Aa
Aa
A
A
A
Close
248382 tn?1274938634

VL Increase at 4 wk VL test

I am 67, type 1b, have compensated cirrhosis,  My VL showed an increase from 1st day of tx to the 30D VL test.  PA increased my ribavarin yesterday from 4 xd to 5xd 3 in am and 2 in pm. Am on 1 x wk peginterferon injection.

My CBC's have been showing good results.  Ast & alt are decrfeasing.

QUestions:    Is this a relatively common occurrence when in early tx?  

I am confused and worried by this outcome.  
18 Responses
Sort by: Helpful Oldest Newest
1317327 tn?1316501042
I went for a 4th Week check up to my GI, the Doctor said my VL was down from 3 million to 600 thousand... I don't know if that was good or not it being only  my 6th week on the Peginterferon Alpha 180 mcg 1x weekly and Ribavirin 600 mg x2 daily.  I don't know my geno type but I can tell you I have stage 3 liver damage.  The doc made me worried because she said that if by week 12 if the VL isn't down to 0 they will stop the treatment.... But I am hopeful because it was @ 3,000,000 and now to 600,000.... anythoughts?
Helpful - 0
248382 tn?1274938634
I had 2nd VL results & this time there is a 1 log drop!  Praying for a 2nd log drop on the 3rd VL test.
So at the end of September I should know wheter I can stay on peg-riba tx or move to something else.  Interfergen There do seem to be possible alternatives.  If I can/t get into a research study right away, the MD will have me do maintenance.  Fine with me.  I love this forum.  Thanks for being there!
Jenn
Helpful - 0
248382 tn?1274938634
Thank you for that tip.  I definitely will talk to my MD about possibility of changing pegs.
Helpful - 0
Avatar universal
I would ask your Dr about swapping Pegs.
For some reason some respond better with PegIntron others with Pegasys.
No telling which one is better till we start responding slowly.

As your VL isnt going anywhere no harm in trying.

All the Best
CS

Helpful - 0
Avatar universal
240'000 IU/ml = log 5.38
300'000 IU/ml = log 5.48
400'000 IU/ml = log 5.60

As you can see above your various viral load results expressed in log are quite close to each other. A viral load test might vary in a range of half-a-log, it is just not more specific than that. This does, sadly enough, indicate to me that you are not at all responding to treatment.

You are doing the right thing, trying to keep calm and collecting information. Don't do anything hasty. Collect information and talk to your doctor. Continue treatment unless something else is decided upon in discussion with your doctor.

If you and your doctor decide not to continue the present treatment, maybe you could get into a trial with the protease inhibitors. Talk to him about that.

Best of luck to you! Zazza
Helpful - 0
248382 tn?1274938634
Hi Wintre, NO you did not upset me.  I am grateful for all info I can get.  You guys are great and blessing in my life.  The more clarity I get the better & that is what I have gotten from all of you at forum.  Thanks.  Jenn (grandmaBRZ)
Helpful - 0
173975 tn?1216257775
I didn't realize your VL went up to 400,000 from 300,000.

that does sound like a  big jump.

Hope I didn't confuse the issue.  i was just trying to point out that fluctuations of a couple of hundred or even a couple of thousand from one week to the next aren't necessarily indicative that you're not responding IF you've already had a big decrease.

My spikes happened after I'd  gone from 1,140,000 to 73,000 around weeks 6 to 16, in between reaching a 2 log drop and UND.  It upset me coz i hadn't yet reached UND.

Keep us posted,

wyntre

.
Helpful - 0
Avatar universal
A 2-log drop from baseline viral load is the same as a 99% decrease. This or UND  (undetected) is what doctors want at week 12. I agree with Jim that I also am a little confused to what your baseline viral load was, but if we use 240'000 IU/ml, a 2-log drop would mean getting to 2400 IU/ml.

Yes, get copies of your results so you can look at them yourself. Please post again any questions you may have.

Zazza
Helpful - 0
248382 tn?1274938634
Thank you for all your help.  The log drop information is very helpful.  Nurse told me that she wanted to see a 2 log drop,  If I get to 4000, I may be eligible for an already approved drug research program which requires 1 shot per day.  Yikes!!!!  All who have responded have been wonderfully objective and helped me to calm way down & see it a rational light.  Yesterday I was  in a panic.  As Jim stated, I must get ALL th e hard copies of my results which is my plan for Monday. I also am going to research altelrnative.  The health meds, not FDA approved, will be my last alternative. Thanks again.

Grandma BRZ
Helpful - 0
248382 tn?1274938634
You are right.  It is confusing.  I am going to stop obsessing and call for copies on Monday.  Thanks for your good direction.  I could have everything all muddled except what she told me on the phone.  I will do my own checking.
Helpful - 0
Avatar universal
Things are still unclear to me. It's very unusual (except in trial situations) to do a viral load test "the first day of treatment". Are you saying that the blood was drawn for this viral load test *before* your first injection, or are you saying the blood was drawn on the first day *after* the injection? If it was drawn after the injection, how long (in hours) after the injection? Also, when was the blood drawn for what you are calling your "before treatment" test where the result was 240,000? Was it drawn the day before your first injection? A week before? Also, it's possible since you don't have actual copies of the test results that there's some communication confusion between you and the nurse as to what tests were done and when as they often don't run a viral load test every time blood is drawn. It's therefore very important to get your own hard copies and double-check what tests were done and when. Something just doesn't sound right about the way you are presenting the numbers and hopefully the doctor will help clear things up. As "Zazza" says, they like to see a one-log drop the first four-weeks of treatment and it appears you didn't achieve that, in fact your viral load appears to have increased. If this is so, the treatment is not working.

