Yup, and I posted essentially the same thing earlier. From the last few years
hanging out here, coupled with the guidelines that Schering-Plough provides
physicians, I'd have to say not having a VL check at 12 weeks is unusual -
perhaps even very unusual.

Need ammo?

Here is something that both the HCV patient and doctors/RNs/PAs/etc should
read. I can't stress enough how much valuable information is in this document.
The document is currently version 6.0c, and it was originated and is regularly
updated by doctors at the California Pacific Medical Center in San Francisco.

http://www.cpmc.org/advanced/liver/physicians/hcv-pathway.pdf

In the appendix on page 28 there is a Treatment Protocol Schedule that shows
the week 12 VL check of which we've been speaking. This is a "make it or end
it" gate for most people on therapy: if your viral load hasn't dropped by at
least "2 log" (which is essentially 99%) the only point in continuing therapy
would be for maintenance purposes, as statistically the patient is not going
to achieve SVR.

Again, regardless of this particular question at hand, *everyone* that either
has HCV, is treating someone with HCV, or is living with someone with HCV
going through treatment, needs to read this document...

More ammo:

From http://www.medscape.com/viewarticle/479959_7

"Viral response can be assessed at 12 weeks of therapy, and therapy should be
continued in those who achieve a greater than 2log reduction in viral
load.[18] Patients who fail to achieve this end point have a less than 2%
chance of achieving an SVR with continued therapy."

[18]Davis GL, Wong JB, McHutchison JG, et al. Early virologic response to
treatment with peginterferon alfa-2b plus ribavirin in patients with chronic
hepatitis C. Hepatology. 2003;38:645-652.

You will find the above study referenced throughout the HCV community.

From http://www.hta.ac.uk/execsumm/summ1021.htm

"No patients who failed to achieve a 2-log drop in viral load at 12 weeks
achieved an SVR." [reference to Davis et al]

From
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1
5288482&dopt=Abstract

"The lack of a 2-log drop in HCV-RNA levels after 12 weeks of treatment showed
a 100% predictive value of lack of sustained response."

This was a separate study of HIV/HCV coinfected cohort to see if increasing
interferon dosing and adding Amantadine would improve SVR rates.

From the International Liver Transplantation Society
http://www.ilts.org/newsletter_issue10_article7.htm

"Patients who fail to respond at 12 weeks of treatment with at least a 2 log
drop in HCV-RNA should be dropped from treatment."

Try Googling "HCV anti-viral therapy 2-log drop 12 weeks". One could spend -
forever - documenting where care has converged at the current standard. Your
doc either knows something we don't know, or he's out standing alone in a very
big field.

How discuss this with your liver doc is the only real question. Not knowing
your situation in detail, or how volatile your doc is, I can't prescribe a
risk-free approach. You'll have to figure that one out on your own...

Cheers

/greyhackles