Week 36 on Pegasys/Copegus

My hemoglobin has been <10 and my WBC has been< 2 and right now is 1.3 for 5 mths.  I take Procrit and Neupogen( spelling?)  every week and have been for 5 mths.  I have 12 more weeks on Pegasys/copegus Tx.  I am sure it helps because I guess I would be half dead if it didn't and I seem to feel better. My HCL was <29 at 24 weeks. Before Tx. it was 150 mllion. I feel like it is worth it and I only have 12 more weeks.  How dangerous is it to have such a low WBC?  I work everyday because I have to no matter how sick I am. I am an X-ray technologit for 4 Sports Med and Orthopaedic Drs.  I do 35-65 X-rays everyday.  I hope it will all be worth it because it has just about done me in mentally and physically!! Do you think that my HVL culd stay <29 frever if it still is 6 mths. after TX?  

[lapis]

By HCL, do you mean viral load?  I'm thinking no one has answered your post because it's not clear what you mean.

In your last sentence you wrote "HVL" so I'm guessing that's hepatitis viral load.  It's best practice to have a viral load done at 4 wks into tx, and of course you're looking for that "UND" result.  A result of <29 is likely a false positive, ideally your test should read UNDetectable.  To go from 150 million to <29 is significant, to be sure.  You should feel great about that!  The success and length of tx is related to your genotype, and how early you went UND, among other things.

What is your genotype?  Did you have a biopsy, and if so, what was the result?  When did you have the first viral load after starting tx?  Is your doctor a hepatologist?  A bit more info might help people answer your questions.

Welcome to the forum!  

Lapis

[diane1975]

At 12 wks my viral load was 700, then at 24 weeks t was <29 which my Heatologist said meant undetecable. I am week 36 now. I had a liver biopsy in 12/07.  I was stage 2 and I am a genotype 1.  My hepatologist said I had had Hep C for 15-20 yrs.and I would have Cirrhosis in approximately 10 yrs. I got started on Peg/Copeg 12/08 with a clinical research study. I will be on the meds until 11/09, 48 weeks. Do you think that patients ever really keep undetectable viral loads without it eventually coming back with the same viral load you started with?  I really  you!! I hope so because I can't see going through this again, although I was very thankfu to be accepted in the research program because I have ben well taken care of and given whatever meds I needed to help with the horrible sid effects!!   Thank you or answing me an I am happy to be with the forum!     Diane

[lapis]

"Do you think that patients ever really keep undetectable viral loads without it eventually coming back with the same viral load you started with?"

What clinical trial are you in?  I was also in a trial, don't know when I became UND but had to be so by 12 wks to stay in the trial.  Altho I'm a geno 1, I only had to treat for 24 wks because I had a PI added to my tx drugs.  I was UND at EOT, at 4 wks post, at 13 wks post, and again at 16 wks post.  So yes, when tx is successful, folks do continue with UND viral loads.  That really is the definition of successful tx.

Did you only have VL's done at 12 and 24 wks?  I think the standard for tx now is that a person continues to treat for a certain length of time after the virus becomes UND, and if you weren't UND till wk 24, then it might benefit you to extend tx.  However, if you're in a study, they might not give you that option.  

I hope that someone else who knows a bit more about tx extension will chime in.

Yes, the sides of the tx drugs can be brutal, but hang in there, it's all worth it when you get that UND at end of tx!!

[frijole]

There is a big difference between undetectible and under 29.  If the test range only went down to 29 there could have been detectible virus, but below the range of the test.  700 IU
mL at week 12 is not a good sign.  Yes, there was a significant drop but more and more studies are indicating that detectilbe virus at week 12 could be grounds for extending treatment to 72 weeks.

This is probably not possible when you are in a trial but it is what it is.  When I was considering a trial I had a back-up doctor who would pick up my treatment if I failed with the trial.  You might think about that.

Another thing you said struck me funny -- " Do you think that my HVL culd stay <29 frever if it still is 6 mths. after TX? "  It depends on whether there is detectible virus or not.  If you are not clear and you only show virus under the range of the test, when the treatment drugs stop, your vl will probably climb right back to pre-treatment levels.

In answer to your question about your white blood cells - or to compare your stats to mine, my WBC stayed under 2 from week 12 through week 56.  There were about 3 tests in that time that it bumped barely over 2.  My WBC and my ANC have gotten back on track just fine since my treatment ended.  Sounds like you are fine to me.

"Do you think that patients ever really keep undetectable viral loads without it eventually coming back with the same viral load you started with?  "    yes, if you clear the virus it should not come back.  I am not convinced from what you said that you have cleared the virus.

frijole

[nygirl7]

I too am very confused by the <29 if you did have detectible virus at this point 72 weeks would be the prudent thing.  The 700 at week 12 reminds me of me who was at 419 at week 12 and had to extend to 72 weeks because of it.

I have been virus free - cured - for over two years however I was tested down to <2 and was undetectible so chances are I was truly UND (In addition to treating for so long).

If you are not truly UND and even had a count of 1 in no time at all your viral load will explode back up exponentially.  It's just the nature of the beast.

Do you even know what week or IF you really ever got  to UND yet?  A viral load of 29 could be a viral breakthrough but you don't appear by any means to have ever gotten to UND yet.

Right now what I would suggest is a second opinion from a heptologist - some things in here just don't add up at all really (for example most doctors would figure detectible at week 24 means your chances of succeeding are like 1% or something and would  make you stop and then start another time with a different version of treatment.)

Good luck.