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Viral Load & Biopsy re: Treatment
Jan 19, 2002

Hi Maribel, You've probably received a hundred questions like this, but you give such great explanations that can be easily understood!! I'm in the process of changing GI doctors and would like some clarification in the meantime, so hopefully you can help. I'm still not clear on the relationship between the amount of viral load combined with biopsy results as it pertains to treatment. I am Hep C positive, Genotype 2b. My viral load is high at 5,000,000, and my liver biopsy performed six months ago says "Chronic hepatitis, Mildly active, Grade 2 (Scale 0-4) with mild portal fibrosis, Stage 1 (Scale 0-4). Clinically Hepatitis C, Steatosis, Mild. Negative for malignancy". I know my Genotype 2b makes me a good candidate for treatment, but do you think it would be okay to wait for Pegasys or should I start Interferon/Ribavirin treatment now?? How important is the viral load compared to the liver biopsy when considering treatment?? If I didn't have ANY treatment, what are my chances of developing cirrohsis??? I do worry about the effects of the Interferon, Pegasys, etc. on the rest of my body. What would you recommend?? I'm a former IV drug user who's been clean for 5 yrs., so it's hard to say exactly when I contracted the disease. THANKS!!!

Response from Dr. Rodriguez-Torres

Thank you.!You may want to look to another question about genotype 2,that I answered today.You have a very good prognosis because your genotype ,and non cirrhotic state.You do have a high viral load (more 2 mill),and that is not as good.What is the exact weight of this prognostic factors,is your question and it is a very important one.Genotype and liver status,and prior therapy or not, appear to be more important.So,your chances of response are very good. The other part of your question is the choice of treatment.The data shows that patients with genotype 2 ,will respond similarly to Rebetron as to Peg Intron -RBV.The side effects of the Peg are more ,and the cost is almost doubled. Data on Pegasys is 85% in combo with RBV ,but the main benefit may be the less side effects. You have time to deal with the problem,as you have very mild fibrosis.If you decide on a trial with Rebetron, and do not respond in 24 weeks,(low possibility),you still can be cured with Pegasys-RBV,as a non responder.



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