high VL

hi

i was just wondering am i right in thinking that the chance of SVR is much lower in some one with a high VL? by high i mean 11 M , ALT200 dont know genotype find out on friday,

thanks

JJ

[newleaf09]

No.  While a low viral load is a good indicator of SVR, a high viral load does NOT mean the opposite.  High VL can come down just fine if you are one who is responsive to interferon.  I read a study recently that said that those who had the genetic make-up to respond strongly to interferon often had high viral loads.  Go figure.

[jessiejames1973]

thank you for your reply, could you point me in the direction of such or similar literature please, as i am keen to learn more thank you

JJ

[jessiejames1973]

In two PEG RCTs, treatment for 48 weeks with PEG 2a + RBV was significantly more effective than the same treatment for 24 weeks [sustained virological response (SVR) at 48 weeks, range 52–;63%]. In the third PEG trial, treatment with PEG + RBV resulted in a significantly higher SVR than treatment with IFN + RBV. All five IFN trials reported significantly higher SVR rates with IFN + RBV (range 33–;69%) compared with either IFN monotherapy (range 18–;23%) or no treatment (zero response).

All eight trials reported SVRs for subgroups of patients according to different prognostic and demographic factors. Logistic regression analysis was also performed to examine the independent effect of these factors on virological response.

In the three PEG 2a + RBV trials, higher SVRs were seen in genotype non-1 patients compared with genotype 1 patients, regardless of length of therapy. Genotype 1 patients treated with PEG + RBV for 48 weeks had significantly higher response rates than patients on the same therapy for only 24 weeks. Treatment duration did not have a significant effect on virological response for patients with genotype 2 or 3.

Patients with genotype 1 and low baseline viral load treated for 48 weeks had significantly higher SVRs than genotype 1 patients with high baseline viral load. In patients with genotypes 2 or 3, there was little additional benefit in extending treatment to 48 weeks, regardless of viral load. Patients with genotype non-1 aged 40 years or younger had a 26% higher probability of achieving an SVR compared with patients who were older than 40 years (relative risk 1.26; 95% confidence interval 1.02 to 1.55). One trial reported results for subgroups of patients with varying stages of fibrosis. In general, SVRs were higher in patients with mild HCV (fibrosis score F0 or F1, scored using the Knodell system) compared with those with bridging fibrosis/cirrhosis (F3 or F4) (it was not reported whether this difference was statistically significant). In mild HCV patients with genotypes 2 or 3, there was a small net loss of benefit when treatment was extended to 48 weeks.

[jessiejames1973]

above post

this is info i just came across

[newleaf09]

The whole article was posted in Nature on-line but you need to be a subscriber to access it.  This is the most complete article I have found about it besides the one in Nature:
http://mgm.duke.edu/news/goldstein_2.htm

Here are the paragraphs I mentioned:
'The researchers also ran tests to see if the presence of the biomarker was related in any way to viral load, a measure of how much virus was circulating in the patient before treatment started. They found a significant association in all groups.  

"Interestingly, we found that the C allele, although associated with better treatment response, was  associated with a higher viral load at baseline--something we have traditionally viewed as a negative prognostic marker when it comes to treatment response," says McHutchison.

That finding, along with other evidence gleaned in the research, suggests that patients who have the beneficial genetic marker might be especially adept at spontaneously clearing the virus through some as yet unknown mechanism, says McHutchison.'

There will eventually be a gentic test for the biomarker that shows response to interferon, but I wouldn't expect it for a while.  Schering Plough, the original maker of interferon, owns the intellectual property for the biomarker discovery and they aren't in the screening test business.  They will sell it or assign it to someone else.

[Bill1954]

I’m not sure you understand the gist of Newleaf’s post; of course, a high viral load has statistically lower chances of SVR. However, if you were to attempt treatment and achieve an encouraging initial response, you have excellent odds of success. Early viral response is probably the best indicator for successful treatment other than genotype—

Bill

[nygirl7]

Patients with genotype 1 and low baseline viral load treated for 48 weeks had significantly higher SVRs than genotype 1 patients with high baseline viral load. "

A low viral load is always looked at as being a good sign of indicating someones chances of SVR but it's not always true. For a small subset of us, starting with a low viral load actually was a disadvantage and while we start out with a great bang by week 4 then we sort of hit a plateau...and stay there past week 12 having to then extend treatment to 72 weeks.

