Anybody ever get a VL PCR count of 5<VL<615?

[jboyhk]

I was always wondering if anybody every got a count between the 'old' detectable level of 615 and the 'newer' count of 5.

I always here people talking about getting the 'better' test but have never heard of someone actually getting a result in between the 2 sensitivities levels.

[Kalio1]

I had a VL measured at 442 once.

[jmjm530]

19, 60, 102 (IU's/ml)

[jmjm530]

Tele was 443, MarkNYC was 52, I believe NYGirl was below 615. Many people test between 5 and 615, in fact there's a study category called PCR negative/TMA positive which is basically folks who test negative using less sensitive tests but positive using the more sensitive tests. This group does not do very well in terms of relapse at critical testing points such as week 48, or even week 12, I believe.

-- Jim

[jmjm530]

I suppose at week 12, they'd fall into the two-log drop group as compared to the non-detectible group. If memory serves me correctly all those who were PCR negative but PCR positive at end of treatment ended up relapsing. Makes sense, since the virus never went away, just flew under the radar.

[jmjm530]

Second sentence of last post should read:

"If memory serves me correctly all those who were PCR negative but *TMA* positive at end of treatment ended up relapsing.

[jboyhk]

Ok, thanks for the info.

It seems strange that the 'normal' test can be off by one log and the ultra sensitive test can detect individuals.

Perhaps its because they don't 'amplify' and literally count.

[jmjm530]

Keep in mind that the one-log "off" changes dramatically as the viral load gets less. At 10 million IU/ml a one-log differential can be a million IU/ml. However at 100 IU/ml, a one-log differential is just 10 IU/ml. At 18 IU/ml, it's just 1.8.

-- Jim

[GrandOak]

jmjm: "here's a study category called PCR negative/TMA positive"

Perhaps it should be qualified here that this does not mean that PCR only goes to 615, or 600, making TMA the only choice patients should demand.  As I prepared to schedule my PCR lab draw for this week I shopped around to make sure my lab orders would be filled with the best test I could find.  Given my VL I figured 50 would be a good threshold, and if my His grace and mercy, that come back UND, I could always request a more precised test.

I suppose I could have settled for a 615 or 600 given that my 2 log only requires me to get to 720,000 IU/ml, but I figured what the hay, if I can get 50 or less and, by His grace and mervy, it comes back between 50 and 600, it might factor into the decision in 3 wks as to what to do with my sorry arse in the foreseeable future (no pun on forseegood intended ;-).

At any rate, here is a link to an interesting article I found:

http://www.medsci.org/v03p0035.htm

[jmjm530]

GO: Perhaps it should be qualified here that this does not mean that PCR only goes to 615, or 600, making TMA the only choice patients should demand.
----------------------------------
As the chart shows, a few PCRs do go below 50 IU/ml. Another not shnown is LabCorp's quantitative that goes down to 3 IU/ml. I think that's also a PCR but not 100% sure.

That said, most PCRs are not as sensitive as TMAs and only go down to 50 IU/ml, if that. My pharselogy "PCR positive/TMA negative" came from the Halt-C trials and similar studies. The PCR used in Halt-C had a sensitivity of 100 IU/ml.
http://www.hivandhepatitis.com/2006roberts/hcv/081106_c.html

Bottom line is that the more sensitive tests give more data than the less sensitive tests. If a negative test with a sensitivity of 100 IU/ml (Halt C) could give misleading data, then I assume the same could happen with a PCR with a sensitivity 50 IU/ml.

With tests (PCR or TMA) going as low as 5-10 IU/ml, I can't see using anything less sensitive once treatment starts. Personally, I had two VL tests show below 50 IU/ml, and if the test wasn't as sensitive I would have assumed I was non-detectible when in actuality I wasn't.

-- Jim

[jmjm530]

Forgot to add that the tests showing a sensitivity of 615 IU/ml use bDNA techonolgy, which I think is different from either PCR or TMA technology. That's why Quest's Heptimax is so popular. One test for all circumstances (pre-tx, during tx, post tx) so you don't have to keep ordering different tests.  Heptimax is a two-part test. First part is a real-time PCR with a sensitivity of 50 IU/ml. If that tests negative -- and only then -- the sample is reflexed (tested again) using quantitative TMA technology.

