VL went back up ??

[annieCinMD]

I did a search on the subject and found others did have this happen.  I went from 2.2 million to 97,000 (at 2 weeks - February 16), which was great.  I just got my results from February 27 (started Tx on January 30), and it went up to 324,000.  I think this is like a .5 log change, and is still way down from 2.2 million, but I'm a bit nervous. I know the 12 week is the biggie, so may be jumping the gun just a bit. My next labs are on 3-26 which should be my 8 week.  I'm supposed to get them at 2, 4, 8 and 12 weeks.  If no significant drop at 12, discontinue.  Thank God Blackberry's keep old calendars, because I just went back through mine to get these dates straight!  I guess I'm just looking for a little reassurance that it's too soon to sweat it.  I have to go take an Accounting Test (happy, happy, joy, joy) and won't be back on for several hours, but will check back before retiring tonight! Thanks! Anne

[jmjm530]

Frequent viral load testing has it's advantages yet limitations in terms of predictive value.

One limitation is that there simply isn't enough data accumulated to reflect the significance of weekly or bi-weekly changes, as the major studied data points are weeks 4, 12 and 24. No doubt this is why your medical team wants to wait for the results of the week 8 test to see if the very good initial drop at week 2 is the real trend line or if a new trend line toward a quasi viral breakthrough is developing.

That said, the added information could reasonably be acted upon depending on how aggressive you want to treat this thing.  For example, some studies suggest the degree of anemia correlates positively to RVR and SVR as acts somewhat of a barometer of ribavirin absorption.  In other words, the more anemic the better in that sense.

So, if you have not had much of a hemoglobin drop from baseline by week 4, then one strategy might be to increase the ribavirin regardless if you're on weight base or not. Fact is not everyone at the same weight absorbs ribavirin with the same efficiency. Of course this assumes that your trial would consider changing dosage which they may not.

FWIW I had my viral load tested weekly from week 1 until UND. . I can't say our results were comparable since I was <600 at week 2 and around 55 at week 3 plus I was on SOC and you may be treating with other drugs.

But my viral load did increase slightly for both weeks 4 and 5 before I became UND at week 6. So at least in my case a linear decline was not required to pave the road to UND and later to my SVR. It's quite possible that many have these little hiccups along the way (a .5 log change may not be significant one way or another) but they just don't get picked up because very few test more frequently than weeks 4 and 12.

Good luck and try not to worry.

All the best,

-- Jim

[annieCinMD]

Thanks for the hope!  I don't think I have missed any meds so far. I will count them if there's any doubt (the Riba). That shot is kind of hard to forget!

[HectorSF]

I'm sorry to hear about your viral load rising. But lets see what your week 8 results are. For now all you can do is stay compliant. Don't miss any meds.
Let's hope the meds start to have more effect.

Hang in there.
Hectorsf

[annieCinMD]

Thanks for the reply. Unfortunately, it is the nature of viruses in general to mutate, and this one is particularly good at it.  My study coordinator said to wait and see what the next one shows.  That one is still 16 days, and 2 more shots away, so not much point in getting too worked up over it now.  It is what it is, and fortunately, I haven't suffered much if any damage, so should this not work out, probably have time to wait for newer, better treatments.  The Accounting test could have been better, but could have been worse. He puts the answer key up at 10 pm the night of the exam, so if you keep your test sheet and mark both the answer sheet and the kept copy, you can grade your test. I didn't finish and guessed on the last five, but only got to mark one of those (wrong). So worst case, I got a bit over 50%, best case a bit over 60%.  The averages tend to run in the 60s, so probably not awful. The teacher said it's only a number, not a D, so I'll take his word for it. He gives lots of work, and if you do all of it, should make out OK.  He's been dead on with his guesses on class averages so far, so I take what he says at face value.  Spring Break next week, so a bit of a silver lining here after all!

[Bill1954]

Hi there,

Unfortunately, my math agrees with yours; it looks as though you have seen a .52 log increase in viral load. The term ‘viral breakthrough’ is reserved for patients that have become undetectable for virus, then become detectable again *while remaining on treatment*. I’m not sure this term applies to you, but nevertheless, it probably isn’t good news.

We like to see a smooth viral decline slope for a good chance at SVR. The best thing to do is call your doctor, and have them verify the dates and results; if they bear out, inform your doctor and get their take on the situation. I hope things work out for you; how was the accounting test, by the way?

Take care—

Bill