detectable virus 36 weeks

my husband has been on triple therapy with incivek.  He was undetectable at 4,8,12,and 24 weeks.  He is a null responder to previous treatment and has cirohsis.  There was a viral load test done at approximately 36 weeks and it came back with a viral load of 431.  No one has called us yet.  We didn't even know that test was done on that day through that office as we are waiting on viral load results from his other dr and they are taking over 2 weeks now.  We only found it by logging in to his account and seeing recent bloodwork results.  Any amount means you stop treatment right?  

[Advocate1955]

Yes, any amount means stop treatment, but before you do that, call the hepatologist's office to confirm that it's your husband's test, that no error was made, and to ask why he hasn't called your husband to let him know.  If indeed it is his test, I'm sorry to say that your husband has had a viral breakthrough.
Advocate1955

[hepccancervet]

Thanks for reply...why now do you think?  Seems it would have come back shortly after incivek?  So disappointing and frustrating.  He was supposed to get a transplant right at the end of treatment....now I dont know what will happen!  

[frijole]

I am so sorry this happened.  I would certainly check to make sure they didn't mix up the labs first.  Have another test run even if they didn't just to make sure.  No doctor has told him to stop yet, right?  I don't know if it is a viral breakthrough or not but I wouldn't want to stop yet just in case it is some error.  You and your husband must be beside yourself right now.  Ifhe does have detectable virus, you are right.  He should stop.

What kind of VL test have they been giving him?  I am wondering if he has been detectable all along but under the limits of the test.  If he is being treated by the VA, I know they used to use a really antiquated test only detectable down to 600.

Cirrhotics are hard to treat.  I hope the tests are an error, but if not, I hope he can go ahead with the TP and treat again after that.

frijole

[hepccancervet]

thanks for reply.
He has been getting the heptimax, the one that measures <5.  So, he truly has been undetectable.  He is being treated by his liver disease spec who he has seen for 10 years but also thru Mayo who is managing transplant.  Mayo did the test and we werent aware they did.  They get results back in 24 hours.  When his LD dr has it done, which we were aware of, it goes to san juan capistrano and seems to take FOREVER.  This is all such a mess.  Our donor is being treated for something and the timing was going to work such that he finished when my husband finished treatment so even if he wasnt rid of virus, at least he would go into transplant with no viral load.  IT all just *****.  I cant even think straight, makes me sick.  My husband doesnt want to call but rather wait for the other heptimax to come back from his LD dr.  i think he is testing the other program and wondering how long it will actually take them to tell someone who is on a horrible treatment to actually stop taking it.

[HectorSF]

Any amount means you stop treatment right?  
Yes. It is called viral breakthrough. The virus overcame the ability of the treatment drugs to suppress it.

I would wait for conformation first before stopping. There is a slight chance the test could be wrong. He will have start all over again.

All hope is not lost!
You said your husband was 'undetectable at 4,8,12,and 24 weeks'. If your husband has a living donor all he needs to do is to treat and be undetectable for a month or more while going into transplant his transplant surgery operation with a undetectable viral load. Then your husband will have a very high chance of not having reinfection in his donor liver after the transplant operation. Ridding his hepatitis C will give him a smoother recovery process and also increase his life span tremendously. Something that is well worth doing. As SVR rates post transplant with current treatments are very low. 20 - 30 % of post transplant patients will develop cirrhosis of the liver again in 5 years. Not something you ever want to happen.
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'Hepatitis-C-virus- (HCV-) related end-stage cirrhosis is the primary indication for liver transplantation in many countries. Unfortunately, however, HCV is not eliminated by transplantation and graft reinfection is universal, resulting in fibrosis, cirrhosis, and finally graft decompensation. The use of poor quality organs, particularly from older donors, has a highly negative impact on the severity of recurrence and patient/graft survival.

If the transplantation is done while viremia is negative, infection of the graft can be prevented in up to 65% of cases.'
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Talk to his hepatologist. If they should know this. There is no need to complete treatment for 48 and achieve SVR to prevent reinfection in the donor liver. He only needs to be undetectable for more than 4 weeks.

Few of us transplant patients can do this because we either need a whole liver from a liver donor and we never know when we will get a transplant. Living Donor Liver Transplant are scheduled.

I am a transplant patient and have been undetectable for 21 weeks now and will treat until the day of my transplant to prevent my donor liver from hepatitis C infection and thus having to treat post transplant which is even more difficult than treating with cirrhosis.

Good luck to your husband!
Hector