-- Jim
Helpful - 0
Avatar universal
A baseline viral load (viral load before starting treatment) under 400'000 IU/ml is a low viral load. For genotype 1 this means a 70% SVR ("cure") rate instead of a 50% SVR rate for those with high viral loads. However, even amongst those with a low baseline viral load there will be non-responders.

I am not a doctor, just another hep C patient with a low baseline viral load. But your week 4 viral load test does not look good to me, your viral load should be going down by now. At week 4 you want to see at least a 1-log decrease, which means reducing your viral load with 99%. So if your baseline viral load was 240'000 IU/ml, it would be a 1-log decrease if your viral load at week 4 was 24'000 IU/ml.

There are better drugs in trial now (protease inhibitors) which hopefully will help those who do not get SVR with the treatment of today.

Good luck! Zazza

http://www.hivandhepatitis.com/2006icr/aasld/docs/103106_d.html
Helpful - 0
Avatar universal
Sorry, that should be:
"At week 4 you want to see at least a 1-log decrease, which means reducing your viral load with 90% (NINETY percent)."
Helpful - 0
248382 tn?1274938634
My NP said I had an Viral Load increase from 300,000 to 400,000.  1st day of treatment it was at 300,000.  The first 4 week labs results showed an increase to 400,000.  I dont have lab copy that Viral load at 300,000.  Before treatment it was 240,000.  
I will be seeing my hepatologist.  My treatment is handled through the Hepatology Clinic at the hospital.  My NP is under direction of a 2nd hepatologist.  My hemoglobin before treatment  was 14.5, hematocrit was at 41.9.  I don't have 4 week labs copy yet but my hemoglobin on my 3rd week labs showed hemoglobin at 12.2 and hematocrit at 35.4.  According to the reference range, at 3 week test, I was  still in range for both hemoglobin and hematocrit..
I take riba varin with food but  haven't noted the fat.  Will do so.  No antacids needed so far.
Thank you for your time, questions, answers and good direction.
Helpful - 0
248382 tn?1274938634
Thanks for the response.  I am on week 7.  I started treatment on July 5 and on that day  NP had me have a blood test.  Viral load was at 300,000.  On August 1, 5th week of treatment, I had the viral load test and my results showed an increase to 400,000.  NP expressed concern about the increase.  I thought the 300,000 range was low.
Helpful - 0
Avatar universal
Also, you said your CBC's "showed good results". Do you know what your hemoglobin was before you started treating and what it was at your week 4 labs? If it hasn't change much that could suggest you're not getting enough ribavirin or you're not assimilating the ribavirin you do have. Do you take your ribavirin with food that has an adequate amount of fat in it? What about antacids? You shouldn't be taking antacids or fiber supplements within a couple of hours of the ribavirin.
Helpful - 0
Avatar universal
First, are you sure you had an increase? You said "the first day of treatment" but I assume you meant to say "before you started treating". There can be a difference.

But assuming you really had an increase from pre-treatment to week 4, then for some reason you are not responding to the drugs and it's unclear if increasing your ribavirin from 4 to 5 times per day will be enough.

Have you spoken to your doctor yet, as opposed to just the  NP? Is your doctor a liver specialist (hepatologist) or just a GP. At this point, you probably want to talk directly with a liver specialist to get better direction how to proceed. Did you get your own copies of the tests to verify what your NP said? Always a good idea to have your own copy of all test results and procedures.

-- Jim
Helpful - 0
173975 tn?1216257775
What was your starting VL and what do you mean by 30D VL test?

is that the one-month test?

If your VL didn't change much, i don't think it's THAT significant.  

I'm on week 34 and somewhere between weeks 6 and 13 I had a couple of minor 'spikes' in VL.  After i got all bent out if shape about it my gastro exoplained how a change from, in my case, 17,000 to 37,000 wasn't that mcuh.

It's good your Dr. increased your riba, though, especially if you're just starting TX.

let us know what week you're on.

Wyntre
Helpful - 0
Have an Answer?

You are reading content posted in the Hepatitis C Community

Top Hepatitis Answerers
317787 tn?1473358451
DC
683231 tn?1467323017
Auburn, WA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Answer a few simple questions about your Hep C treatment journey.

Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
image description
Learn about this treatable virus.
image description
Getting tested for this viral infection.
image description
3 key steps to getting on treatment.
image description
4 steps to getting on therapy.
image description
What you need to know about Hep C drugs.
image description
How the drugs might affect you.
image description
These tips may up your chances of a cure.
Popular Resources
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.