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3 month post tx test results
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3 month post tx test results

Hi - have not posted for awhile, but just got my 3 month tests back.  I am(was?)  1a, about 3 mill viral load, on 48 wk trial of interferen and either viramidine/riba.  Still having sides, mostly fatigue and brainfog/depression, but slowly improving.  This test was done by an outside doctor, because it is not part of the protocal of the trial

HCV load bDNA   result <615
log10  RNA      result <2.79

along with a note saying my viral load is normal  

I assume this is very good news, but need opinions..  also, does anyone know the chances of being permanently clear, when 3 months out we are clear?  I am so cynical and don't want to get my hopes up, it's hard for me to accept good news!  Makes me realize how hard this struggle is, living with this for so long (for me, about 20 years) and the toll it takes on all of us..
thanks
Carol
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27 Comments Post a Comment
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Avatar_n_tn
If you're clear three months after treatment, I think your odds for SVR are really excellent. Congratulations! Wow!

Bob
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Avatar_n_tn
you need a test that goes down to 50< .....you could have a VL of 500 but not know it...I would get a more senstive test or the Heptimax

robert
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Avatar_f_tn
Yes make him redo it with a sensitivity to the least amount you can.

I tested at 4 weeks at 411 and at 12 week 419 - had I had your test to 615 I would have believed myself to be completely CLEAR.  By the old standards I was but realisitcally I was NOT.

Using that ratio I have been clear since week 4 - but in reality you can see I'm NOT CLEAR at all.

Well I am not probably ;-) will see at 24.
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Avatar_n_tn
Congrats! I know a wonderful feeling that is!

Question:  I'm coming up on my 1 year post tx test & I'm having a little anxiety.  I was a type 2, clear at 3 & 6 months post TX, but for some reason am really afraid of going back for the 1 year test.  Does anyone have any stats?
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Avatar_f_tn
http://hcvadvocate.org/news/reports/AASLD_2004/Posters_AASLD_2004.htm#A62
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96938_tn?1189803458
I'm not sure that I agree with the need to go out and get a more sensitive pcr at this time. It would have been nice if your 3 mnth post was, but it wasn't.  The indicator of success is at 6 months post, which will be coming up for you.  I have read that if clear at 6 mnths the chances of staying so go up to 97% or 98%. Since you will likley have another pcr there's no use dwelling now. At that point, 6 months, ask the doc if he'll rx a more sensitive. Although I (this is me) would not kick and scream at a 6 month pcr that went down to only 615. I figure that at 6 months, the odds being with me, that if the virus had returned it would be more than 615 anyway.
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Avatar_f_tn
It's just had because she wants to know if she is clear or not and right now doesn't really know...why doctors can DO THIS to us makes no sense - order the BEST TEST you dummo so we have no questions!!!!!!!!!!!!  ;-)
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92903_tn?1309908311
The sensitive TMA test is considerably more expensive than the PCR. We all complain about the costs of health care, insurance companies working against us, yah-da-yah-ya. Let's assume the PCR costs $200 and the TMA $500. Would you yourself pay for the TMA when the PCR is more affordable alternative to the TMA as a post tx diagnostic?

Remember folks, when we spend insurance dollars, we're not taking from the insurance company. Those costs are eventually passed through to all the other issured members of the pool. Indiscriminate spending contributes to the escalating costs we see every day.    

I think I'm with FLguy, where I'd probably choose to spend the extra money on the TMA, but if I already had a PCR in hand, I'd simply go with that.

I don't like to think that Doctors 'do this to us'. I prefer to focus on the good they do. It seems to me that most Hep Drs are responsible caring people, dedicated to their hard earned professions and the difficult job of curing people of this disease.

Just my two cents. Peace.


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Avatar_f_tn
The reason I feel so strongly that a 615 is a waste of time is really the fact that it did affect me so greatly.

I could say yes I am undetectible - by OLD standards ... but I am  not really.  I think it is very important for us to know pretty much when we DO really clear so that we can have the additional 36 weeks tx to achieve SVR.

