>Hi John. I'm very sorry that you relapsed. I relapsed 3 months after my
>first round of tx. Geno 1b, 60 weeks of IFN/Riba. Every day I think
[quoted text clipped - 36 lines]
>Best Luck
>Kathy
>No real disagreement, but one thing you might want to research is the actual
>persistence of mutant virions after conclusion of treatment. From what I've
>read in the past (and particularly wrt VX950) it appears HCV returns to its
>"wild type" genetic coding once anti-HCV drugs are withdrawn. If true this may
>mean you actually carry no predisposition to failure, and that a different
>treatment regimen may actually work next time...
I agree - a number of studies have shown that retreating, even
retreating with the same combination of meds, can result in an SVR. I'd
think that you'd probably want to change the equation a bit, at least
switch from alpha-2b to alpha-2a or vice versa, or trying Infergen.
IIRC, the success rate is somewhere around 20-30% for relapsers, which
isn't too bad, but not too great, either.
If it's a choice between maintenance and retreatment, and it's the first
failure, I'd go with retreatment any time. But if the liver is still
holding up, and 2-3 years won't lead to serious problems, I'd consider
waiting for VX-950 or similar developments as well.
Thomas

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kjoh - 01 Feb 2007 18:26 GMT
Thanks for your thoughts, you guys. The issue of viral resistance is of
more than academic interest, to be sure. I started looking through the
pubmed.gov abstracts and found no easy answer. One thing that is apparent
is that there are many strains of HCV both within and among genotypes, it
mutates like crazy, and more "quasispecies" arise in response to tx.
How long they persist, and how they interact with our own immune system is
a central question. I will keep looking, and put the question to my tx doc
in a couple months. He is an infectious disease specialist, so he should
have to deal with these issues.
One thing I can't figure out is if Ifn treatment improves liver health,
or at least stops the progression for a while, why Ifn maintenance
wouldn't do the same thing. I suppose its because it takes the full
battalion of Ifn + riba to keep the virus down long enough for the liver
to heal (?). Either that, or most of what is known about Ifn maintenance
therapy is from folks who with very advanced desease :-(
kj
wild type
john - 02 Feb 2007 00:54 GMT
Thanks for all the great feedback guys.I might retreat but i know i am
starting off with 48 days of infergen.Doc said the 2 year maintenace
will buy me time untill hopefully this new inhibitor becomes
available.
Is this true?It can only help your liver status if alt and ast goes
normal and viral goes is low.In other words you gain 2 years of more
damage?
john
> Thanks for your thoughts, you guys. The issue of viral resistance is of
> more than academic interest, to be sure. I started looking through the
[quoted text clipped - 15 lines]
> kj
> wild type
greyhackles - 02 Feb 2007 01:17 GMT
>> Thanks for your thoughts, you guys. The issue of viral resistance is of
>> more than academic interest, to be sure. I started looking through the
[quoted text clipped - 24 lines]
>damage?
>john
Reversal of damage may be too much to hope for, but I would be surprised if
the preponderance of evidence taken from stage < 4 patients under IFN
maintenance belied the belief that it is beneficial to at least sustaining the
current stage. I did look into this roughly one year ago, and while I didn't
construct a comprehensive case, what I was able to find supported that
position.
Cheers, and good luck.
/greyhackles
elmoemerson@webtv.net - 02 Feb 2007 14:08 GMT
Maintenance therapy with Peg til you get yourself into clinical trials
for the protease inhibitors.....that's my suggestion. Sorry to hear you
relapsed, Bud.
elmo
http://community.webtv.net/elmoemerson/DocElmosHepFile
http://community.webtv.net/elmoemerson/TheFamilyAlbum