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Re-Post What is the Definition of 'High' Viral Load During Pregnancy/Birth?

I'm sorry, I reposted this b/c the 'post a comment' option was somehow disabled on the first post I had..It leads to a web page instead.
I have been trying to research information on the web re: vertical transmission of HCV & viral loads. I noticed there seems to be a correlation between the mother's viral load at the time of birth & transmission to the newborn.
I have been Hep C positive since at least 2000. I gave birth to a son on 9/30/03. My last test for viral load before I gave birth was 7 months prior in March, 2003 & it was 572,000, way up from 188,000 in Sept 2002..VL seemed to spike during my pregnancy & then afterward, dropped to down to 29,500 in March 04, then undetectable June 6 2006 & now I just got more results today, Aug 8th & VL is 5,035, up again.
My question is what is considered a dangerous high VL for a mother while pregnant or giving birth? IS Hep C transmitted intauterinely or during the birth?
Is it possible the pregnancy caused my VL to rise or is that just a coincindence? IS it normal for the ranges to fluctuate so greatly?
Thanks,
Lisa
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Yes, that is strange. Snook, maybe you better lay off that fancy HTML code for awhile. It appears you have directed all of poppea's replies from her first thread to another web site :)

Poppea,

I don't have any answers, sorry. All I know is that the ratemother to child transmission is very low. Hopefully, others more knowlegeable will stop by. Anyway, if you click on the comment button in your original thread you'll get to a web site that Snook tried to direct you to :)He knows a lot more about this than a lot of us.

-- Jim

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Hi,
I read your comment & wanted to answer you but the 'post a comment' option on my first post doesn't lead to a dialog box, instead it leads to a web site..

So snook, I take it you are an adult & have had HCV your whole life? Wow...And now you are going for treatment? What is your genotype? I am 1a which I'm told is bad.
My levels are very inconsistent which I'm not sure what that means.
I am confused about the medical reports re: vertical transmission. The results are often contrary to one another. I think I saw some reports saying the virus spreads through the placenta. But then, it seems like they aren't sure.
I had a C-Section & my son was yanked right outta there in 2 seconds then rushed over to the wash area.
Did you ever see that kids' show "It's a Wide Wide World"? The main character is named Snook.
Lisa
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Viral loads fluctuate.  Even at it's highest, yours hasn't been that high.

Here is a link for you that discusses viral load:

http://janis7hepc.com/Viral_Loads.htm#Viral%20load%20chart

There's more info at the main site:

http://janis7hepc.com
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Also, I had twins a couple of years ago while infected with HCV.  Soon after their birth, my viral load was around 2 million.  Neither twin is infected with HCV.  

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I stumbled across a post of yours on here from 2005 where you explain your mom's natural water birth. I wanted to ask you, how can you be totally sure that your birth is the way you got HCV? If you weren't tested til you were 15 when you started getting symptoms? Some people just don't know where they got it, maybe yours was transmitted via some other means you were unaware of? If you've answered this question already like, 1000x please forgive me snook..I'm a newbie..
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I have know idea what happened in the thread below, but I emailed Cindy and Phil to have it deleted..
I am 29years old, infected at birth. I WAS genotype 1a, but "cured" by taking the 48 week combo tx.
Your levels being inconsitent are somewhat normal..Viral loads do tend to fluctuate. But then being so incredibly low, and even going undetectable at times, correlate with an extremely strong immune system. Your body is fighting, but just does not have enough to knock it out for good, so to speak. This is how it was explained to me. Our immune system might knock it down to an undetectable level, but then stress or heavy alcohol consumption may allow it to increase. Like I said, you are one of only a few I have seen in my years on the net that have had such a low starting VL.. Mine was only 4000. But at the same time, I had moderate fibrosis, stage 3. My Dr explained that the immune response being so strong, played a contributing factor into the progression of fibrosis, sort of like auto immune hepatitis, where the body is actually attacking the liver.
That is why I became sooo concerned during tx, as my ALT's never normalized, and this is a sign of AIH..
But I did 48 weeks of tx, cured, and ALT's are now 21..

The information you find on the net in reference to vertical transmission is limited. Being that you had a c-section, odds are VERY low of your child being infected. From everything I found, and my wife being a nurse, the virus is transmitted during the breaking of the placenta, and the baby exiting the birth canal.