[BThompson4]

I just got vl result of 561 iu/ml at week 12, genotype 1a, after being 1430 iu/ml at week 10.  I am thankful for getting a test more sensitive than the <615 iu/ml.  Huge difference at week 12 between being undetectable and in the middle three digits iu/ml.  If next vl [15 weeks] is not undetectable, I will be worried and thinking about changing treatment length/intensity, etc.

[mkeela]

Good to see you again BThomson! Make sure and let us know how it goes ok? When is your 15 wk? Blessings to ya!

[BThompson4]

Im hangin in there for now.  Got 15 week pcr Thursday, and will know results in a couple of weeks.  Need to get UND ASAP!  I'll be sure to update then.

Hope you and your husband are well!

[NYgirl]

I tested at 411 at week 4 and 419 at week 12 then at UND < 5 at 24.

By old standards...I would have been UND all along (but I surely wasn't)

[friole]

At 12 weeks I tested at 40 IU/mL (the test sensitivity was 2).

At week 16 I was given a test sensitive only to 50 IU/mL which, of course, was UND -- but was worthless information to me.

At week 20 I was UND with a test sensitive to 2 IU/mL (5 copies)

I used the information from week 12 to determine that I should continue beyond 48 weeks.  If I had not had that sensitive test, I would have never known thta I was not clear at 12.

What study was it -- can't remember -- where they retested the same blood taken for the 12 week PCR of relapsers who were clear at week 12.  The first test was sensitive to 50 (I think).  WHen they restested using a more sensitive test, there were a significant amount of nonresponders who were NOT clear at week 12.

So, it really DOES matter how sensitive the test.  

frijole
(clear so far -- I have my 3 month post treatment PCR coming up the first of November)

[NYgirl]

"Pegasys Commander on deck" salute salute salute.....boo hooooooooooo hoooooooooooooooooo hoooooooooooooooooo

Did you see Sol's EYE in shock? Wow. They have to kill her now...man oh man.

[GrandOak]

I understand where you were coming from Jim, it just seemed that a clarification was necessary so the newer folks, of which we seem to have had a lot of in a short time period lately, do not get the wrong impression that PCR tests do not go levels which make them useful.

IMHO, the jump from 5 to 50 is not nearly as great as 50 - 500 and one of 50 may be adaquate in many cases at the prior to tx or even at the onset of tx where very high VLs are involved.

[NYgirl]

Still hanging...as long as I don't have a "Gaius" in my life to sell me out to the cylon's there is NO way I'm gonna stop.  Even if I really really REALLY want to!

My skin...looks like I'm 80 years old now I swear to God I almost just decided enough is ENOUGH the other day.  But today FINALLY I picked out a wig and it's cute so maybe between that and using Collagen again I'll get some semblance of normalicy back! How depressing it gets...just LOOKING and FEELING like **** all the time for so dayum LONNNNNG!

But.........I WANT the SVR and if I can go to bed at night knowing I"ve done everything i could have...then I can relax and let it all go.

It's hard to believe my friend...but it's almost tax time again, can you believe it?

[friole]

Boy that has more truth than you know.  I don't know what the deal is with that character getting fat, but so am I -- LOL.  That peg-copeg diet was the best I have ever been on...

How are you doing, Deb -- still hanging tight?

[friole]

Are you cussing at me (telling me it is almost tax time).  Tax season just ended today -- the final procrastinator's deadline.But you are right - breathe slowly for a couple of months heare and then here we go again.

Did you ever get sqaure with your little problem?

That Gius Baltar - he really is a sleeze bag, isn't he?

[aiuta]

My pre-treatment viral load was 140.  I was an acute case, so I had come down from a VL of over 3 million 2 months before.  That test was to a scale of 10.  Thanks for the post.  It was very helpful to read about others experience with this.  Aiuta