Is there medical value in more viral load tests?

Is there medical value in having viral load tests more often than 4 or 12 weeks?  For instance if there is a significant drop at 4 weeks but not undetectable is there any value to doing another viral load test before 12 weeks?  I'm trying to find posts that explain why people have an 8 week viral load test.  Is it just for personal curiosity?  Also what constitutes early response - only undetectable at 4 weeks or some percentage of decrease in viral load?

[jmjm530]

It really depends on how your doctor will use that information. In my case, I had my VL tested weekly until non-detectible. After that, my doctor tests monthly. He believes in frequent testing both to track progress more closely so he can either tweak/change meds; and also to help determine more accuratly the date you become non-detectible which may determine treatment length. The monthly follow-ups are to make sure you stay non-detectible. Jensen at the Clinical Options site also believes in monthly VL testing as discused in the "Doc Eye for the Hep Guy" video.

On the other hand, if your doctor isn't going to use this information and only believes in for example the 12-week stopping rule, then more frequent testing can become academic. Still, it might be useful to have in case of relapse or if you want to switch doctors.

All the best.  

-- Jim

[NYgirl]

Personally my own doctor believed in the 24 week stopping rule for UND (4 / 12 for 2 log drop).  I asked for a 4 week but generally he wouldn't do one until 12 - because at 4 weeks he would not consider anyone ready to quit.

However I find value - and once he understood WHY he did too. But I had to explain it and NOT come off like a real know it all (who usually know why LESS than people who admit it LOL) Some doctors aren't really up to snuff when it comes to CURRENT studies and unless you show them to them - don't get it because they haven't read it in a text book on HCV or whatever.

I saw my doctor last night and he said "why are you here at this point you really do know more about HCV than I do" and he was serious.  But I gave him the info on Commitment to Care and on this forum where I found that invaluable information.....and told him to share it with others...and then asked for Percocets for the days I can't get out of bed (that was why I was really there!)

He asked me if I wanted a PCR and I said no not really I had a TMA down to 5 in August and unless my enzymes really spike...I'll wait.

So - it depends mostly on what YOU learn and believe and if he doesn't want to - are able to convince HIM to do.

Does that make sense? Mine didn't think I needed a 4 week - but once I explainned WHY he totally agreed.  He hadn't really read the studies yet so he didn't know - but now he does.

Good luck.

It really does depend on what your doctors practices are.

[bobbyullc]

I WISH I HAD A 6 AND 9 MONTH PCR AS IT WOULD HAVE SHOWN IF THERE WAS A VIRAL BREAKTHROUGH SO THEY COULD DISCONTINUE TX AND NOT LET ME SUFFER. IF YOU ARE STILL NOT 2 LOG DROP AT 12 WEEKS YOU WANT TO STOP. I REALLY SUGGEST A 4 WEEK AS IT SHOWS A VERY GOOD CHANCE OF SVR IF UND...

[motheroffour]

Uhmm food for thought.  When the question was asked of the doc by my h why not an 8 week, the answer was "it won't change anything, you still "gotta go" at least 48 week and I bet you're undetected by 12 so it doesn't make any difference".  After that this doc does 24, 36, 48 and then not 'til 6 months post tx. Even though my h doesn't think it's a big deal (no 8 week pcr) I know it's going to kill me not to know (if he's undetectable).

[FlGuy]

Early Viral Response is usually defined as 2 log VL drop, or undetectable, from the baseline (beginning) VL in 12 weeks.  Rapid Viral Response is the same in 4 weeks.

[l-horn]

" Doc Eye for the Hep Guy" video "

I watched that video. What I got from it as related to frequent testing is because you can have a breakthough, then go back to undetectable, and not be aware you had the spike if you're not testing monthly.

[copyman]

like i posted before i will see what it is at 4 weeks if it is at least a 2 log drop then i will continue to 12 weeks, if unde at 12 i continue if not i stop the suffering and wait for better meds.

jimjim, arent pcr tests like $700 a pop. did your medical cover this. i do not think mine would. but i do like the idea. have you ever said who your doc was/is?

