 99.9% chance of permanent cure So if you finish treatment and there is virus left it will grow back, your viral load will increase again and you relapse. If we can not detect any virus you are at SVR and the longer that remains the case the more certain we are it is permanent. Patients reaching SVR24 post interferon/ribavirin have remained virus free for 18 years of follow up. With DAAs we don't have that length of follow up but basically with no drugs to hold the virus off if it is still present it grows back, and if it is not still present it can not grow back because it is gone. You can be confident at SVR4, really confident at SVR12 and pronounce yourself cured at SVR24. There is a strong suspicion that anyone relapsing after SVR24 is not a relapse, but rather a reinfection because if the virus has had 24 drug weeks to grow back and has not..... YMMV The following user(s) said Thank You: tweakmax, Chapel, Joy, LondonGirl, coral, 2b, mgalbrai, Debs, Paul-Jarman-facebook, Ariel, Gaj, Lynne-Francis-facebook, isaing4, darbara, MtGoat, magpie, Matt-Kenney-google, jay kim | |
Understanding SVR - Why don't we call it cure? 8 years 3 months ago #13691
| So do you recommend being tested at 24 weeks as well and 4 & 12? Lives in Bendigo, Victoria No prior treatment Genotype 1b Fibroscan 0 (only showed a bit of a fatty liver) Diagnosed in February 2015 Currently on my last week of treatment taking led/sof Last LFT normal Insomnia the only side effect Undetected at 4 weeks SVR4 - undetected - all bloods good and GP very happy SVR12 bloods to be done at end of April 2016 SVR12 - undetected!!! |
Understanding SVR - Why don't we call it cure? 8 years 3 months ago #13695
Yes, it's probably not a bad idea but unless you were one of those asymptomatic people with normal liver functions if you did relapse you would expect to feel sick and this to be obvious on your liver function tests. After SVR24 maybe check it in a year to satisfy paranoia and declare yourself cured beyond all reasonable doubt. YMMV The following user(s) said Thank You: Ariel, Lynne-Francis-facebook, isaing4, magpie, Michael-Henry-facebook, Matt-Kenney-google, jay kim, Donna | |
Understanding SVR - Why don't we call it cure? 7 years 11 months ago #20749
I just saw this pessimistic take on SVR and "cure". I think he is being overly pessimistic, but still, he has been in the field for 30 years and is worth listening to: hepatitiscnewdrugs.blogspot.com/2016/04/...uate-to-cure-in.html | |
Understanding SVR - Why don't we call it cure? 7 years 11 months ago #20751
If there is no levels of he virus in the body 6 months after your treatment, many Doctors are calling that a "cure". You can't pass the virus on to anybody and there is no damage being done if there is no virus in the blood test results. I undertand about him talking of no "long term studies" but I'll be happy when my liver values are in normal range and not in the 400 hundreds like the last 20 years. Genotype 1A ALT 473 AST 226 Virus Load 3,119,030 Results as of May-2016 5 week viral load/undetected as of 12/02/2016 Liver Biopsy Results from Feb 2013 Portal/Periportal chronic inflammation and mild interface hepatitis (Grade 2) Focal Lobular chronic inflammation (Grade 1) Portal/Periportal fibrosis (stage 1-2 trichrome and reticulin stains utilized) Negative Iron stains. | |
Understanding SVR - Why don't we call it cure? 7 years 11 months ago #20752
Well, I agree for the most part. But he claims that even in the case of those who have undetectable virus, some shed viral particles occasionally and in one experiment, these have caused infection in others (chimpanzees). | |
Understanding SVR - Why don't we call it cure? 7 years 11 months ago #20753
| I'm not a doctor, but this guy is full of shit. I read many years ago that if you were exposed to the Hep C virus, via sexual contact or IV drug use, the standard for declaring someone "uninfected" is 24 weeks. Seems to me that logic would indicate if a Viral load test cannot detect the virus at 24 weeks, you are 99.9% cured. If Dr. Freeman says this, then I believe that 1000% more than some unknown doctor. Dr. Freeman is being quoted world wide in the press. Dr. Freeman is out here risking everything to help Hep C patients. Even Gilead is saying if you are SVR 12 that is a cure. So between Gilead and Dr. Freeman, I believe SVR 24 is a cure. Forget this loser, he's just looking for exposure. Maybe one in 5000 people is still infected after SVR 24. I'll take those odds. 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 SVR 125, VL UND, 9/22/18 SVR 230, VL UND, 10/3/20 |
Understanding SVR - Why don't we call it cure? 7 years 11 months ago #20754
| Tommy I hope you move forward with treatment. I sent you a pm. 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 SVR 125, VL UND, 9/22/18 SVR 230, VL UND, 10/3/20 The following user(s) said Thank You: Tommy |
Understanding SVR - Why don't we call it cure? 7 years 11 months ago #20758
