Does my viral load actually mean anything?

[HopefulinScotland]

I've found out my viral load, which was tested in July. It's 32,000. I reacted very positively and said "Wow! That's so low That's great!" and the nurse kinda... put a damper on it. She said it doesn't really mean anything. She said it's useful to check for response during treatment, is all.

I thought a low VL meant you have a higher chance of achieving an SVR.

Is that true for genotype 3?

[Rockerforlife]

I think there are studies out there that say having a low VL = better responses to TX,proberly not a big difference tho and i would think all geneo types would apply.My  BASE VL was 21,000,000 and im still UD 3 months post TX

[epiphiny]

Your nurse is right, viral load is really only useful when determining an individual's response to treatment.  

However there are studies around that say if you have a low VL to start and you achieve a Rapid Viral Response (virus undetectable, or UND, in your blood 4 weeks after beginning treatment) then you MAY be a candidate for a shorter treatment period.

On the other hand, I have heard people here mention that although they had a low viral load it took them longer to achieve UND and therefore they had to lengthen their treatment.

What is important to note is that VL is not an indicator of liver damage ie: low viral load does not mean low damage, and conversely high viral load does not mean a lot of damage.

I had a high VL of 17M, carried the virus for 20+ years and yet only had Stage 2 Grade 2 damage when I first treated.

I don't know what the doc/nurse has told you about Geno 3 but until recently it was considered to be "easy to treat" and therefore people with Geno 3 only had to treat for 6 months with a standard dosing regime.  Over the years it has become apparent that some Geno 3s are difficult to treat and the trend nowadays is to tailor treatment dosages and lengths according to the patients response to the meds in the first 4 weeks.

If your Doc is not up to play with this way of treating I would suggest you move on to another Doc, preferably a Hepatologist, who is well versed in current and upcoming treatment protocols and has treated numerous patients.  You could also look out for trials with some of the promising new drugs that are being tested.

All the best to you,

Epi.

[HopefulinScotland]

Thanks, Epi.

I am being treated by the NHS, via a clinic of specialists. The clinic is definitely very experienced as there are a huge number of people with Hep C in Glasgow and this clinic is the hub for the West of Scotland.

I know they will not shorten tx to 16 weeks, but they will also not lengthen beyond 24. I love the NHS, having moved here from America after not being able to receive any medical treatment at all, but there is less leeway for creativity on the part of the doctor.

[susan400]

It means more when you're getting ready to treat, treating, or just coming out of treatment after clearing the virus(while you're waiting to see if you're SVR).   I find that it is also helpful if you're still uncleared from the virus (not SVR) and you periodically check it, just to see how your body is handling the virus away from treatment.  I know that's not real scientific. But, it seems to me that if you're post treatment over a year and you have an extremely low viral load, that you must be less 'active' on the stress that's going on inside with regards to the havoc on the liver.  And if your viral load was like 40 million copies..., it seems to me that more is happening with regards as to what's going on inside.  I realize that the gold standards are like ultrasounds and biopsies.  LFT's can fluctuate just like viral loads.  You can have a normal LFT and still have cirrhosis, so it's really not any better of an indicator, according to what I've been told. Viral loads(PCR's) and LFT's are just tools to add to the ultrasounds and biopsies.  All together they present the whole picture.  But, basically viral loads are more important with regards to treatment.  Susan400

[Bali05]

I was dx in June 09 with a VL of
38k.Just now in Oct. it was 100k.
My ALT stayed the same.
Yes, your VL is very low.Does it mean
much , no.You can have a severe
liver damage and low VL.You can have
VL in the millions and no damage.
You know you have an active infection
that is what a VL first of all shows
no matter how high.
Now the most important next step is
to assess liver damage.
Than while you decidE what to do about it
you need keep inflammation=fibrosis
to a minimum.

Don't be upset if your next VL is a lot
higher.It flactuates.

[jessiejames1973]

low VL means nothing i have seen people with 250 000 start tx and at12 wks only drop to 11 000, sometimes a high vl will drop quicker
you just cant say

[nygirl7]

Yes unfortunately I was one who started with a relatively low VL and had great response at week 4 almost clear (411) but then at week 12 I was stuck at 419.......I did finally clear before week 24 but sometimes what we have SURMISED is that a person with a very low VL has their immune system already ramped up and working to kill the virus so the meds aren't as helpful as they should be. Then you see people with 10,000,000 who are UND at week 4 - so go figure!

that is only a GUESS on the part of some of us who had this happen.

You can't tell what will happen you can only go in treating aggressively as you can and get rid of the dayum disease once and for all.

Good luck!

[newleaf09]

Low VL is a positive predictor of early clearance and potential SVR.  Don't let anyone tell you different.  32,000 is one of the lowest I've heard of.  They can jump around; my first VL reading was 48,900 and a few mos. later on Day 1 of TX was 250,000, still good and low.  I cleared in 1 week on SOC.  Here a few links to reports about low baseline VL as a positive predictor:

http://www.natap.org/2005/AASLD/aasld_55.htm
http://www.natap.org/2007/AASLD/AASLD_62.htm

I can produce more references; don't know why others are trying to steer you away from being encouraged.  Baseline VL of 32,000 is fantastic and bodes very well for your chances!

[GrandOak]

This was addressed at our local support group just the other night by a prominent Hep doctor in my area who is also involved with many of the research trials for HCV.

He reiterated what many of us know and has been shared above that the VL is simply and indication of whether the virus is present and/or if a person is responding to treatment.

There is no corelation between VL and the activity level of the virus in a person nor the level of liver damage.  Some can have low VL and significant liver damage or extremely high with only minor damage.

Studies on effectiveness of treatment are to varied and inconclusive.  One can find studies both pro and con to VL being an effectiveness of TX indicator, and with any study one has to consider the study itself to determine if the findings are credible.

However, just as no one can predict how a patient will react to TX, likewise they can not predict if a person will attain SVR or not.  The general consensus appears to be that one seems to have a better chance, but the odds can not be predicted and assurance of attaing SVR can never be given.

I also do not think that people are attempting to steer someone from being encouraged insomuch as trying to prevent someone from beinglead into a false sense of security then having to possibly face the inability of attaining SVR.

Bottomline, based upon the genotype the odds are well established given conventional TX therapy and appear to be improved with new meds on horizon of being added to the cocktail mix, not in lieu of exisiting TX.

[nygirl7]

Excellent post Grand Oak - glad such a reputable heptologist was in your area.  

It is so true you can find pro/con viral load mattering studies everywhere.  You can find a study to stick up for or object about just about every topic there is - that is why I try to find the big studies at least then you know they are subjective.

As a person who had a low VL to start I guarantee...it's not really a predictor at all - I've seen too many others who have had the same difficulty over the years.

Sometimes I think it's almost better to have a high one....but it sounds backwards logically so people think the opposite!