[jmjm530]

Sounds like a plan. My insurance covered all my PCR's which were WEEKLY until week 6 and then every month or two after that.

My understanding is that this is not unusual as long as your doctor writes you an rx for the test. My original NP said she'd "have to fight" for an early PCR but she was wrong. No fight, only a rx turned out to be needed.

$700 BTW seems pretty high. Maybe it's the "retail" price. Many labs like Quest will give you a break on cost if you're paying out of pocket.

I thought I read somewhere that someone paid $350 for Heptimax. Heptimax by Quest Diagnostics would be a very good test for you to take at week 4 and week 12 for that matter.

No, never mentioned who my doc's are. I take too many of them to task here to use names :) Plus, I feel privacy issues are involved especially when sharing private conversations and treatment protocols that may be a bit out of the box. Just my own take on things. Others have theirs. That said, I consider three of the Hep doctors I saw world class by any standards.

Be well.

-- Jim

[l-horn]

" jimjim, arent pcr tests like $700 a pop "

Heptamax is $475 retail at QuestDiagnostics. I get my bloodwork done through my GP, who has an account with Quest and is discounted. Not exactly sure what the cost was, but my last test costs were, for a CBC, Liver Panel and Heptamax $325. So, the heptamax was probably $275 or so.

Try negotiating with Quest or go back to your GP and talk to him about it and see if he gets discounts.

[motheroffour]

Does it make sense to request a more sensitive test at 12 weeks.  The one that my hospital sends is from Mayo and it it is the one that doesn't detect under 500 or something like that or do you need consistancy from test to test?

[jmjm530]

At week 12, I'd like a test with a sensitivity of at least 50 IU/ml and ideally down to 5-10 IU/ml. One such test is Heptimax by Quest Diagnostics.

Others, partly to save costs, order a less sensitive test like a bDNA with a sensitivity of around 600 IU/ml that automatically gets "reflexed" (tested again) with a sensitive qualitative (limit 5 IU/ml) if the Bdna is negative.

I think the first (Heptimax) approach is simpler and also gives you a number, while the second method can leave you not knowing your exact viral load if the Bdna comes out negative and the qualitative comes out positive.

[copyman]

i use labcorp because my coverage pays 100% if i go there but i have no problem going to quest and paying for the 12 week pcr if it is better.
hey jim here is what the labcorp test says: "this test measures HCV RNA in international units (IU) per ml using real time polymerase chain reaction (RT-PCR) technology. It quantitates HCV RNA from 10 to 100,000,000 IU/ml".
Is this test any good or should i use the quest hepamax for the 12 week test? thanks again for the advice you help with here.

PS, i hear you about dropping your docs name here, prob not a good idea. he may get mad because you probably know more then him about HCV, LOL

[jmjm530]

LabCorp is excellent -- just as good as Quest -- and 10 IU/ml is certainly sensitive enough.

BTW which LabCorp test is it? They also have a Quantasure Quantitative and something called an Ultraquant? The former goes down to 2 IU/ml. So if insurance covers it, why not use that one?

If it were me, I'd just call LabCorp up and ask them what is their best/most popular and most sensitive test for HCV and try that one, but like I said, the one you mention sounds fine. Sometimes I wonder why they have so many d*mn tests for Viral Load. Would make life simpler if they found one that was really good and then standardized things. Funny you said that about my doc. Whenever he has residents or visiting doctors around, he always asks me to talk to them regarding treatment protocols I'm using. I do feel blessed to have found a doctor who actually appreciates and listens to my input allowing me to fully participate in tx decisions which I did. I think his attitude derives from the fact he is so confident in his own knowledge of the disease which is mind boggling in many respects. Here is one of the Lab Corp tests I mentioned.
http://www.labcorp.com/datasets/labcorp/html/chapter/mono/id004600.htm

[bobbyullc]

i believe rapid viral response is UNDETECTABLE at 4 weeks...a test at 8 make little difference.