Checking viral load decrease

[stg088]

Hi everybody.
I think I'm on information overload.  I read somewhere that people who have cleared the Hep C virus after 4 weeks of treatment are less likely than a "late responder" to relapse after treatment ends.  This study also indicated (I think) that later responders probably need 72 weeks of treatment instead of 48.
I am genotype 1a on my 3rd week of treatment.  NIH and my doctors office say that viral load doesn't need to be rechecked until week 12 (but then, my doc's office also told me that I didn't need any lab work until week 4 - when I pointed out that NIH recommends checking blood count and transaminases at 1, 2, and 4 weeks, they said "oh yes, that's right" and the NP ordered a basic metabolic panel (doesn't contain liver enzymes), a TSH, and a CBC.)  So anyway, I'm trying to stay on top of things myself.
My question is this:  is there any reason why I need to know how much my viral load has dropped at week 4?  Might this info be helpful later if I find myself in a situation where I have to decide whether to extend treatment?
Thanks!

[nygirl7]

If you are UND at week 4 you have excellent chance of success of treatment.  
Week 12 is the 'normal' point where we need to have a two log drop (take two zero points off the number for example if your viral load was 100,000 you would need to at least hit 1,000) but preferably have to be UND.  If you are not UND at week 12 you need to seriously consider extending to week 72.

At a week UND 12 you have a 50/50 chance roughly.  After that it sharply declines but by doing the 72 ups the chances again.

That is why week 4, 12 and 24 are the most important tests for us.

I had a count of only 411 at week 4 but at week 12 I still had 419, not UND.  I was UND by week 24. Therefore I treated for 72. I have been cured for almost three years.

I hope that helps. It IS a lot to process.

[Duke3d]

Yes I think a 4 week viral load test is invalubale. It lets you know how you are doing. If you relapse later it can help you better understnad if you are  a slow responder. If for some reason you have issues that make you and your docotr consider stopping treatment early , or have a need to reduce meds it  helps you know where you stnad at this point in time.

4 weeks is the new first  benchmark for taking a look a what is happening and how things are going. That info  can tell you a lot about your odds of svr and can be used to tailor the rest of your present treatemtn or follow up treatment if that is needed.

I would insist on it.

Gail

[neptune235]

"Might this info be helpful later if I find myself in a situation where I have to decide whether to extend treatment? "

Your exactly right -- there is a growing volume of jounal articles that break out sub-groups of respnse to treatment, and I think the trend is strongly towards treating each group differently  

As has been pointed out, if viral load is UND at either week 4 or 12, your chances of attaining SVR are the best -- with a course of 48 weeks tx..

Then there are those people that, for whatever reason, still show a detectable viral load at 12 weeks, but become UND before 24 weeks.  It is this subgroup that there is growing evidence that an extension to 72 weeks of tx improves SVR rates significantly.  This effect has been documented in journal articles, and should be well known by hepatologists and, I think, also gastroenterologists.

What follows is my opinion.  If you are DET at 12 weeks, but clear by 24, one extends to 72 weeks of treatment.  I think that at this point, the number of remaining weeks of tx AFTER becoming UND is important.  

Obviously, if you clear at 12 weeks and one day and go the full 72, you have nearly 60 weeks of tx after UND.  If you clear at 23 weeks and 6 days and go the full 72, you have just over 48 weeks of tx after becoming UND.

It would be interesting to document whether those folks closer to the 12 wk + 1 d end of the range have better chance than those closer to 24 wk - 1d end.

This supports the idea that the sooner you knock down the initial viral load to zero, the better your chances for SVR.