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Jim: 2 wk VL results in-->4 wk

My pre-tx viral load was 2,840,000 IU.  My two week tx viral load results using LabCorp Quantasure Plus ( # 550027) is 136,000 IU.    According to my calculations,  2.84 mil IU = 6.45 logs and 136,000 IU = 5.13 logs which comes up with a 1.32 log difference.  
  I do not know if the 2 VL wk result is an indication of what to expect for the 4 wk result.   Do you think the 2 wk VL result is significant enough  for me to request LabCorp ngi hcv quantasure # 140639 for my 4th week vl test.   Or is the result considered mediocre and should I stay with the LabCorp Quantasure Plus ( # 550027)?  Thanks. Ginger.
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Avatar universal
Well,  I won't see the doctor till next week at which time I get my 4th wk blood work (and at that time, I guess it would be too late for a 4th week RVR).  I am not totally winded (not sitting down yet),  but find myself huffing a bit more when doing things.  I will talk with my doctor when I see him - unfortunately, he does not seem to encourage conversation.  Thanks Jim.  Take care...Ginger
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Avatar universal
I'm sure most docs would say to stick on the riba dose you're on, given your stats including liver damage, viral response and hgb drop.  Still, a case could be made for increasing the riba but there are some risk such as more side effects and faster hemoglobin drop.

Personally, I'd probably ask about upping the riba to 1200 and go for that RVR, but again, I don't think most docs would go along and the fact that you use the word "winded" gives me pause, so I'm assuming you're not "winded" to the point where you have to stop, sit  down and rest when crossing the street which is where I found myself.

If you do increase, you would want weekly CBCs (twice a week if symptomatic) and the ability to get Procrit (epo) if necessary. The idea here is to squash the virus quickly while taking reasonable risk.

-- Jim
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Avatar universal
Thanks for the info.  I called my doctor's office, and found out my 2 wk HGD dropped to 12. (pre tx was 14.5 and 1 wk was 14.0).  Does this drop discourage the possibility of increasing the riba?  Is there a particular HGB low number that I should watch for in order to get ready for a rescue drug?
They also said my 2 wk WBC dropped, but didn't give me the actual number.  (It is not easy to get info from them).  (pre tx WBC was 6.4 and 1 wk was 4.6).
My next blood tests will be Feb 5 which will be the 4th week VL and CBC.
I try to eat a good breakfast and dinner with some fat. I take 2 riba in am and 3 riba in pm as per my doctor.  I am not a good sleeper to begin with, but since I have been running a fever I take tylenol pm when I go to bed, and that helps me to sleep.   Thanks.  Ginger
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Avatar universal
I agree with FL if sleep is a big problem, but everything being equal, I'd take the riba with your biggest and fattiest meal -- so if that is at night, then I'd go 3 riba at night. The other thing you can do to help sleep is simply have your dinner meal earlier, if the logistics work. When I treated, I ate twice a day, with bkfast usually between 10am and 12PM and dinner between 3-6PM. I think eating dinner early helped me sleep. BTW not necessary to space your riba 12 hours apart as riba has a very long half life. At least according to my doc, NP and two other consultants I spoke to.

-- Jim
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96938 tn?1189799858
If I took and odd number of riba I think I'd take the 3 in the am and 2 in the pm.  As much refreshing sleep as possible helps you maintain a good pace.  Two in the pm may cause less sleep interruption then 3. Give it a try if you encounter sleep problems.  No problem in switching around as long as you get your full daily dose.
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Avatar universal
You are on weight-based riba.and hard to say if you could handle more riba with only week one hgb results in. I would think your week 2 hgb value would have been in before your viral load test unless they didn't do a CBC at week 2? I guess what I'm getting at is that if your hgb stays flat at say week 2-3 (it only dropped half a point at week 1 from pre-tx baseline) then adding another 200 mg/day or riba is something you might discuss with your doctor to try and get to UND as soon as possible. Personally, I'd ask for weekly CBCs until UND as well as weekly viral loads until UND, assuming your insurance will pay.

-- Jim
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Avatar universal
here is my response...thanks....ginger
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Avatar universal
Thanks Jim.  
I don't mind requesting the NGI HCV Quantasure for my 4th wk vl - if my doctor agrees.  
My pre-tx hemoglobin was 14.5 ,  WBC was 6.4 x 10E 3/ul,  RBC 4.41 x 10 e6/ul,  HCT 42%, Platelets 322 x 10 e 3/ul.   I only have 1 wk post tx results:  HGB 14.0, WBC 4.6,  RBC 4.26,  HCT 40%,  Platelet 328.

I started tx 1/8.

My height is 5' 5', and my weight is ~ 119 lbs (though I feel like I have put on a lb or two eating my fatty riba meals).  I am taking 1000 mg of riba a day (2 x 200 mg w/ bkfst and 3 x 200 mg with dinner).  I am taking 180 mcg of Pegasys weekly.
Overall I am feeling ok.  Usually in the evenings, after my riba dinner, I tend to run a fever and feel tired.  Some days I feel weaker, other days I feel ok - but I do realize that I get am getting winded easily.  Thanks.  Ginger





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Avatar universal
I didn't do the exact math, but it does appear you had between 1-2  log drop, which means you are responding, but still a ways to go.

If you do want a test more sensitive than 10 IU/ml,, then by all means get the NGI HCV Quantasure at week 4, because it's possible you will be UND at week 4. That said, if it's going to cost you out of pocket, you might want to wait unitl UND via Quantasure Plus before ordering Quantasure. Quantasure Plus (limit 10 IU/ml) is still considered a very sensitive test.

BTW how are your other values, for example, your hemoglobin -- both pre-treatment and at week 2? How are you feeling? Also, I assume your're on weight-based ribavirin, but curious how much do you weigh?

All in all, I think you should be optimisitic for an RVR or something very close. If you're not on weight-based riba, or if you haven't had much of a hemoglobin drop in two weeks, then you could discuss with your doctor upping the riba.

All the best,

-- Jim

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