4 Week VL Test Questions

Hubby took his 4 week test last Thursday (day before his 5 out of 24 shot) and we were so hoping for UND.  After reading so much here on the boards I know this would of been a great indication of SVR - but sadly it was not to be.  I have not seen the actual results yet and won't for at least a couple of days but the NP told me that it was 27.  She also told me that he started with a log of 6.36 and is now down to 1.43.  Are we where we should be?  Is this good, bad or so-so?  Hubby took the news a little hard - we really wanted to here that UND and I would love to be able to show him some encouragement but also don't want to steer him wrong.  As some of you know we are having to fight tooth & nail for everything - I had to beg for a 4 week vl and now I have already started to beg for an 8 wk. - this dr. only ever does 12 week tests and he did give the 4 week after a little pressure, but I am not sure how willing he will be to the 8 week.  Please any insight you can provide with this would be wonderful.  I thought I have been good about doing research - but test results are still a little confusing to me.

[jdwithhcv]

That's almost a 5 log drop in 4 weeks - very good news.  If he is UND by week 12 your husband should do very well with 48 weeks of treatment.

Good luck.
jd

[Trinity4]

Your husband is a geno 3 which ideally, they want UND by 4 wks considering the duration time for tx is 24 wks.  His detectable vl is so low that he should be UND very soon if not already.  If he is not UND by 12 wks, discontinuation of treatment is usually recommended for those on 24 wk tx therapy but treatment protocols are changing and 48 wks could be a consideration.  However,  I think he'll be fine.  
Trinity

[NewandConfused]

But he was only suppose to treat for 24 weeks - can I still consider this drop very good news?  Or do you think this is a problem?

[jdwithhcv]

my mistake, I assumed he was geno 1a.  please disregard my remark about 48 weeks.

[NewandConfused]

So it sounds like we can still have a pretty good shot at this?  The NP sounded so positive on the pone - telling us that we were almost there and everything looked great.  However when she was drawing the blood for the test she made a comment that she expected it to be UND.  So despite her words on the phone while giving me the results, it just kind of felt like failure or kind of settling for second best.  So I was confused at what I should be expecting.  I was not sure what to believe at that point.  Thank you so much for the reassurance!

[Trinity4]

My opinion is he has a very very good chance.  If they allow you a 8 wk PCR, I'll hedge my bet he will be UND.  If the treating physician will not consent to 8 wk, perhaps you could get your primary care physican to order it if this would give you some piece of mind.  
Good Luck and results are very good at this point!
Trinity

[NewandConfused]

Thank you so very much!  You have brought a huge smile to my face today!  I can't wait to share the encouragement with hubby!

[jmjm530]

First, get hold of your own copy of the test results. I've seen sensitivity limits confused with viral loads a number of times here -- and sometimes by the doctors themselves.

Assuming your husband is detectible at week 4, you really then should try to dig up some studies as to whether extending to 48 weeks makes sense, factoring into the equation other variables such as age, how he's handling side effects, amount of fibrosis, etc. Also, try for a week 6 test and then a week 8 test if still detectible at week 6. The more dots the better. For example, I was tested for viral load on a weekly basis from week 1 until UND at week 6.

Lastly, if your're unhappy with your doctor, minimally you might try for a consult a liver specialist (hepatologist). They will review your history, both pre and during tx, and help guide you in terms of treatment length, etc. This could be a one-time meeting with or without a follow-up -- or if it works out, you may decide to switch doctors. I had a couple of one-time consults during tx and was able to contact those docs on follow-up questions via phone or email later on in treatment. Like the viral load tests, the more docs, the more dots you have to connect for hopefully the right answers.

-- Jim

[portann]

I'm in week 17 of 48 and have not got over the disappointment of not clearing at week 4. The truth is neither has my family or my nurse, although we spin it this way and that. We all know my odds are now greatly reduced, however we play cheerleader.

The practical impact, though,  is that my week 4 results didn't change my plan to continue treating, although it cast an undeniable shadow on me and I bellyache periodically about why even persevere. My odds are lower but I can't throw in the towel and bail out. This isn't a financial investment decision. I can't  look around for a better return. I'm here for the long haul, lower odds or not, whether I ultimately am SVR or not.

I really wish I had been able to test at week 8 (even at 5!)  I was tested only at 12 - when I was clear -  but it unproductively haunts me whether I cleared AT 12 or BY 12.

Still, the additional information may have subtly changed my outlook or realistically changed the predictability of my SVR but it still wouldn't have changed my decision to take my reduced chances and run with treatment until my last interferon shot.