Hmmm, I'm not a doctor either but I notice that one of his complaints is that 1-2% of those who were F3-4 and achieved SVR in his study developed complications such as HCC and decompensation of their cirrhosis. I know that the rates for comparable patients who either don't SVR or don't treat at all are quite a lot higher. I do agree with him that long term retrospective studies will usefully add to our knowledge and I'm sure that these will happen over the 20 or more years that he throws around. ..........however, he hasn't walked a mile in my shoes so I will just state that I won't be waiting that long as I have already felt the difference to my quality of life that treatment has brought about (despite an initial relapse) so I'm looking forward to maintaining those improvements by successfully achieving SVR whether it meets his definition of a "cure" or no. 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 | |
Understanding SVR - Why don't we call it cure? 7 years 11 months ago #20759
G1a dx'd in 1992, Biopsy F2 VL 8mill +. Tried tx with Interferon/Riba, back in 2008 didn't last long it felt horribly ugly!! I stopped tx, after 5 weeks!! Started tx 6/1/16 with Harvoni. 12 Month Labs= UND | |
Understanding SVR - Why don't we call it cure? 7 years 11 months ago #20762
| I agree with Dr. Freeman's assessments and say, "well said" to the recent posts. Could not agree more with the eternal optimist, Gaj. Matt GT1a; Got it some time in the 70's; Diagnosed @1976 Tx naive METAVIR: A2-F2 SOT May 18, 2016: CMP: AST 162 ALT 241 VL 13000000 3 weeks after SOT: AST 27 ALT 31 VL 138 Reached EOT Aug. 10, 2016 / Received svr4 results Sept. 20, 2016: AST 22 ALT 24 Hep C RNA "NOT DETECTED" AS OF 3/20/2017 ,Hep C RNA PCR "NOT DETECTED" THAT'S SVR24! |
Understanding SVR - Why don't we call it cure? 7 years 11 months ago #20764
That's not optimism Matt, rather confidence. 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 | |
Proxy for viral load test 7 years 11 months ago #20771
Dr Freeman, Just wondering – getting a viral load test at 24 weeks is expensive for most people (or for the taxpayer if one's quota has not run out) and takes a long time. Would just doing the LFTs be a cheap and quick proxy to test SVR at 24 weeks and beyond? If one assumes that a relapse will be associated with rising ALT/AST/GGT, would this be an economical runaround just to check that everything is still on track? Then one could do a PCR if the LFTs were high (assuming they had been abnormal during the original infection). What do you think? G4, F4, cirrhosis. Thank you to Gilead, Michael Sofia, and the terrific folk at FixHepC for making this adventure possible. YEAR..... ALT..... AST..... GGT... FERRITIN........................................ 2009....... 210..... 215..... 953..... 1400........... (Bad health, stupidity) 2015....... 60....... 45....... 150..... 360............. (Improved diet and health, FixHepC treatment) 2016....... 20....... 24....... 25....... 156............. (SVR 12) The following user(s) said Thank You: pat1 | |
Proxy for viral load test 7 years 10 months ago #20803
Hi A.L. With the proviso that your ALT was elevated out of range pre treatment (a handful of patients with a significant VL have normal looking LFTs at baseline) then ALT elevation is a reliable marker for relapse. Elevations of LFTs for no obvious reason are the usual reason doctors look for HCV. So, at SVR24, if your ALT is normal, and you're not feeling any of the "usual suspect pre-treatment symptoms" then HCV RNA PCR is largely academic - we are not going to find anything. My reason for ordering it would be to remove patient doubt/anxiety, rather than because it's strictly needed and I'm not already sure what the result is. YMMV The following user(s) said Thank You: pat1, Ariel, Gaj, re_roll, MtGoat, Greedfighter, Fara, Matt-Kenney-google | |
Understanding SVR - Why don't we call it cure? 7 years 10 months ago #20815
Good morning Re this question, from my perspective: I'm doing SVR 24 for two reasons 1. To provide data for FHC 2. To provide peace of mind to Ariels head. Recently I did LFTs they were fantastic so relieved totally agree that it's a great indicator of how things are going. Today at around 21 weeks post EOT I am getting my scan results in hard copy and another LFT bloods done. As James said above re peace of mind, I am doing this for me and my headspace really as I am absolutely certain I have been cured but I am an old relapser and need to be extra reassured. Simple. Seems sensible to me. I like to provide data too, as I am sure we all do, I think it helps attract people to FHC the more data the better I guess This week I have achieved more than in four years since the old tx and I am so grateful to FHC Ariel Gen 1a Peg/inf/riba 2012(!) stop @ Wk 43 potassium low +issues (rlps week 4 post tx, VL120,000) scnds eg. adenomas. pre sof/led VL 240,000 Fibsc F0 Day 25 <30 Day 32 UND Week 10 UND EOT UND ALT11AST17GGT19 SVR4 UND ALT10 AST16 GGT13 SVR8 UND ALT <9 AST16 GGT15 SVR12 UND ALT14 AST19 GGT12 Bili 5 EOT +18 ALT13 AST20 GGT9 Bili 5 EOT +21 ALT11AST15 Cured SVR12 Dysplasia Adenomas RemvdAug '16 SVR24 UND ALT11AST16 ColonoscopyClear Nov17 LumpectomyClear ‘18 LithotripsyCytoscopyBiopsy 4/18 The following user(s) said Thank You: DrJames, coral, pat1, Gaj, Hieupham, MtGoat, Greedfighter, Fara, Matt-Kenney-google, Sven | |
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