Re-compensated SVR rates

[sickpuppy]

So, I'm an abnormal case. I've never been compensated (well, maybe, but I didn't know, I was under 10 years old).

I was infected at age 1-2 (probably, based on liver progression) and discovered at age 11-12 when I bled out from varices. The next 4 years were very hard. Another 3 episodes of bleeding, high ammonia (apparently that's a sign for HE, but I don't remember having it, pun intended). After that, things went quiet. Varices resolved (now there's no sign of ever having them) and ammonia levels are normal. I feel fine and bloodwork is CPT A, borderline CPT B. MELD fluctuates between 12 and 14.

To the point: I've been decompensated, then re-compensated and stayed that way. If you want a better description and "re-compensated" does not sit well with you, then let's call it "mildy decompensated" or "on the edge of the fucking cliff".

SVR rates for decompensated patients were lower than that for compensated patients.

I guess I'm in between, but I just wanted to hear some thoughts on this. What do you think actually affects the SVR rates so much between a compensated and decompensated cirrhotic?

[sickpuppy]

Found my answer:

"Duration of Therapy

There are three main factors involved in the debate about whether it will ultimately be preferable to treat patients for longer durations or to treat patients with more drugs, according to Brown. “One is that we may not be getting drugs into every place we need to because of fibrosis or portosystemic shunting. The second is that there may be impaired immune function leading to viral persistence,” he said. “The third is that cirrhotics have had the disease longer. The first two argue for longer therapy and the last one argues for more drugs.”

Feld built on this point. “People with cirrhosis may also respond less well because of poor drug metabolism and impaired tolerability,” he said. “It may well vary from regimen to regimen, but on balance I would say that that longer duration will be more helpful in cirrhosis than more drugs.”

Full article here: http://www.healio.com/infectious-disease/hepatitis-c/news/print/hcv-next/%7B5a302f58-1018-4a5f-bc38-8c80c2772a32%7D/a-matter-of-compensation-hcv-and-cirrhosis?page=2

Bottom point: Portal hypertension causes the body to grow new veins and habits of transporting blood around it (like a clogged freeway, with drivers choosing alternative routes). This leads to the drugs not getting in hard to get places, where they should. Fibrosis and scarring also harbors hard to reach places. Longer TX duration might solve this.

Interesting article.

[dragonslayer]

Excellent find, Pup. Thanks for posting..