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Dr. Dieterich, URGENT, HEP C Question, Following UP, Please help
Nov 5, 2004

Hello doctor,

I hope you are doing really well. I have written to you several times over the past 3 yrs regarding my dad who is infected with HEP C. As always you have helped us with effective feedback.

Here is a recap.

In March 2003, my father has finished his peg intron and rebetol for a yr without achieving an undetecable VL. his VL was about 57K; his enzymes were 46 & 52 a bit above the normal range. He then took a 6 mons break. During that 6 mons break, his VL has risen to about 310,000. In Septbember 2003, he started with Pegsys and rebetol, in October-November 2003, his blood test/ counts were normal as far as the enzymes functions but he has not performed a VL test (since this test is very expensive overseas) In JUNE, 2004, I was told by my dad his VL is now about 250,000. That is a drop of only about 60K in about 8 mons of treatment with Pegsys and Rebetol. HIS LIVER enzymes however, were in the normal range: ALT 20; AST: 22.

My dad's biopsy as of March, 2001 was Chronic Heptatis with Moderate Activity grade II and focally brdiging fibrosis stage III. His Genotype is 4.

I have written to you in June 204 and you said the 'The severity of the biopsy indicates that we should consider maintenance treatment with half dose".

I conveyed this msg to him. But nevertheless my father chose to continue the full yr of pegsys and rebetol with full dosage as he was approaching the full yr.

When he went to do his blood tests in early October 04, he found out that his VL has became undetectable, or in other words, his VL is less than 1000 copies; detection limit is from 0-1000.

I am not sure if there is a lap error, but it sounds like based on what i have told you is that he has dropped his 250k VL in about 4 mons.

All his liver functions are in normal ranges.

As of October 3rd, my father has been doing the maintenance therpay, taking 90ml of the pegsys and dropping the rebetol.

What do you think he should do at this stage? We are really excited the fact that his VL dropped significantly or now undetectable. On the other hand i am afraid, his VL can go higher once he stops. I told him since he is taking 90ML of Pegsys and he is not really bothered by it, take it for a full 3 mons, and do more lab tests. if it is undectable then my dad is cured, if not then, he should continue with this maintenance therapy.

Or should he take the full dosage again after having stopped it for 3 weeks?

what do you think?

Many thanks to you Doctor.

Response from Dr. Dieterich

Sounds like he should go back up to full dose and keep going for about 15 months total to ensure that he will be cured. He needs to be undetectable for about 36 weeks or 9 months before we can be reasonably convinced that he will have a great shot at a cure. Wish him luck! DTD

Bilirubin and Liver Enzymes
hiv@hepc is viramune o.k.?

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