PRC Levels and Length of Treatment

I am a female with genotype 1a and am now on week 41 of treatment with Pegasys and Copegus.  I was an early responder and had a zero viral load at week 6.  Each month I maintained that until week 24 and it elevated to 9,200.  That was in December.  For the last 4 months, I went back down to undetected (the test is HCV QuantaSure Plus (Serial). I was even yanked off the ribaviran and had the interferon reduced to 90 mcg/week on March 1st as my hemaglobin dropped to 6.2 and had to be transfused and the dr. wanted my CBC's to stablize. I was off ribaviran for about 4 weeks and on a half-dose of interferon for two weeks. Again, I had my viral load done and am still undetected.  Has anyone else experienced this?  Earlier I had posted to this forum and some said that I had a breakthrough at week 24 and suggested I change treatment. Given that information, I've got a few questions: What is the possibility of the 24 week report being a false positive?  Has anyone ever hear of someone "breaking through" and then go back to zero?  Also, my dr. who I last saw at the 24 week mark said at that time that he wanted to extend my treatment to 72 weeks (guess he didn't plan on me going back to undetected). I have an appointment with him next week and I want to see if the 72 week extended treatment is warranted. I've scoured the internet for trial studies, etc. of anyone who has ever been an early responder, had a viral load show up once, and then finish treatment being undetected. All input would be appreciated.

[anise]

I haven't heard much about breakthroughs, but there are plenty of folks here that can help sort this out for you.  I kow that NYgirl and R-T-S had a crazy type of breakthrough.  It might be a false positive.  

Good luck to you and keep us posted.

[Kalio1]

That is a weird scenario, maybe a false positive is the most logical answer.
You were then and remain UND in spite of the med adjustments, right? That is great! I think I'd chalk it up to a false positive and move on since it hasn't happened since.Did they retest right after that positive test?

You don't mention your liver damage status, weight, age, etc.that might factor into the decision to extend, one reason he wants to extend might be that puzzling positive test.

Are you stable ( meaning your blood values) now and taking the standard dosages?

[Tcorm]

I asked my dr. to re-test the viral load and he felt it was "no use"...I think he felt from his experience that it was unlikely that I'd go UND again.  So, I was to go for 48 weeks of tx initially and by putting me on a 72 week tx, he was basically starting my treatment all over again.  Obviously, I don't want to have to go longer on tx if it's not necessary.

After I was transfused, I've been watched carefully by a hemotologist and I do not have any anemia right now and my CBC's are still very good and within normal range (except the WBC, of course).  I am no longer even on Procrit.

Thank you both for your quick reply!  I want to go into his office next week and be prepared to "negotiate" the length of tx with him, so I'm trying to gather all my facts.

[Tcorm]

Oh, I am also 51 years old and I had 0-1 inflamation (inflammation) from my liver biopsy 8 yrs. ago.  Back then, the total biopsy results indicated that I didn't need tx...that I was considered a "slow progresser".  Now, I believe they try to treat everyone, even if their liver is in good shape.

[Tcorm]

It was four weeks between my bloodwork from the time it showed that it had elevated to my next labs.  I get my viral done every 4 weeks now.  In fact, it's been UND since and I'm now on week 41 (of what was supposed to have been 48 weeks).  Also, remember that I was without riba for 4 weeks through March and only on 90 mcg of interferon from March 1st to March 14th and my viral load is still UND. Yeah!   My PRC test detects from 100,000,000 to <10.  It's LabCorp's Quantative Sure (Serial) test.

[jmjm530]

If it was a false positive, then 72 weeks is an awfully long time for someone with possibly little or no liver damage to treat, especially if you were non-detectible at week 6. On the other hand, if you did have a viral breakthough, you probably wold be increasing your odds of SVR by extending.  How much time passed between the 24-week postive and your next viral load test which I assume was non-detectible? Also, what was the sensitivity of the tests used at week 6, 12 and 24?

-- Jim

[Kalio1]

It's hard to say with an 8 year old biopsy, it could be the same or it could have changed, hard to say. Assuming it is the same, what is the purpose of the extension, just to cover for that breakthrough? Could be, Im just asking. I'd see what the doc says and what his reasoning is, I think when there is a gap in the meds and the lowering of doses  might be the reason.

.

[nygirl7]

I recently went for my first post treatment pcr and it came back 65<50 which my doctor and his partner believe makes absolutely no sense - that two months after stopping the meds if it were a true positive it would be MUCH higher a number.

I still haven't retested yet (personal problems in the way and laziness of not wanting to know its back).  But they believe that it could easily be some sort of false positive. I don't know.

If I were you - I would continue on with treatment considering it to be a false positive and not a breakthrough.

I did 72 weeks because I had a few (400) critters that kept hanging around and around till somewhere between week 12 and 24.  The problem is that you don't KNOW it was a real count. You could err on the side of caution and continue on and do the 72 if you aren't sure or you could assume it was a false positive.

There really isn't any way you are going to know now. It SUCKS that it wasn't retested immediately.

I think also that you really should have had a biopsy right before treating.  Just because it was 0-1 8 years ago means literally nothing right now. As you know you can go along for 20 years with no damage and then in five years go to stage 4 out of nowhere.

It's all such a damn crapshoot it really is. There just are no hard answers.

I'm sorry I wish one of us could tell you for sure what to do.

Debby

[returntosender]

I had a positive result (65,00) 6 months after completing treatment.  That came out of nowhere since I had been clear at 5 weeks, 12, 24 and 3 months post.  I retested immediately and was undet on that test.  At that point I had one good result and one bad.  I retested one month later at Quest and also a separate test at Labcorp - - very sensitive tests - both were undet.  I assume that the one test was either a false positive or some sort of post treatment viral spike or immune system handoff or something but it was just weird - weird number (too low) weird timing - only took one day for them to do it - and definitely weird since it was one and gone.  

Your situation is complicated because your still treating but my feeling is one positive followed by a few negatives means you can throw out the positive.  From what I have read, false positives are definitely possible with these tests - very possible.  It doesn't make sense that you jumped up to such a low number and then went right back down.  Usually when there is a breakthrough it is more consistent from what I have seen anyway.  I would really think the extended treatment - takes a long time to recover from 48 weeks let alone 72 weeks.  I am just getting my feet back under me and its been a year!  Your were RVR and consistently undet. with one out of the blue positive.  It just doesnt add up - I would test again at 48 and if its clear, break out the bubbly.  Good luck.