I'm not much of a self-advocate and mostly coast along with what my medical team's policy is. (I hope this character flaw isn't grounds to be banned from the forum!) I'm  sure you will find a way to arrange the eight week test, even if it's through another avenue.

All the best to you and your hubby.

[Marc1955]

NewandConfused – Your husband needs to try to not get discouraged. What I've learned through this is that illness can't be avoided. We all will encounter it if we haven't already. He'll use his strength and your support to deal with whatever comes down the road.

So he wasn't undetectable at four weeks. He had a huge viral load drop and there's every indication that things are moving in the right direction. You've gotten some great advice on this board. Hope your idiot doctor is not too much of a problem.

God doesn't promise anyone an easy time of it. You both will be fine. Just relax.

[Trish77]

I too missed out on my RVR and I can relate to the disappointment.  I missed it by 256 or something close to that in the 200's after being 615 the week prior.  I had dropped significantly each week so I think it hit me hard partly because I just assumed done deal.  Who'd figure I'd only drop 400 virions in a week after dropping hundreds of thousands each week?

I relate to your disappointment.  However, let me spin it this way for you.  Your chances didn't drop.  Rather, they didn't go up.  You went into this with a 40% chance of a cure being a geno 1 and if you were other geno's, with the cure rate for that.  That didn't change. You were no further behind than I was...and I know we badly wanted to be further ahead but we weren't more behind.  Yet that's how it makes you feel..but it's not like that.

Here's the other thing.....you have no idea if you cleared later that afternoon, the next day.. no idea.  Somehow you have to find a way to wrap your head around it...however... push for that 8 week test because the next test being UND definitely helps to deal with the very real disappointment of missing RVR at 4 weeks.  

btw.. I went UND at 6 weeks.   Even that.. it took me awhile to get past the RVR disappointment...I think it took continuing UND's for me to finally let it go.

Good luck Portann and to you and hubby, NaC.

Trish

[comeagain]

I´m a geno 3 are your husband that as well?
I think you shall ask Dr Dieterich what he thinks about extendng the tx.

Then you ought to post hubbys age, fibrosis stage, ferretin level, baseline vl and if hubby has other health issues such as diabetes hiv or others.

My four week result was between 10-20 iuml.
I´m doing 48weeks my baseline viral load was about the same 3.8 milj,  6 log is 1miljon and one log is 10  7 log is 10milj.

So i think its correct with 27iuml its a very good drop from 3.miljon something.
I´m in a study for relapsers and my nurse told me that this little amount is quit common
among former relapsers that are participating in the study, and she also added there is a reason why you relapsed first time.

I have a friend here same geno 3 he started with only 75000 iuml but had 90iuml week 5
I dont now if he was UND week 12  first he said he wasn´t then he said he was  told him to get a hold of labs papper and show me, he hasn´t yet.

After my first tx a doc at the lab said maybe you only had to go a couple of more weeks to clear.( did 24weeks on first tx mild fibrosis and inflamation (inflammation) grade 1 stage 0 but was a
little to fat ,that you should post to Dr D aswell, your hubbys BMI mine was 28 first time. )
If you ask Dr D at expert forum I think he would like your hubby to extend 24 weeks after hes UND but you better ask because I`m not sure.

I think your hubby and I have advantage compared with my friend with the low virus load,
and that we both cleared the next shot week 5 pure speculation though, I´m not gonna know when i became UND until 1.5 year after tx when studie is compleated.

Its good, the result but better safe then sorry I think, so get a second opinion on how to continue.
Congrats to your hubby and God bless.

BTW  my friend is extending to 48 weeks and he is not in a studie.

ca

[orleans]

Sure way to get an 8 week test is to pay for it. I paid $324 for the Lab Corp Quant Plus < 10 IU/ml. Pretty good little chunk of change, but if you can,-- it was worth it to me. jerry

[lolitriqui]

i don't know your husbands GT, but from what you write, i assume GT3; the same happened to me; however most data are a GT2/3 mix; almost every GT2 is UND at 4w, so  the percentile of GT3 is actually lower than advertised; if he does a 8w test, he is probably UND, just looking at his log drop; that is also a factor; log drop wasn't bad; if you not undetectable, some voices suggest you extend TX; now it becomes tricky.... the only data we have is based on 48 w TX; hubby can certainly do that; i can tell you what they do at columbia university; if you not UND by 4w, and have and are UND by 12w, which you should be, they extend TX 24weeks from UND point; so it was suggested to me, to extend to 36weeks; that's what i did...good luck to you....