Rusty...I am so sorry that you are in this bind. And I'm not talking
out my a.s here, I'm in week 44 of 72 myself--and the thought of doing
this again is...I don't have the words, ya know?

As to your situation...

Well, yes, if you want to stay alive into a ripe old age and die of
something not liver related, yes, you do need to retreat. But when and
with what are open questions.

Some thoughts:

1) Pegasys 270mcg and Ribavirin 1400mg for 72 weeks sounds good,
though I would also add fluvastatin to whatever you take if your
doctor is okay with that--google it.

2) Is it still possible to get into trials for either teleprevir or
one of the other competing drugs? I would certainly look into that.

3) Have you talked to your doctor about the pros/cons of high-dose
Pegasys vs. Infergen ( http://www.hepatitisdoctor.com/infergen.htm )
or Pegasys+Infergen?

I am sort of under the impression that because of the similarities
between Peg-Intron and Pegasys, your first go round might be able to
tell you a lot about whether or not you are likely to respond well to
Pegasys. Looking back, did your viral load fall very slowly? How long
were you undetectable before you ended treatment, etc.

4) I am a big, big believer is taking whatever other drugs you need to
take to get through treatment. I recently added fluoxetine to the mix,
because after about week 40 the depression really started to kick in,
but the biggie for me is OxyCodone, which has helped greatly with the
pain caused by combo treatment & Neupogen...

Hang in there. This guy has a great website and often responds to
emails:

http://www.hepatitisdoctor.com/

Hi Rusty - and welcome back to the feral cave dwellers club ;-)

It would certainly be easier to recommend waiting until Telaprevir (aka
VX-950) becomes widely available - the numbers being touted are quite
encouraging for relapsers. But with your rate of progression it probably
wouldn't be wise to wait the two more years it will likely take for Telaprevir
to gain approval.

Do you recall how well you responded to the first course of treatment? What
weeks did you receive VL checks, and what week you first went undetectable? It
would be good to know those numbers, so you can compare your progress on the
second round - especially with the switch to Pegasys.

Your doc wants to go with Pegasys at 150% of standard dosage, toss in an extra
cap of Ribavirin, and simmer for 72 weeks. While that sounds like a plan, I'd
have a discussion with him about tracking your response tighter than what
(still) seems to be the norm, starting with a VL check at the end of week 4.

You might also ask your doc what he/she thinks about adding Amantadine to the
combo drugs. 100mg taken twice a day appears to have significant results with
minimal side effects (there is enough study data to substantiate this). A few
folks here added Amantadine to their second round of treatment.

Good luck, Rusty. We'll be cheering for your success!

/greyhackles

Rusty--check this out:

http://investors.vrtx.com/releasedetail.cfm?ReleaseID=325650

Phase 3 Development in Patients Who Failed to Achieve SVR with Prior
Treatment

-- Vertex and Tibotec are initiating in Europe Phase 3 clinical
development of telaprevir in patients who failed to achieve SVR with
prior treatment of pegylated interferon (peg-IFN) and ribavirin (RBV).
This study is focused on 48-week telaprevir-based regimens and is
expected to enroll approximately 650 patients. The companies are
engaged in discussions with the U.S. FDA to transition to Phase 3
clinical development of telaprevir in patients who failed to achieve
SVR with prior treatment of peg-IFN and RBV and plan to begin patient
screening in the U.S. in the third quarter of 2008.

Hi Rusty,
I am not a doctor or really know the status of your liver but i did 3
treatments the last being 72 weeks of night infergen with pegasys
mixed in during the last month.
I was lucky that i didnt need procrit,ephogen or anything except
lunesta and lexapro.I feel that if i could do it anyone can,but as we
all know it sucks and makes life a living hell............john