PCR vs. CBC

[LadyY]

hello Deb (nygirl) and everyone,
I saw my GI on the 5th. I asked about PCR. He said he saw no reason to do that at this point and ordered a CBC instead. He said he would order the PCR around the 12th week. What say you?
Thank for anticipated input.
Yvonne

[ladybug52]

Refresh my memory please, what week what geno type. Not that it matters, I would still want a 4 week sensitive pcr like heptimax. Also you get the blood taken the day before or day of shot 5. Whenever the meds in the body are lowest. You may have to go to another dr, like your pcp and ask for the heptimax, that's what I had to do.
good luck
Bug

[LadyY]

Good idea,
thanks so much...I am geno 1a, just did 4th injection on friday (4/06/07)

[ladybug52]

Good you still have time. Try again with your dr about the heptimax, and how important it is too you.
Good luck
Bug

[mikesimon]

Maybe you could direct your doctor to www.clinicaloptions.com where there is a lot of good information on HCV and treatment.
I found this quickly but it may be relevant:

"Jensen and colleagues examined data from a large, randomized, phase III study that treated patients infected with HCV genotype 1 with standard and low-dose therapy for 24 or 48 weeks to determine if those who achieved an SVR after 24 weeks of treatment could be identified by an RVR at Week 4. Patients with an RVR had a higher rate of SVR, regardless of treatment group. The data also suggest that there was no difference between SVR rates in patients with RVR when 24 and 48 weeks of therapy were compared. Furthermore, for patients who did not achieve RVR, SVR rates increased as the duration of therapy and the ribavirin dose increased."

I think it is pretty well established that a patient's 4 week response to treatment is highly predictive of the likelihood of achieving SVR. I just don't understand why any knowledgeable practitioner would be reluctant to test VL at 4 weeks with the most sensitive test available.

Mike

[mikesimon]

From:
http://clinicaloptions.com/Hepatitis/Annual%20Updates/2006%20Annual%20Update/Modules/Sulkowski/Pages/Page%207.aspx

"Taken together, these studies suggest that the current standard of care—monitoring HCV RNA at 12 and 24 weeks—is not sufficient to guide treatment decisions during treatment with peginterferon and ribavirin. Increasingly, strategies that emphasize early monitoring of viral response are being incorporated into clinical care to improve treatment outcomes and limit exposure to therapy that has a low chance of success based on patient or viral characteristics. Current treatment guidelines include consideration of early (Week 12) identification of treatment failure (< 2 log10 decline in HCV RNA from baseline), which can justify treatment discontinuation to limit toxicity and cost for these patients who are not likely to have a virologic response. A more recent development is the use of early viral RNA level at Week 4 of treatment to determine the probability of viral relapse, which may further refine the use of early virologic response monitoring as an effective guide for identifying the optimal duration of a treatment regimen.[9] Emerging data suggest that some patients with rapid viral response (eg, HCV RNA undetectable at Week 4) may be able to shorten their course of treatment, whereas others without complete suppression of hepatitis C replication (HCV RNA detectable at Week 12) may benefit from extending the course of treatment.[10] Future HCV treatment guidelines will need to incorporate these data on individualized treatment duration to improve outcomes with current therapies."

Mike

[jmjm530]

I think what Mike is saying is to tell your doctor to get off the pot and order the d*mn 4-week test :) The trouble of course with the doctors that don't order the 4-week test is that they are the same ones that don't indivdualize their treatment approach based on viral response earlier than week 12. Still, only an upside to get the test but perhaps more uphill battles with this particular doctor, as with many, many of our doctors. Best time to get your week 4 test is the day before your fifth injection or the day of the fifth injection but before the injectrion.  Mike, you saved me some time as I was looking for something from the site to post over on the other side in your dear friend "Mo's" "riba" thread. I therefore copied the link here.

- Jim

[mikesimon]

Thanks for making my post clearer. I was trying to be diplomatic and that stifles me a bit. There in no valid excuse for not testing at 4 weeks - unless ignorance and/or disregard could be considered valid. It's appalling that we patients know better than our doctors - or maybe we just take it more seriously than they do. Mike

[jmjm530]

No, you made it clear, I was just having some impolite fun :) I agree, about some of the doctors treating us. A few have posted that by the end of treatment they knew more than their medical team. While this is a testament to those who learned so much, frankly if I for a minute thought I knew more than my medical team in regard to HCV, I'd switch immediatly to a medical team that knew more than myself, as I'm sure you would as well. I do understand however, that depending on the part of the country people reside in, as well as other factors, switching doctor is not always that easy.

-- Jim

[Kalio1]

The 4 week PCR test is SO important, I would call that doctor and basically demand the test. You need to know the results of that test so you can make decisions about your treatment, ie how long to treat. You need to get the test sometime this week if at all humanly possible. I would not take no for an answer, he is correct that he should again test you at week 12 but he needs to update himself and be testing his patients at the 4 week mark to determine their viral load if any.

He is using old info if he doesn't recommend you PCR test at week 4 of treatment! I'd get in there and get that lab slip for the PCR DNA test.

I'd take the info. MikeSimon gave you to him or fax it to him or have him review the info at clinicaloptions.com. You need to know if you are RVR(rapid viral responder) if you are, and you are Undetectable at week 4, your chances of clearing the virus and obtaining SVR improve.