When to check viral load

I am finishing my second week of tx. Did regular blood test today (not viral load) and was told to continue. I asked about check for viral load (my initial was 7.5) and Dr said - in 12 weeks! Otherwise, if I don't respond well, the insurance company may pull the plug. Does it make sense?

[Bill1954]

Hi again, Rupro—

Yes, if you haven’t responded sufficiently to therapy by the 12 week juncture, there is little reason to continue with treatment. As a genotype 2 patient, you have an excellent chance of responding rapidly, though. Typically, a 2 log reduction in viral load at 12 weeks is required. This can be calculated by moving the decimal place to the left of the end of the number by 2 places; for instance, if your starting viral load was, say:

1,200,000 IU/mL

Then, a 1 log reduction would be 120,000 IU/mL

And a 2 log reduction would be 12,000 IU/mL

As far as the next test is concerned, with genotype 1, a test at 4 weeks allows adjustment to dose and or duration of treatment if the response is less than optimal; I suppose the same would apply for genotype 2.

The standard of care requires testing at 12 weeks; you might ask your doctor for a 4 week test, if you plan on altering therapy. If not, then a 12 week test would be sufficient.

Good luck—

Bill

[Marcia2202]

If you are geno 2 or 3, it is VERY important to check at 4 weeks. Preferably on the day of shot 5, but BEFORE doing the shot. You can also test the day before.

When you are a geno 2 or 3 and don't clear at week 4, you should consider extending treatment.

For all genotypes the following is generally true. If you clear by week 4, your chance of SVR bounces up to 90%. So the 4 week PCR is an important one

[Marcia2202]

I just looked at your other posts.

You are a genotype 2, you should definitely have a 4 week PCR.

I would say that that is the most important PCR (viral load test) during the whole treatment. If you are clear by week 4, you will have little to worry about.

[TriPolar17]

Hello- I just started my treatment on May 16th . . .  The doctor told me that I should have my blood drawn on June 14th to see if I have cleared the virus. I am having regular blood test weekly until then. How are you doing with your treatment so far?

[copyman]

I agree that the 4 week is probably one of the most important tests you should get. there are many treatment decisions that can be made from this test, including stopping after 16 weeks if you test undetectable. Of course only stop if you are having unbearble side effects, otherwise do the complete 24 weeks. good luck

[IAmTheWalrus]

Like Marcia said, 4 weeks is an important test. At 12 weeks treatment is generally discontinued if you have not have at least the 2Log reduction. Generally this is not an issue with genotype 2 and 3.

Just guessing that your original test result of 7.5 may be the Log (base 10) of your viral load. It is sometimes reported that way.  If so, then calculating the 2 Log reduction is to simply subtract 2. So a 2 Log reduction would be 5.5 which equates to about 300,000 IU/ml.

Most genotype 2 or 3 patients are UND (no virus detected) by 12 weeks and discontinuation of treatment is not an issue.

[Marcia2202]

Just wanted to add, one doesn't use the 2 log drop theory with geno 2 and 3.

If you do not clear by week 12, you stop.

So you actually really want to clear by week 4.

If you clear after week 4 and before week 12, you have to extend treatment.

Individualized treatment would look like this for geno 2 and 3. UND between after week 4 and before week 12 is based on a formula  UND + 24 weeks = length of treatment

UND week 4  =  24 weeks
UND week 6  =  30 weeks
UND week 8  =  32 weeks
UND week10  = 34 weeks
UND week12  = 48 weeks