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Follow-up to HCV Treatment Stopped
Feb 1, 2005

Follow-up to HCV Treatment Stopped

Dear Dr. Dieterich,

I have some follow-up questions to my first message on November 29, 2004. I was taken off treatment after 9 weeks because my WBC was 1.3. I was tested by PCR at 10 weeks non-detectable. I was able to see a liver specialist after that and he suggested a couple of options. First, that I am a fast viral responder unusual for type 1. Since I have had HCV over 30 years and I am just stage1 grade 2, put off treatment for several years until some new treatment comes along with less side effects. He even suggested that I might outlive the disease because it has progressed so slowly. Another option is to retreat with peg-intron and rebetol using neupogen and procrit to tame the low blood count. This is all good except.. I was tested again 6 weeks after stopping treatment and my quant HCV viral load was 4.6 million. It was 1.9 million before I started treatment.

Is this typical to go from non-detectable to 4.6 million in 6 weeks? Over twice the load I started with. It seems to me one of the tests could be wrong. I have read that higher viral loads do not equate to more liver damage. However, it would seem that the virus is back twice what it was to begin with.

The good news is that I responded to the treatment. Will it effective again the second time? Would you suggest waiting or treating soon?

Thanks again for all your help.

Response from Dr. Dieterich

Tough question. The viral load does not really mean anything, so I would ignore those numbers. The fact that you responded so rapidly the first time bodes well for re treatment. None of us is getting any younger and the longer you wait, the less likely to respond to therapy. The numbers are about 1% per year decrease in response rate for each year you wait. The progression of liver disease is not linear, it is exponential and goes faster as you get older. With all those things in mind, I would probably go ahead with treatment with neupogen and epogen if necessary. However the decision is yours. There are two brands of peg available now too. Peg Intron and Pegasys are both once per week and combined with ribavirin. Good luck! DTD



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