Post-TX PCRs

I hate to keep asking what I feel are the same questions over and over, but you guys always give me great answers.  Hubby finished tx this week.  Does he get a 24wk PCR now and then go back for another in 4 weeks?  I was confused and thought he would just get one done 4 weeks post-tx, but reading some other posts and literature it seems he should have one done now.  

[FlGuy]

Others may differ on this.  Let's say hubby finished tx and took his last shot and swallowed the end of the riba and he has no more meds and has no easy and convienient way to get more. Also, I assume that during tx he was undetectable. If that's the case, a pcr now is merely information. Significant information would be a 2, 3 or 4 week post tx pcr to get an early peek at results. But, if he has access to more meds, would continue tx (mostly uninterrupted) and if he was not undetectable then an end of treatment pcr would be more meaningful.  When I get to that point I might have a pcr about a week or 10 days before the end so that, if necessary, I could conceiveably continue. But more lilely than not, I would not continue beyond the end.  Therefore, even my end of tx pcr would be meaningless.  Reading the jibberish I just wrote reminds me that I did peg last night.

[Maui lover]

Even with last night's Peg what you said makes sense.  His 4 and 12wk PCR's were both UND.  I am pretty darned certain that if he had one today and it came back detectable he would not jump right back into treatment.  He went to hell and back on tx and he's really not into making a return trip just yet.  That being said, we will most likely stick to the plan of getting it done 4 weeks post.  Thanks!

[spcecst2]

I did test one month before stopping to see if I was going on, but if your hubby is not going to retreat right away then what does it matter if he waits 6 months to test! If not retreating and he takes test at 2/6/12 weeks he still needs to take test at 6 months! Or not, your call, who knows!

[FlGuy]

The first time, I waited 5 months after tx for a pcr. The wait was nerve-wracking I wish I had done it sooner. Not that I would have jumped back in, but to get me off edge and a little peace of mind.  PLN wrote in a recent thread about about being UND after two weeks after tx.  Although it's not conclusive to SVR, (like Space says 6 monhts is THE answer) PLN has a least some of the weigth off her mind.  Being und at 4 and 12 is great news and you and Mr. Maui have reason to be optimistic. But, the waiting is brutal. It's another sx of tx - without the meds. Good luck to you both

[jmjm530]

You want to test now  at the end of treatment and then at 4, 12 and 24 weeks post treatment. The reason for the end of treatment test is to get the last reading of  viral load while your husband is still on the treatment drugs. This is important because it can distiguish between relapse and viral breakthrough, something you would just be guessing at if he came back detectible in a post treatment test. If you don't want to do so many tests, then I'd drop the week 4 post treatment test unless your husband plans to jump right back into treatment.

All the best,

-- Jim

[jmjm530]

It's also important that all of the tests -- especially the EOT test -- are the most sensitive you can find. Two good ones are "Heptimax" by Quest Diagnostics and the "NGI Quantasure" by LabCorp. Sensitivities are 5 IU and 2 IU/ml respecitively.

-- Jim

[Kalio1]

My thoughts on it are that it would depend on when EOT is, by that I mean some take Riba for the week after they take the last shot. If that is the case, then you test one week past last shot.
In my case, I waited until the two week past last injested meds. I figured if I was lucky and cleared by then I could rest a bit easier if I knew sooner but knowing I would have to retest at 1,3,6 and 12 months. As it was I relapsed and had planned to retreat right away if that happened so I wanted to know ASAP. I was afraid a one week test was too soon back then, but this time when I finish I will test at the one week past mark too.

If EOT dosing is both Riba and the last shot stop on the same day, I wouldn't recommend taking your EOT test until a week after that last shot to get the truest reading. You don't want to PCR test right after taking an Interferon shot, better to always do them just prior to taking the shot or in the EOT situation, after the week has passed.

[GoofyDad]

I wasn't to get one because the doc (and he's a pretty good one) didn't think it mattered. He wasn't going to keep me on the drugs if I had a breakthrough, and he seemed to feel it unimportant to distinguish between breakthrough or relapse at that late point. I know he felt the chance of relapse was relatively slim, so maybe he thought breakthrough was so unlikeley it didn't warrant the cost of the test.

My thinking was closer to Jim's - I though breakthrough vs. relapse could be an important data point. So I finagled a test at 1 week before eot so that I would have the results soon after stopping.

Then nerves got to me so I finagled a 4 week and 12 week. Also a 24 week and 36 week. No more tests for a while for me.  

[CitizenSmith]

In my humble opinion a 10 or 12 week test is the way to go.Although not definitive it's pretty much as good as a 6 month to say if you have SVR.

[Kalio1]

technically taking your test the "day before your last shot" would not make it an EOT test. In order to be an "end of treatment" test, your treatment has to end first. Your scenario the person is not getting an EOT test, they are getting a test during the last week of treatment.

[jmjm530]

The EOT test is somewhat of a misnomber.

Because as you correctly point out, if you take the test right after tx ends -- say the day after your peg shot -- you may get a false read because of the shot. And, if you wait a week, like you suggest, it's not end of treatment at all -- it's *post* treatment and therefore no way to differtiate a relapse from a viral breakthrough if result is positive.

Therefore, what you have to look at is the *purpose* of the EOT test. And the purpose is to differentiate a viral load reading while still on the treatment drugs as opposed to a viral load reading after you're off the drugs. Because if you're off the drugs, then again, it's a *post* treatment test.

So, in a sense, the EOT test means taking a test at the end of treatment, not after treatment has ended.

Be well,

-- Jim

[jmjm530]

I'll also add that I'm sure different doctors order the EOT test on different days, and from what I read here, some don't even order it. I'm sure there are also many here who don't take their vl tests on the "trough" day either. So, maybe there is no single definition of when to take the EOT test, although researching out several trials studies would probably get you closer than anything to a consensus, maybe. But according to my understanding of the purpose of the EOT test, you take it as close to the end of treatment as possible, with the limitation that you want to take the test on the same day as you've always taken it, which should be on your "trough" day -- day before the shot, or possibly on the day of your shot.

[jmjm530]

Good point, when exactly is EOT, but I disagree in terms of your second scenario, i.e, if you stop the peg and riba at the same time, which is probably not the right way to end treatment IMO.

If you take riba for a week after your shot, then the ideal day to test EOT would be six days after your last shot. That way, in case of a positive test, there would be absolutely no confusion whether it was viral breakthrough or relapse.

However, if you stop riba with your last shot, then the ideal time to take your EOT test would be the day before your last shot. If you wait a week, you again run into the problem in case of a positive result, i.e. is it a viral breakthough or a relapse. Of course, you could argue that a week later you still have peg and some (albeit less) riba in your system, but since there's no reason to wait the week, why do it?

After your EOT test, then post treament viral load testing is really a matter of how soon you want to know, keeping in mind that only a positive is definitive, while a negative only starts to become close to definitive at 12 weeks post treatment.

-- Jim

[Maui lover]

I guess an EOT test is out of the question since he did his last shot a week ago Friday and took his last Riba three days ago.  I guess we'll stick with the plan of doing it 4 weeks-post (using the Riba end date).  I probably should have asked this questions before he finished treatment!  Appreciate everyone's input.  

[jmjm530]

Insurance, money issues aside -- if it were me, I'd still get sensitive a viral load test Monday. Maybe not a perfect EOT test, but it could have some diagnostic value in the future. Or, you could just test four weeks after the last riba.

All the best,

-- Jim

[GoofyDad]

I'd still get sensitive a viral load test Monday.

Now tell the truth.... just one???