If I went by the test 615 - it would really change that number pretty drastically you know?

I believe that if insurance is paying the doctors should just be as diligent and precise as they can be with getting our results.

If it was my 12 week - I would not want to be under a false impression, I'd need to know the truth as best as possible so not to make a mistake later with SVR.

Does that make sense?  I think it's crucial - just my opinion.

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Avatar_f_tn
like the guys said, 3 months post tx, that bug would have come back way above the 615IU, you are in the SVR group, most likely.
YOU WERE A 1A, just like me and tnguy and oreos, and all the other one As that have checked in recently with their good news.

I should make a list of former 1a's.
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Avatar_f_tn
while on tx, yes, get the most sensitive test you can get, at 12 wks post tx, you are probably ok with a less sensitive test, since the virus multiplies like fruit flies!
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Avatar_f_tn
Hey Congratulations on 3 month clear!  Looks like you are out of the woods and can rest easier these days.  Yep,,,the 615 PCR to me is still a definite,,,,if you would have not cleared and had say even a very low viral load when finishing,,,,that would have multiplied big time by your 3rd month. Best Wishes!
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Avatar_m_tn
Post tx, a viral count is somewhat irrelevant. Either you're non-detectible and therefore SVR, or you're not. Therefore there's no logical reason to order anything other than a qualitative test that tells you that you're positve or negative. Why play games when these newer tests are now on the shelf?  Alternatively, you could order a very sensitive PCR/TMA combination like Heptimax with similar sensitivity as a qualitative.  From what I've read the post-tx three-month test correlates very highly with the six month. In fact, the one-month post-tx PCR supposedly is around 90% predictive of SVR. More important, newer research suggests the serum levels of deltamethrin in the blood of the North American Webbing Moth is highly predictive of SMR (sustained moth response). But I seem to be digressing...

-- Jim
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92903_tn?1309908311
Hmmm... on re-reading, it's unclear to me whether Carol is at 12/48 or 60/48? Seems there's some confusion on that. Carol, have you completed tx?

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Here's an article I think maybe we saw posted once before.... but it's relevant to our discussion in this thread.... seems a neg TMA at end of treatment is a pretty good indicator of SVR...

Minimal residual viremia detected by TMA was highly predictive of post-treatment relapse that, overall was seen in 25/26 (96%) TMA positive patients compared to only 14% of the TMA negative patients. This difference was independent of HCV genotype.

How Should TMA Be Used-- Hepatitis C minimal residual viremia (MRV) detected by TMA at the end of Peg-IFN plus ribavirin therapy predicts post-treatment relapse
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Avatar_m_tn
Hmmm... on re-reading, it's unclear to me whether Carol is at 12/48 or 60/48? Seems there's some confusion on that. Carol, have you completed tx?
________________________________________________________________

Good point there, its easy to read it both ways.
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Avatar_m_tn
I thought the main point was not that a neg EOT TMA was a good indicator of SVR but that "minimal residusal viremia detected by TMA (and often not detected by PCR) was very highly predictive of post-tx relapse. To my moth-infected brain these are two different concepts but the bottom line appears to be that there's no logical reason these days for anything but a sensitive qualitative or very sensitive PCR/TMA combo once treatment begins continuing on to post tx.

-- Jim


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Avatar_n_tn
TMA: can we obtain this test??seems like a v useful tool at end of trx & one i would like to avail myself of;help make decision 'bout extending treatmnt....soo,is this test even available ??? are you guys gonna get it done at appropriate time??-Thanks for waking me up...rem. this test discussed previously,but gosh. i seem to let things out for a walk& never see em again..
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92903_tn?1309908311
Jim: As I read it, 14% of EOT TMA negs will relapse. Thus 86% will not. That's across all genos, I didn't note the distribution of 1's vs 2's and 3's. I'm thinking 86% likelyhood of SVR at EOT is favorable to currently accepted odds, but I dunno?  

