UND After 7 Days

I am just beginning week 3 (Combo Peg Intron/Riba), and went in for blood work a week ago for a CBC and Platelets.

Well, my hepatologist's nurse called today to say that my VL after the first week was "undetecable".  It seems the lab lady also included the full virus RNA, QN, Real Time PCR the first week, that would have been at weeks 4 and 12.  So nurse said "wow, you are really responding well, and we can now just go forward to week 12 for the qualitative."  

I am only still learning about all this, but do understand that the qualitative RNA is the most important and detects if any virus detectable in the blood, you want to see the 2 log drop.  But am sort of head-spinning right now.

I am F/52/155,stage 2, geno 2ba and started in Oct. with a baseline LOG 6.25/1.8 mil. If UND after 7 days, how significant is that in relation to length of treatment (planned for 24wk)?  And does it make sense to skip the quantitative at 4 wks now and go all the way to the quantitative at 12?  Thanks, G

[FlGuy]

You have good care. Don't skip pcrs. The pcr at 7 days was probably not a mistake on the doc's part, forwrd-thinking folks.  UND is super and may open options for you shorter treatment duration.  A doc who does 1, 4 and 12 week pcrs probably has his stuff together. You might talk to the doc to see how this result may beneficially affect further treatment plans.

[ladybug52]

Has your liver recovered any now that you are clear? Were you 55 in 2002 or now? I am 53, geno 2 with an original viral load of 11,000,000, stage 1 grade 2. I worry about that high viral load I started out with. Thanks for any info.
Gazebo: Way to Go!!!! I should have said that first but it's kinda all about me! And what does 155 refer to when you stated F/52/155?
Thanks for everyones help.
Bug

[jmjm530]

What was the sensitivity of the test you took at week 7. If you don't know, ask the nurse, in fact you ask for copies of all lab tests and procedure reports,etc.

I would ask for either a qualitiative or very sensitive quantitative at week 4 AND 12. In fact, if your insurance allows it, wouldn't even wait until week 4, I'd have them re-test me now with the more sensitive tests. A good sensitive quantitative is "Heptimax" by Quest Diagnostics -- same sensitivity as the qualitatives and that would be a good choice.

In terms of treatment duration, they often use the result of the week 4 test which is why it's important. In order to consider a shorter course you must be non-detectible using a sensitive test but there may be other factors such as pre-treatment viral load and how much liver damage you have. Also, the trials using the shorter course had everyone on weight based ribavirin as opposed to a flat 800 mg/day. How much ribavirin are you on and how much do you weigh?

Congruatulations on what appears to be an excellent start.


All the best,

-- Jim

[new-sojourn]

I cl'd w/in 2 wks-a 2b, f/55yr old infected via transfusion in 1967.  end stage liver disease.  dx after complete liver failure and  a masssive varices esophagael bleed.  That was in 2002.  2's didn't do log drops @ that time.  I was doing interferon/riba.

Und is Und.  My doctor said that in his experience, those who were going to respond responed w/in the 1 st wk or 2.

Tx seems much more complex now, b/ und is und.

Enjoy your good fortune.

[ladybug52]

Oh now I remember you better when you mentioned your back pain. Way to go! I'm so happy for you now that I remember what you have been enduring. You're so lucky to have such good news so early, heartfelt congrats!
Bug

[mikesimon]

Very nice! Things are looking good for you. Good luck. Mike

[gazebo1]

Thanks for the replies.  My doc called this am (nurse yesterday) to reconfirm the UND at first week test, but said a long road ahead, and although the results are encouraging that the tx is having good effect in my body, that the 12 and 24 wk qual. is when we will have a more definite evaluation.  I am on 150 Peg Intron and 800 Riba, so has me on a pretty high SIG.  Just hope the increased spinal pain (preexisting) from the Interferon will taper off, it really is tough to endure - on top of the "interesting" sx these first weeks.  Regards,  G

[GoofyDad]

There are several studies supporting shorter (12 or 16 weeks) treatments for genotype 2's who clear by week 4. You seem to be even ahead of that. If I were you I would be interested in looking into those studies and geting an opinion on duration from a progrssive Hepatologist familiar with thse sudies and protocols.

You can get started by googling 'mangia 12 week' and 'von wagner 16 week'.

A qualitative test is very sensitive and accurate and tells that the virus was either detected or not. A quantitative test attempts to count the number of virons present. Once you get to undetectable, I would think qualitative is most telling. As Jim points out, getting a highly sensitive test now might be a great idea.

Good luck!