Pre-treatment Predictors Of Response
There are known factors affecting the successful outcome of treatment. The most important of them are:
- Drug/alcohol abuse
- Steatosis (level of fatty infiltration)
- Cirrhosis (advanced liver disease)
- Viral Load
- Gender (females are more likely to respond to therapy)
- Insulin Resistance
The ultimate goal of treatment is to eliminate the hepatitis C virus from your body. Treatment is considered successful if there is still no detectable virus in your blood 6 months after completing therapy. Successful treatment is called sustained virological response, or SVR. When this is accomplished, your liver begins to heal. It regenerates new cells to replace the ones damaged by HCV.
The standard of care, or SOC, is what the FDA considers the most effective HCV therapy available: pegylated interferon-alpha plus ribavirin. The length of time a person stays on treatment is based on the substrain, or genotype of HCV he carries. For genotypes 1 and 4, the length of treatment is 48 weeks. Genotypes 2 and 3 require only 24 weeks of therapy.
Interferon cannot yet be taken as a pill. For now, it must be injected under the skin. Your doctor, or a member of your healthcare team will teach you how to inject yourself, and how often. The FDA protocol is one shot of interferon per week. Of the two pegylated interferons available, one is based on your weight. The other is based on standard, flat dosing. Ribavirin dosing is always based on your weight. Ribavirin comes in capsules and pills, taken by mouth twice a day.
Predictors Of Respose After Treatment Has Begun
Beginning viral loads can range from the low thousands to many millions. The optimum viral load for starting treatment is 2 million or less. However, a higher viral load shouldn’t stop you from treating. The rate at which viral load drops within a specific period of time has shown to be an accurate predictor of response.
The goal of treatment is Sustained Virological Response, or SVR. It means the patient is undetectable for virus, one year after completing treatment. During treatment, the amount of virus in your blood, or viral load (VL), is counted at defined intervals to see if the medicine is working effectively – if treatment will likely result in SVR. You will know within 12 weeks of treatment if SVR is likely.
The most reliable predictor of successful treatment is Early Virological Response, or EVR. If EVR is attained, treatment is continued, side effects and other factors permitting. If EVR is not attained, the patient is usually withdrawn from treatment, as the risk of taking the medication outweighs the predicted benefit of therapy.
Rapid Virological Response (RVR)
Week 4: Patient is undetectable for virus. Patients who achieve RVR have an 87% - 96% chance of attaining SVR. If this goal is attained, treatment duration may be shortened.
Early Virological Response (EVR)
Week 12: Even if RVR goals are not met, the patient still has 8 more weeks to show EVR, determined by 1.) Undetectable for HCV; 2.) A 2 log10 drop in viral load. In other words, two zeroes are now gone from the patient’s viral count. (Example: If treatment began with a VL of 2,000,000, a 12-week VL of 20,000 would show that the patient has achieved EVR.) Patient continues therapy for full duration (48 weeks for genotypes 1&4; 36 weeks for genotypes 2&3).
Interferon/ribavirin therapy causes different side effects in everyone. You won’t know exactly how the medicine will affect you until treatment starts. Many patients are able to continue their normal daily activities, such as going to work, or classes. Treatment side effects are usually mild. Most patients report they feel like they’ve got the flu. Low-grade fever, chills, and fatigue are common. These side effects are usually controlled with analgesics like acetaminophen (Tylenol). Some patients report feeling depressed. You should tell your doctor right away if you experience depression while taking interferon.
Ribavirin causes some degree of anemia in nearly all patients. Feeling faint, weak or out of breath may be signs of anemia. Your doctor will monitor your blood cells during treatment, and will take steps to correct blood-cell deficiencies caused by the medicines you take.
Your doctor can help manage physical and psychiatric side effects. It’s also important to have a good support system of friends, family, HCV support groups, or people in your rehabilitation community. Keeping a positive attitude, staying connected with your support group, and reporting side effects to your doctor can help you stay on treatment, even when side effects are present. Taking all of your medication at the prescribed doses and on time is extremely important to finishing treatment successfully. Don’t be afraid to ask for help during therapy. Your treatment team can help you only if they know you need help. You should never have to feel afraid to ask for it.
Before and during treatment, getting answers to your questions can help you feel more relaxed about therapy. Ask your healthcare team about any medical concerns you may have. In your support group, seek out those who have already undergone therapy. They are usually eager to answer any non-medical questions you may have about interferon/ribavirin therapy. Many patients report that having a strong support group played a major role in getting them through the months of treatment.
When treatment successfully clears the virus from your system, you’ll find yourself much healthier. Thousands of people have reported that after treatment, the emotional weight of illness is lifted. They feel as though they’ve got a brand new life ahead of them, and a great sense of accomplishment, knowing they are free from HCV.