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Medical Forum / Diseases and Disorders / Hepatitis / February 2007

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john - 31 Jan 2007 01:38 GMT
Just got the bad news after stopping the meds.relapsed.vl 1.7m ast and
alt way up.
My options are 2 years of treatment starting with infergen again or 2
years of maintenance including 7 weeks of infergen and ribavirin then
switching to interferon and stopping the ribavirin (which sounds like
quitting) or going to Cornell Medical and trying these new protease
inhibitors.Is it crazy to take lower meds to keep things at bay for 2
years to see if something better comes down the pike???????
Just when you thought you slayed the dragon it pulls you back
in.......john
Paul - 31 Jan 2007 07:45 GMT
On 30 Jan 2007 17:38:47 -0800, "john" <otk355@hotmail.com>, in message
ID <1170207527.502802.153940@q2g2000cwa.googlegroups.com>, in the
newsgroup alt.support.hepatitis-c wrote:

>Just got the bad news after stopping the meds.relapsed.vl 1.7m ast and
>alt way up.
[quoted text clipped - 6 lines]
>Just when you thought you slayed the dragon it pulls you back
>in.......john

I suppose it depends on the condition of your liver really.  If there
is little damage then maintenance is probably overkill - but I doubt
they would suggest maintenance unless your liver has a fair bit of
damage.
Sorry to hear your tx didn't work.
kjoh - 01 Feb 2007 04:21 GMT
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
about whether or not I should re-treat, or whether I should pursue
maintenance interferon therapy.  So far I have not found any evidence that
maintenance IFN is helpful, though there may be some evidence out there
somewhere.  Here are the words
of Doctor Cecil (hepatitisdoctor.com),  and the results of a new study I
found on pubmed.gov  on long-term IFN tx for cirrhotics.  Have a look at
them.  Dr. Cecil isn't crazy about maintenance therapy and though the new
study results are very difficult to interpret, but the bottom line is that
2 years of maintenance  IFN maintenance did not " significantly" improve
survival of cirrhotics.  

Dr. Cecil's website:
"Should you take maintenance interferon if you are a nonresponder?"
http://www.hepatitisdoctor.com/maint-inf.htm

Effect of Prolonged Interferon Therapy on the Outcome of Hepatitis C
Virus-Related Cirrhosis
"Conclusion...This randomized controlled trial showed that a 2-year course
of IFN has little or no impact on complication-free survival in patients
with high-risk compensated HCV cirrhosis."

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstra
ctPlus&list_uids=17261383&query_hl=2&itool=pubmed_docsum


For myself,  I have chosen to wait until a third combo drug (VX950?)
Becomes available, rather than start now with infergen, because I don't
want to relapse again, thereby  propagating an even more resistant strain
of the virus.  Treatments that end in relapse may mean you have developed
a population of resistant virus.  If I went through an Infergen/Riba tx
and relapsed again, I might have an impossibly resistant group of bugs to
deal with when VX950 becomes available. I believe that my liver is in good
enough condition that I can afford to wait (grade2/stage1, normal LFTs).  
If anybody out there disagrees, please say so, because I am winging it
just like the rest of us.

So John if I were you I would see what Cornell has to offer.  

Best Luck
Kathy
greyhackles - 01 Feb 2007 14:27 GMT
>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...

Cheers

/greyhackles
Thomas Wagner - 01 Feb 2007 15:56 GMT
>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
 
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