What's the best timing for viral load tests/JmJm?

I got a pcr at week 4 and the test was sensitive to <50. I was und. Then I got a heptamax at week 5 and was und. My dr. did not have me scheduled for another pcr (I just realized last week) and I was unable to get an answer from her office this week. I did shot 12 last night. Should I insist on another heptimax next week? Believe me, I called the clinic every day and have had a difficult time getting a response.

[purplecat]

end of week 12 just before my 13th shot I was tested. Dr said since I'm 1b week 12 is very important to follow TX.  I was not UND week 4 but had 2 log drop then was UND week 12. The clinical links posted about a month ago were very informative concerning percentages of SVR with RVR and EVR.  End of 12 week important.  You were lucky and if UND week 4 your chances are high but week 12 should be verified still UND.

Wow, you are doing great.    

[ladybug52]

Thanks! I know I should have stayed on top of this, but she was so ggod about doing the 4 week pcr, I forgot to ask about the 12 week. So you had yours done after the 12 week shot? Congrats on being und. I'm geno 2 so it was easier stats-wise for me to be und. What week are you on or have you finished tx?
Bug

[Jordie59]

I am on week 36 of tx geno 1. My doctor only ever did one pcr at week 12 which did come back undetected, when I asked about doing one at week 24 to make sure everything was still okay he said there was no reason to it's expensive were his words. He better be right.

[Myown]

I'm with you. I'm not sure either. I do have an appointment just after my 9th shot (couldn't get appoint the day of)but to tell you the truth, I don't know if that is just for regular labs or Heptimax too. And I guess we just get the TMA now being we were UND already, but not sure.
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Jordie, if you have insurance and insurance covers it, I would push for the test. God forbid you had a viral breakthru, you would want to extend I would imagine?

Some of these doctors I just don't understand. I sometimes wonder if they would handle their daughter or son the same way if they had hep.."Sorry son the test is too expensive."
I just can't picture a doctor telling his son that.

Maybe someone else that knows more will come on and advise you.

Wish you the best!

[orphanedhawk]

  All I know is my new and improved Doc, usually does one at 4 weeks and again at 12.  I'll probably be getting one this week when I see him.   Call your doctor and get an answer. They work for us, not visa versa.

[GoofyDad]

Your UND's at 4 weeks and 5 weeks hold you in very good stead. Congratulations! Kinda fun, chatting about your UNDs, BTW.

Now, the purpose any further testing is to monitor for viral through, which is quite an unlikely event. Week 12 is a relatively important testing milestone for pts who have yet to clear, but since you're clear, I don't see the difference betwee 12, 13, 14 whatever. One could certainly make the case that since you were tested at week 5, week 13 would be more appropriate than week 13.

My advise? Chill out and take it sometime in the near future, whenevr convient.

Disclaimer: I am not a certified JMJM :)    

[ladybug52]

Jordie: Myown is right! Is your dr. paying for the test himself or something? If he's trying to save you money, myabe you need to decide how important it is for you to know whether or not you have remained UND. Thanks for responding, I really didn't know if anyone would respond so I threw JmJm's moniker out there.

Goof: I'm just a step late with your jokes! My brain is not as quick as yours, or maybe it's the subject matter you have more of a passion for than I do!

[jmjm530]

That's EXCELLENT news being non-detectible viar Heptimax (<5) at week 5. While you can't be certain, I think there's every reason to believe you were non-detectible to the same limit at week 4, as well -- possibly earlier -- which makes you an RVR (rapid viral responder). That's the way to start things off!!!

As the certifiably ______ Goofyman says, the purpose of further testing during treatment is to guard against viral breakthrough which is unlikely but does happen.

If it were me, I'd probably test again via Heptimax the day before your 13th shot, which would be your week 12 test. If for no other reason than week 12 is an important juncture with most studies and trials. But like Goofy says, if for some reason you can't test the day before your 13th shot, then do it the day before your 14th shot -- really shouldn't mattter since you were non-detectible at week 4 and 5.