Beamer: There are qualatative and quantatative VL tests. The quant is more acccurate for measuring the level of virus, whereas the qual is bettering for establishing the absence of virus.

TMA is the most sensitive of the qual tests. It goes down to 5-10 IU. Heptomax is a test that includes both qual and quant components. A plain TMA can be ordered without the quant test.

Ask what the sensitivity of your VL tests will be - it's easier to negotiate for a more sensitive test before the Doc has ordered and run it.
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Avatar_m_tn
Goof said: As I read it, 14% of EOT TMA negs will relapse. Thus 86% will not.
------------------------------

I'm not saying it doesn't say that -- frankly I'm too fried to look at it again LOL -- but it can't be that simple. What about EVR? Treatment length? Histology? Does this mean that a late-responding geno 1 who doesn't become TMA negative until week 30 -- and only treats for 48 weeks -- will have an 86% chance of SVR?

The Drusano model comes up with a similar SVR percentage, but only after adding 36 weeks of additional tx after the non-detectible point.

-- Jim

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Avatar_n_tn
SORRY,

ONE OF THE MOST PREVALENT SIDES IS BRAIN FOG AND I ATTEST TO THAT. GOOD LUCK
PS THAT IS A REAL POOR TEST TO USE IF IT ONLY GOES TO 615,MY TEST WENT TO 75IU AND WAS ONLY $248.
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Avatar_n_tn
THAT READING OF  2.79 EQUALS THE COUNT OF 615 VIRAL.
YOU STARTED WITH 6.48 AND DROPPED TO 2.79 A 3.69 DROP WHICH IS A LOT BETTER THAN THE 2 LOG DROP NEEDED. YOU ARE DOING WELL.
THE TEST PROBABLY WENT TO 50 BUT YOU WERE ABOVE THAT.LUCK.
BOBBY
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Avatar_n_tn
SORRY BUT JUST TO BE CLEAR.
YOU PROBABLY HAD A SENSITIVE PCR TO 50 OR 75 BUT YOUR RESULTS WERE 615 OR 2.78 LOG. NOT UNDECTABLE BUT NOT BAD FOR STARTING AT 3 MIL.
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Avatar_n_tn
Sorry guys I should have been clearer...  I finished my 48 weeks in Nov, so I am 3 months post tx.  Thanks for all the great input, I want a TMA 6 months post, I think.  Right now my plan wouldn't change much either way if I was totally clear or not,  but at the 6 month mark, I definately want to know if I am really clear so I can explore other options if I have to - so I will hold tight until then, but it sounds poitive so far... In the meantime, I hope this gives other 1a's hope that this tx does work for some of us, and not to give up!!!
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Avatar_n_tn
Bobby the results say that my results are less than 615 and 2.79, not that they are 615 and 2.79
thanks
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Avatar_n_tn
thanks for posting-always want to hear about trx from your perspective...The Otherside!!!! tests sound  good to me,GOOD LUCK
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92903_tn?1309908311
Hi NYgrl,
Sensitivity of the 12 week (from the start of tx) is, of course, paramount. Personally, I place more importance it than the post tx test, because actions taken based on it can certainly affect outcome of treatment. In the case of the 12 week post tx test, I'm not sure it's as important - since the horses are already out of the barn, if you will.  

I'm including Jim the Study-meister on the addy - I think he may know of a study that speaks to the predictive value of TMA at 3 mos post TX. If my cloudy mind has it right, I think the 3 mo TMA is deemed as predictive as a 6 mo PCR.

Having said all this, when my Doc proposed a 6 mos post tx PCR, I offered to pay out of pocket for a 3 mos post TMA.  

PS Don't mean to pick on you here - just airing differing views :)
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Avatar_n_tn
no problem Bobby - I agree with your opinion, and will try to get a more sensitive test at 6 mo - I Have Kaiser and might have to wrestle to get it...   thanks everyone for being so supportive...
bless you all
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