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Jun 2, 2004

Hello again Doctor Dietrich.

You have been a great asset for us here.

Pls read below for my previous question and your previous answer.

I was told by my dad that his VL is now at 250,000. He has begun / re-started treatment in September of 2003 (with Pegsys & Rebetol). His VL at that time was 310,000 (AFTER being on a 6 mons break). So in essence we can see a drop of ONLY about 60K in 8 mons. That is not a good response. However, his liver enzyms are normal; AST: 20 ; ALT:22 (his liver enzyms were not normal after a full one yr treatment when he was on pegintron and rebetol)

Some other helpful information. My dad is Genetype 4; his Liver Biopsy, as of March 2001 states Chronic Hep. with moderate activity GRADE II and focally bridging fibrosis Stage III.

What options do we have? He does not seem to be responding well with his second treatment. You have mentioned your in your previous posting, perhaps maintenance therapy might be granted to prevent Cirrhosis. If so, should he continue for the full yr or 15 mons for example before starting Maintenance therapy? Should he take a break after the full yr and start with maintenance dosage, such as 90 ml of pegsys? Also, should we at this stage try to get him on a tansplant list?

Many many thanks doctor for your feedback.

February 2nd, 2004 Posting

Dear Doctor Dietrich,

Thanks a bunch for your follow-up, guidance and support you have provided.

To recap, my father who is 58 yrs old now has finished his peg intron and rebetol for a yr without achieving an undetecable VL. his VL was about 57K. (he was undetectable within the first 3 mons, but disconntiuned at 6 mons; restarted again due to high VL but by the end of the yr, he was never undetectable, Feb 2002)

He took a 6 mons break and during those 6 mons, his VL jumped to 300,000. In september 2003, He started PegSys and Rebetol and within the first 3 mons, all his liver enzymes are in normal and iam assuming his VL is undetecable. My question to you is, how long should he take the PegSys combo? In sept, it would be a yr. Do you recommend a yr or as i read in your previous answers, perhaps 18 mons? His geneotype is 4. If after a yr or so, he is undetectable, what is his options??

Thanks you so much doctor.

Best regards, nyc...

I would recommend that he be treated for about a year after his first undectable HCV viral load. So at least 15 months, maybe 18. That is our standard. Good luck and good follow up! DTD

Response from Dr. Dieterich

If he has not responded after 6 months, then he is not doing well as you said. The severity of the biopsy indicates that we should consider maintenance treatment with half dose. I would stop the ribavirin and drop the dose of peg to 90 mcg per week. Wish him luck! DTD

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