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HCV Treatment maintenance for nonresponder

Dr. Rodriguez-

I have a friend with 3a genotype who was a nonresponder to monotherapy several years ago. She's been on a treatment study wtih PegIntron and Ribavirin since January. She has been quite ill the whole time, just miserable! Pre-treatment viral load was 26 million. In April her viral load was 800,000. In June her viral load was again 800,000. Several researchers have stated that if a patient is not negative by 3 months the chances are 2-3% they'll be negative at the end of treatment. My question to her doctor was why continue the treatment if she's not going to be a responder, and the answer was to improve histology and lower her liver enzymes.

My question is, if she's not a responder, won't the beneficial effects stop when treatment ends, and meanwhile is there a lower, more tolerable dose that will accomplish the same thing? Thank you!

-- M.

Dr. Rodriquez writes--

Everything you state is true. Your friend has a very low possibility of viral response at this moment. Peg-Intron seems to have more side effects than Rebetron, and Pegasys. The benefit of treatment to improve histology is well documented. It is unclear if lower doses of interferon, specially now with the pegylated forms will achieve the same effect. Our impression is that half doses will be fine, but actual trials are just starting or in design. Good luck to your friend. MR

from Jules Levin: Peg IFN can be used for mantenance therapy. This is what you were referring to in terms of continuing therapy at a lower dose. Data from studies and experience from use by doctors suggest that using a lower dose of IFN as maintenance therapy may help slow progression of HCV. This may be particularly true in your friend's case because she had a big viral load reduction from 26 million to 800,000. Results from a study by Mitch Shiffman show a person with such a large viral load response and an accompanying imp roved liver histology is most likely to respond well to maintenance therapy. There are many new drugs for HCV in development. So, staying healthy enough for when they arrive is important.