Moving on from there, you should be tested minimially at week 24, 36 and EOT, which would be six days after your 48th shot, assuming you will continue taking ribavirin a week after the last shot. If you stop taking riba with your last shot, then I'd do my EOT test the day before my 48th shot. That said, some of the doctors, including mine, test viral load monthly during treatment, I suppose to be right on top of any viral breakthrough. Personally, I found monthly Heptimax's too stressful so pretty much followed the schedule above.

From there, a week 4, 5, or 6 week post treatment Heptimax will give you a pretty good idea if you're going to SVR or not. Your 12 week post treatment Heptimax will give you almost an exact idea. And, of course, you would want to take a six month post treatment Heptimax and then at one year post treatment. Beyond, that, not sure what the point is of testing viral load unless you suspect something wrong or your liver enzymes are elevated. Relapse after 1 year post treatment is extremely rare.

Going back to your results, you should really be quite happy! Forgot how much liver damage you have, and what was your pre-treatment viral load -- but if you had a low pre-tx viral load and your liver damage isn't significant, you might speak to your doctor about the shorter 24-week course treatment. Some think it's a gamble although the studies show similar SVR rates. Personally, I think treating longer is also a gamble on screwing up your immune system -- so it's really which gamble you want to take.

All the best,

-- Jim

[GoofyDad]

At the risk of splitting hairs on the UND's - I'd venture that once your in the arenas of breakthroughs, studies following the 12 week tesing model are pretty irrelevant. We're it me, I'd probably be more inclined to follow the 8 week interval which would place the test at the 13th week - or preceding the 14th shot. Hope I'm not picking nits.  

[ladybug52]

Thanks for all the info. I thought, until others answered this post, that week 12 pcr was suppose to be the day of shot 12. I thought I'd really "GOOFed" up.
I'm geno 2 BTW, so I will probably treat 24 weeks, might discuss shorter options at my next appt. I addressed this post to you because you had really urged me, (everyone) to get the heptamax or something as sensitive, when I first started asking questions about viral load testing. Also, I left my first dr. because he didn't do a 4 week pcr, and you had stressed the importance of the testing on this board many times. Thanks for steering us in the right direction.
Ladybug

[ladybug52]

So how does what your saying apply to me? I mean, once I get the 12 week pcr, when do I want to test again? Week 20 or week 24? Thanks for responding, I know it sounds like it's all about me, and it is!

[jmjm530]

Think of it like this -- a one week viral load test would not be the day of your first shot (or the day before your first shot) -- it would be the day before your second shot. That's why a week 12 viral load test is taken the day before your 13th shot. Not to confuse the issue, but you could also take your week 12 viral load test the day of your 13th shot, but you would want to take the test before the shot, not after.

-- Jim

[scubadiver30]

I know this won't be too popular, but it seems to me you are an RVR (superesponder)and according to this CCO study you only have 8%less chance of SVR than those     g 2/3 with 24 wks if you stop at 16 wks IMHO.
How much do you weigh?
I'm doing it since I'm starting to have problems with my thyroid going hyper and no signs of going hipo.
I asked the doc about permenent damege to Thyroid and said wasn't sure. That most likely the inflamation (inflammation) will go away, but no one knows 100%...He's always patronizing me with my sx
It wasn't the anemia, my adverse sx are direct result of pegasys
IFN is a healer but can also do some damage...
I remember somebody posting the SpecialOps approach:
Gettin in and out as soon as you can after the job is done
saludos

http://www.clinicaloptions.com/Hepatitis/Conference%20Coverage/Boston%202006/Capsules/340.aspx

[ladybug52]

There was a big discussion about 2 weeks ago re: shortened tx. Everyone has a pretty strong opinion about it, most feel like it's crazy to stop early.
JmJm was one of those who feel along the same lines as you do. The treatment for the virus is poison. I'm undecided till I talk with my dr.
Take care, I wrote auita.