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Birth was Dr's explanation, based on the fact my mother is infected with same genotype, 1a, and amount of damage to my liver.
Studies suggest that children progress slower than adults, and the median time from stage 1 to cirrhosis is 30years.
Well I had biopsy at 26 I believe, and that would correlate with 30 year theory.
Another theory was that I was infected at like 10 in Jamacia from my mother via blood and open wound, then the over active immune response and heavy alcohol consumption speed the progression up.
I don't think anyone is certain of the exact point of infection, unless maybe a healthcare worker with a needle stick or something.
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I have to get my son tested & I'm so afraid to find out which I guess is normal. It would seem the odds are in his favor but I'm having panic attacks thinking about it. I have been very stressed out lately, maybe that explains the little jump in the viral load. But I'm nervous now that there is a higher risk of the fibrosis if you have low viral loads. The tx is another thing I'm pretty scared to do. I kinda wish HCV drug options were less terrifying. 48 weeks is a pretty much a year of treatment. It seems like most people are just sick the whole time with the Interferon combination therapy.
Lisa
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Your son needs to be 18 months old or more before he is tested.  Otherwise, he will test positive.
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I have not posted here in quite some time, but have been lurking.  I saw this post and had to respond.  I am a geno2, almost 12 weeks post tx.  My most likely mode of transmission was a blood transfusion I had at birth.  I have a 2.5 year old daughter who was infected via vertical transmission.  Let me pass on to you the little info that I have.  

First of all,
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Hey Lady,just noticed your reply to and to poppea and had to say what a wonderful change so many go through from our first timid or fearful queries on this forum to jumping in to correspond with others who's worries you can identify with. Thanks amommy, hope post tx is going well.
Be Well,
Don
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Been missing you how are you , I was reading this post earlier, and thought of you,
Hows your hair doing, has it started growing back? im plugging away on 35/48 will be done in early november, have you taken your post tx pcr? I know you were worried about it, i think that will be the longest 3months when its my turn to wait for that result....
                  Blessings to you and your family
                              angie
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151543_tn?1233628148
Wow I'm sorry. Are you seeking treatment for your baby or waiting til later? Your viral load was 1 mil or so at birth? I am concerned that mine was 525,000 7 months prior & wonder if it could have jumped to/past 1 mil in that time. The numbers really went down, down after I gave birth. My son is gonna be 3 in Sept so he could be tested, I'm just really worried. Really, what new drugs Your
I had a C-Sect but it wasn't planned. My water broke hours before but labor didn't progress at all for 5-6 hours so they went in.
I read somewhere tonight that girl babies are infected slightly more than boys..
Lisa
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I don't know about vl and verticle transmission but amommy is correct on the 5% rate.  That percentage is for viginal delivery (snook I have know idea if water birth is included in that data) and even lower for c-section, 3% but obviously it does happen.  My baby is 3 too (yours almost)and we just got the all clear a couple of weeks ago and it was very scary.  I know I don't have to tell you how bad it feels but the entire time I kept thinking about how my life has revolved around protecting my baby and what if it turns out I am his worst enemy by giving him this virus.  Fortunately, that was not the case for us and I hope this will be true for you as well.  And appears snook turned out pretty great even though the fates were different:)

Alady makes a good point that a positive antibody test until the age of 18 months does not mean much except that the baby created antibodies to the virus in utero.  After 18 months however a positive antibody test most likely indicates the child does have the virus according to pediatric infectious disease specialist we saw. Further on that, children infected this way have a 50% spontaneous recovery rate...more good news.

Amommy, I am curious about your child's doctors treatment recommendations.  I know they will treat children as young as 3 but the doctor we saw said he did not recommend treatment until a much later age because of the slow progression in infected children and improvements in treatment.

Hope some of this info helps and I will be thinking about you and your baby.  Keep us posted.
Kathy



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Hey Strator, how are you doing my friend?  I saw your post the other day, and I have to say I am so happy for you that you have come to such a peaceful decision to stop tx.  I hope and pray for you that your sides disappear as soon as possible and you get your life back.  Your cure is coming, and it will be sooner rather than later, I just know it.  You gave your liver a good break from this stuff, and kept up with your busy, demanding life at the same time.  Kudos to you. You need to stick around here, you are such an asset to this community!  

Goldyn, I'm hanging in there!  I will go on Monday for my 3 month post blood test.  Anxiety is running high.  So, I found myself glued to this place the past couple of days.  Always find comfort here!  You are so sweet to check in on me.  My hair has pretty much stopped falling out and is much thicker now!  My fingernails are so incredibly weak, it is kind of odd.  Overall, I am feeling great!  I keep picking up these summer colds, but that's what a snotty 2 year old gets ya.  How are you holding up?  You are ALMOST THERE!  I know it seems like time is dragging during treatment,and for me anyway, it got worse once the end was in sight.  I promise you that it will go by quickly!  You are doing great!  Can't wait for your post saying you are done.  

