UND questions

Now that I've reached UND, I realize I have no idea of what it REALLY means.

If the test measures below 10, or 5, or 2, does that mean there can still be a couple of virons left?

Can it really take only 2 virons to start the whole disease process again?

If that's true, why is the UND goal such a benchmark?  Is it the equivalent of observations such as; "When the sun rises the earth gets warmer?"

Do people who stop TX once they reach UND ever achieve SVR even if they don't complete the SOC TX length for their particular genotype?

How often do 'viral breakthroughs' occur?

Just wondering.

wyntre

[desrt]

Undetected means undetected in your bloodstream. A year after treatment, if you are still undetected, you have a 99% chance of staying that way. If your liver and 'compartmentalized systems' (lymph, cerebro-spinal, etc.) still show positive and negative strand HCV RNA, it seems to be of little consequence. You're still at risk for HCC and complications  from NAFLD, but the chances are much, much lower than those of someone who isn't UND.
I stopped tx at 22 weeks even though my doctor wanted me to do 48, and I'm still UND 4 years later - my choice, my gamble. Nowadays, a geno 3 with my stats could do 12 weeks and have a 66% chance of staying clear.
It's a probability thing at this point and seems to have as much to do with your genes as it does the virus'.

[wyntre9]

Congrats on 4 years UND!

What I don't understand (and there have been several posts about this topic) is that the old UND was <615, the new ones are <50, <10, ,5 and <2.

But none of them go to zero.

So even if you get <10 (like me) or <2, doesn't that mean there could still be a couple of virons in your body and they could multiply back up to a large VL?  

And if that's true, then UND only means undetectable by that particular test because it can't register a small number of virons.

And (sorry to ramble) if that's the case, what's the real significance of UND?

Sorry, I'm a bit dense,

wyntre

[jboyhk]

One other point of confusion that people often have is a count of 2 does not mean 2 virons in your blood, It is 2 per millilitre. So the average person has 5 litres of blood , so the math says 2 copies/ml = 2X5X1,000 = 10,000 copies circulated in your blood.

There is no PCR test that goes to zero and probably never will be (it is entirely possible that when you get that low of viral count, in the ml sample you are tested you can have zero count but some count in other samples of your blood).

Unless someone finds an antigen the virus produces when replicating (such as is found in HIV or HepB).

What we do know is that <2 means a good chance it is not in your bloodstream anymore (whether its in the liver is still debatable)

[desrt]

The 'real significance' of UND is that we're still learning as we go and we're all lab rats, whether you're in a trial or not. Also, if you share your toothbrush, you probably won't spread the virus and your disease probably won't progress to the point where you'll be cutting in line for liver transplant in front of someone who wrecked theirs with good Scotch. (Sorry if that's too political.)
If you're the type of person who is upset by the thought of sharing your body with microbial organisms, accept a one year post-tx UND and get on with your life. (Also, don't eat yogurt or go barefoot at any time.)

[wyntre9]

Jboyhk,

What a great explanation!

thank You!

Dsrt,

I just reached UND at week 18 of 48 (72) week TX.  That's why I'm wondering about all this stuff.  Plus, I'm curious.

When I complete TX and I'm still UND 6 months after, then I will probably never give any of this much of a thought.

For now, I'd like to know (TRY) to understand as much as I can.

Congrat again on your 4 year UND.  I still have 28 to 52 more weeks to go.

wyntre

[nygirl7]

Even if we tested 0 in our bloodstream unfortunately there still could be "virons" in our organs...bone marrow... etc.  That is why we do treatment much after we are UND - to try and get them all and also for the interferon to 'train' our bodies to fight fight fight.

When you think about it - we only have a 50/50 chance at SVR, right?  but...all of us have to be UND for us to continue onwards in treatment.  So, viral breakthrough and relapse are just as common as not.

When someone has a test and says yay I am UND but their test goes only to 315...it's VERY easy for them to not really be UND at all, if they don't know better...then their entire course of treatment is wrong.

I had the heptimax <2 and still = definitely a chance it could have still be there and once the meds stop...come right back into the millions, fast.

It's not right I hate this disease.

[wyntre9]

So, relapse means you completed tx, were UND at the end of TX but within a couple of weeks or months the virus is detected again, right?

Does that mean it's the SAME strain you were originally infected with and that it (the virons) were just hiding?

And is viral breakthrough something that occurs durng TX?  (Eg; You're UND at week 12 of 48 but suddenly, at week 32, the virus is detected again?)

I know I've read explanations of these issues in the many links that are posted but I need the EASY explanation.

Yeah, you're right, this s*ucks.

Ok, what happened with you?  Do you know yet?  Got my fingers crossed for you.

Oh, and BTW, don't know if you read the other side post about prescription purgatory but I just got back from the pharmacy with my meds - after 2 days of phone work i got the (new) prescription plan to authorize an over-ride of the rule I had to get meds via mail.  But thanks for the commitment to care info, and what you posted to zazza, above.  Your experiences with this disease and the TX process are invaluable to us newbies.)

wyntre