After 48 weeks of pegylated interferon and ribavirin, another viral load test is performed. Referred to as the end-of-treatment response (ETR), this viral load measurement marks the end of therapy and the beginning of a waiting game. For treatment to be considered a success, the viral load must remain negative for at least six months after the end of therapy. Unfortunately, some patients relapse and test positive during this six-month period. Relapsers should follow up and discuss their situation with a hepatologist and consider options such as enrollment in research clinical trials of new and experimental therapies can be considered.
A patient who completes therapy, waits six months, and remains virologically negative is described as having a sustained virologic response (SVR), and the treatment is considered a success. For patients who achieve an SVR, a relapse is highly unlikely. This is essentially the same as a cure for 97 to 99 percent of patients.
Finally, an important caution about lab tests: If a patient achieves a sustained virology response (SVR), the virus remains undetectable. However, the antibody test does not change and may remain positive for life. The antibody is the footprint of the previous infection. It indicates that the patient was exposed to the virus;
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Laboratories report viral loads as positive (with a numerical value) or undetectable. Clinicians, on the other hand, commonly tell their patients that a test result is negative. For the purposes of this book, the terms can be used interchangeably.
it does not indicate active infection. These test results are often misinterpreted by medical staff, who, in turn, can confuse and frighten patients. If you have obtained a sustained viral response (SVR) and are told you have the virus again, call your hepatologist for clarification.
Treatment of genotypes 2 and 3. Genotypes 2 and 3 require six months (24 weeks) of therapy with lower doses of ribavirin. Viral loads are checked after one month (4 weeks), three months (12 weeks), and six months (24 weeks). To determine if he or she has achieved a sustained viral response (SVR), a patient must wait for six months after therapy concludes and achieve a negative or undetectable viral load.
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Patients who don’t respond to standard treatment—called nonresponders or relapsers—have options and should not give up hope. The first step might be a referral to an academic or research institution. These organizations will review the medical records of treatment(s) undertaken thus far to make certain that the patient was given medications in the proper doses and for the correct duration. A patient might receive a recommendation to undertake a daily interferon treatment with a drug called consensus interferon (brand name Infergen) in combination with ribavirin.
Another alternative is to enroll in a clinical trial. All new and potentially more effective medications have to be researched, and large medical centers often have a number of ongoing clinical trials of newer treatments that are not yet approved by the FDA. These trials are usually conducted under FDA and/or NIH supervision.
The third option is watchful waiting. Healthful living is important and strongly encouraged. If a patient does not already have cirrhosis, a repeat biopsy may be obtained in three to five years to assess progression or lack of progression of disease.
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