Poppea and mommy too, we are more than likely going to wait on tx for my daughter until she is a bit older.  Her specialist is one of the leading guru's for hep c in kids, and in some ways, I think she wants a test subject so I need to keep that in mind and not let it affect our decision.  Her recommendation is based on getting the kids done with treatment before they start school.  Less stuff to deal with if it is done and overwith before the kindergarten years.  Also, the fewer years you have the disease, the more likely you are to clear it.  I however, feel optimistic about vx 950 and think we will wait to see what shakes out with that.  My daughter is going to be 2.5 this month, so we have 6 months to see what the VX 950 data is showing.  We will not even think about it until we get some more info about that.  It IS stressful, but at the same time, she is such an AMAZING and incredible little girl, that I can't imagine it any other way.  
I am anxiously counting down to 6 months post tx so we can try for another baby! :)  
Blessings to all of you!  
It is so hard to keep up around here these days, that I haven't been posting much, but I'll pop in when I see a thread I can contribute too!
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I agree that the most recent studies indicate that the difference in transmission in vaginal births versus c section births is not statistically significant.  That being said, when it was me in that situation, I actually fought for a C section because I KNEW that I had to do everything I possibly could to decrease the odds of transmission.  Now, having been through what I have, I know the C section wasn't the answer, but in the same situation again, I would make the same decision for the sake of the CHANCE to keep my unborn baby from being infected.  Does that make sense?  It's just that unwavering desire to protect your child in any way you can.  Anyway, at the time that I was researching all of this ,and bringing articles in to my specialist, the articles were indicating the rate was slightly less.  It seems that that has changed.  Additionally, in my hospital I actually had to fight for the C Section.  I delivered in one of the major urban hospitals in Boston and it is not a matter of course to do c sections for hep c positive births.  HIV is a different story, and those are mandatory C sections, but I had to fight for a C section for hep c.  
I'll try to drudge up some links tomorrow.  Now I need to go to bed!
Goodnight all!
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Do you know if it's typical for viral load to go up during pregnancy? Mine was definitely up higher than it ever was or has been. Maybe from all the stress on your body from being PG.
Lisa
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I'm happy for you all is well with your baby. You must be so relieved. I have to get my son tested. He's never been tested yet. He's on vacation w/his grandparents right now but I am taking him for bloodwork the day after he gets back the on the 13th.
What is vx 950?
Lisa
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You underwent tx while caring for a toddler? I am so in awe of you.
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I just wanted to say that it's really nice, even after tx, to see a group of currently/once HCV positive moms of little ones.  I finished treatment about a year and a half ago & remember feeling like the only person my age that was dealing with a toddler & treatment at the same time. Welcome:)
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Hey,
Thanks cao.  I am very fortunate that I have a supportive family.  Also, I am fortunate to be a geno 2.  I was clear at 4 weeks so I ducked out of tx at 20 weeks.  It remains to be seen if that was a good decision, but at the very least, it allowed me to survive.  I feel a little guilty because my 2 year old watched MORE than a little bit of TV during that time, but thankfully it was over a brutal winter so she didn't miss out on too much.  
I often wonder how many of us moms really are out there.  It is nice to see more around here.  I just wish NONE of us were in that boat!  
About viral load during pg, in alot of people, viral load actually decreases during pregnancy.  For whatever reason, I did not react that way.  

Hope that all of you have a great weekend!  I am about to take a nap :)  My 2.5 year old got up at 4am UGH.
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recent studies do not support c section as a better delivery method for hep c infected mothers. it does not decrease the risk of transmission. No one is certain when it happens and how, so either method of delivery carries the same risk of infection. There  is one study that got published early this yr or sometime last yr. Do not choose c section because you think it might decrease the risk, it is not supported by medical data.
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Not to call you out or anything, but can you point me to the studies? Interested, as my wife worked 6 years in Labor and delivery, and they still make C sections mandatory for infected mothers. The reason being, less probability of infection.
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Are any of these studies available on the web? I'm very interested in reading them. Yesterday I spent several hours Googling/reading articles/abstracts about vertical Hep C transmission. Many of the articles are studies done on groups of mothers & I would say the majority of them imply that planned C-Section is less risky than vaginal. Maybe because the planned aspect of it means there's less that should go wrong & a less prolonged time of exposure to the mother's fluids as in a vag birth. Also said somewhere that the rate of infection is lowest in the US, where C-Sections are more commonly performed. However, some of the articles were 6-8 years old & it's hard to tell if it's still the current belief. I agress that maybe 1-2 studies, I think the one from the link in one of the above posts showed no correlation between decreased vert infection & C-Sect.One thing all the research agrees on is that C-Sections are safer for HIV/HIV-HCV co-infected moms b/c HIV is in all body fluids. The info seems somewhat ambiguous re: HCV-only infected C-Section where blood is the only carrier.
Lisa
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Seriously, C-Sections are mandatory for HCV deliveries at your wife's hospital? That suggests to me that the medical community is pretty convinced they are less likely to vertically transmit, even
if not 100% safer than vag. There also seems to be a lot of conflicting info on episiotomy vs tearing too but I never had a vag birth so I can't really relate any experience on that.
Lisa
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I read up briefly on vx-950 & wow, I hope it works as well as they say. There are threads on this forum re: clinical trials for it which I will read now..When is vx-950 scheduled for release? Exactly how long does it take for a drug on the FDA 'approval fast track' to get to the public? If it works as well as they are touting, (little or no adverse effects) it should be flying off the shelves but will probably be expensive, I'm guessing. Coincidentally, I went to grade school w/some of the Johnson (& Johnson) kids. They were so bleeping rich I couldn't believe it.
Guess they are still making $$ hand over fist.

http://www.vrtx.com/Pressreleases2006/pr063006.html
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Forgot to mention that my viral load during pregnancy was around 5 million.  It did not decrease at all during pg.  However, my ALT and AST decreased during pg.  :)
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In this link you posted above it says:

"A 1997 Italian study reported on a sample of 245 infants, with a vertical transmission rate of 3.7%, but higher figures in HCV/ HIV co-infection (15%). This group also reported a higher risk in vaginal vs. caesarian delivery. As will be seen, later data from larger prospective trials refutes the potential benefit of C-section."
Then it lists 5 other studies, a few of which show results that differ greatly IMO from most of the other studies I have read.

One of the other studies states no difference in infection rate between HCV+ & HCV/HIV+ mothers which contradicts like every single study I read.
The summary for the whole article states:
"Prophylactic caesarian section is not recommended in HCV infected or HCV/HIV coinfected mothers."

It looks as if there is still much conflict within the global medical community re: vertical transmission.
Lisa
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So I figured if I ever did get the tx, I'd wait til my son was in kindergarten so I'd have the day to be sick/rest/go to the dr or whatever..I'm very interested to learn how you ladies coped with drug tx & cared for small children at the same time. Were you home all day w/the kids or employed out of the home as well? Did you take them to day care or to your parents'? Did you have help at your house cooking & cleaning & stuff? I keep reading that being on the tx is like having the flu all the time-is that like a severe, 103 fever, puking, wanna sleep all day flu or a mild, under-the-weather-but-I-can-cope flu? And is this a constant symptom that never, ever goes away during the course of tx or does it pass? It sounds like something that would be difficult to bear for women with a little one or ones to change, clothe, feed, play with, discipline, carry around, take to the park, etc. full time. My son is a handful, BTW..very, very active, I mean I can't imagine caring for him while having the flu for a year but, hey it mustn't have been so bad for you ladies b/c you both completed tx, right?

Lisa
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This is a vertical transmissiom article which says studies indicate serum HCV RNA levels increase during the second and third trimesters & serum alanine aminotransferase levels decrease.
What does that mean, exactly? Do they cancel each other out?


trimestersttp://www.hcvets.com/data/transmission_methods/hcv_and_pregnancy.htm
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I'm sure the experience varies from person to person, but for me it was more of an annoying feeling yucky but could cope feeling than a 103 fever unable to function thing.  I'm a stay at home mom, so I had the luxury of being able to lounge on the couch when I needed to, which I'm certain helped immensely.  We did more takeout than usual, but I did keep the house pretty clean & didn't need to use my inlaws to babysit at all (which was something I was moderately sure would happen before starting).  I didn't have a single day that I needed my husband to stay home/work from home to accomodate tx.  I went to playgroups, the zoo, etc. just like I did prior to tx & was pretty much the same as I'd always been, just a little less energetic.  I didn't tell anyone in my social circle what I was going through & I'm 99% certain that none of them had any reason to suspect anything was different.  

My son too was/is crazily active & I was worried about keeping up with him as well.  It wasn't a huge problem, however, I can see that now that's he's almost 4, it would be a little harder...he's only getting more energetic.  I understand the thought though about waiting until your son is in K -- it would be nice to have downtime while your child was in school in case you needed it.  I felt strongly that I wanted to have another baby & put this behind me, so I rushed ahead with tx...

I should say finally that I only did 24 weeks of tx.  I'm not sure therefore what 48 weeks would have felt like.  I was dragging more at the end than in the beginning & I can imagine that another 24 weeks might have been tough.

Good luck!
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this is not exactly the article I was talking about, but it more or less establishes the same facts.
http://www.hivandhepatitis.com/hep_c/news/2005/ad/110705_a.html

there was no benefit in transmission prevention with c sections.

I am surprised that any hospital mandates a specific method of delivery. I don't think that is actually true.  Some things might seem like mandates like episiotomies and monitors but you have the right to refuse them.  No one can mandate an invasive procedure, snook.
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