We've seen people with low VLs not succeed and people  with extremely high VLs breeze on through.   As with everything having to do with hepc just about it seems it's all each individual case of a persons immune system reponding to the meds and nothing more.

All the guesswork and hypotheses mean nothing in the end it would appear....you just have to go for it, have faith and stick to it - that's the best you can do.

[Rockerforlife]

My  BASE VL was 20 million
at week 2 is was 55,000
at week 4 it was  6000
at week 6 is was Undetected

[Rockerforlife]

BTW ,1 month post ,still UD.

[Bill1954]

From personal experience, I have never had a viral load above 150,000; and I’ve had many quantitative tests over the years. It required two treatments involving 152 weeks of interferon/ribavirin treatment to resolve. I had a slow initial viral response in my first treatment that even high dose ribavirin and Tx extension could not overcome. While viral load is one indicator to consider there are many more; probably including genetic markers that we don’t fully understand yet.

Bill

[nygirl7]

Oh btw I was just trying to point out how you really can't second guess hep but - of course as I'm sure you understand a lower viral load of course does imply a better chance of success than a high viral load & vice versa obviously.

Mostly though, we use viral load just to determine how well we are responding to treatment....and to see which mile markers we hit on the way to decide if we should continue, increase meds, increase duration of treatment etc.

[FlGuy]

Although not overlooked in the the study narrative that was posted the other factors, I believe, need to have more than just passing attention as well.  Some of those factors were mentioned; age,  fibrosis and geno type.  Treatment, if planned, should be done so with other health aspect in mind also; weight and BMI, insulin resistence and blood sugar issues and general health.  Curioulsy enough, it's a good thing to be in good health while undergoing treatment for this stinkin' disease.

[nygirl7]

See both Bill and I had low viral loads and had trouble with successful treatment.......while others in the multimillions were just fine and treated with no difficulty.  Do not let your high VL get you down.

[Rockerforlife]

Like ive read here before,the trump card is getting UD by week 4,no matter what your VL.

[nygirl7]

I agree with Rocker. Make sure you have a sensitive low reading test and don't worry about it any more.  UND at week 4 is wonderful news.....but some of us sure didn't get it (my count was only 400) but still managed to get SVR so go figure!

(I did extend to 72 though).

[newleaf09]

Well said on everything, nygirl.  You just can't put all your faith in what has been published as 'Positive' and 'Negative' indicators.  All of the variables are not currently understood.  HCV is a very fast moving research area right now and in 5-10 years everything will end up being completely different from what's known now.  

I sat through a very uncomfortable 2nd TX week visit with my doctor who was trying to keep me from getting my hopes up, trying to keep me from being discouraged that I would not cure the disease because I was not under 40 and mostly because I had cirrhosis.  I also sat through a deliriously happy phone call from the nurse 4 days later when the labs came back UD after only 1 week of TX.  Blew them away.  You just have to do it and see what happens.  All the predictors in the world cannot stack up to your individual response.

[copyman]

with the new PI drugs due out in the next few years VL is not even a factor for SVR.

The SOC data showing high starting VL's having a lower response is at least a few years old but makes sense. It will not matter with the PI's.

I personally waited to get into a Telaprevir study because I knew I would have the best chance of SVR with my high VL. I was UNDE before 3 weeks, my starting VL was 10 million.

[Rockerforlife]

Im damn lucky to have gotten in the BOCEPREVIR trial,i was all set to go on SOC drugs but cancelled one week before i was to start because i was still 200 lbs and i wanted to be at 185-190...but as luck would have it, 2 weeks later,out of the blue, i got the call to do the BOC trial....i guess being slighty overweight maybe saved my life....why is my life so ironic?



"Cheerfulness is the very flower of health."

[nygirl7]

I was not under 40 and mostly..."

how many of us in here ARE under 40?  Not too many and we seem to be doing pretty dayum good these days judging by the forum. :)

I think education (ours, the patients) is changing the outcomes at dramastic rates (as the doctors strive to keep us with US) and as long as we can keep giving people hope - they will always have a chance.  It's when doctors discourage anyone and they give up that they really cannot succeed.

[jessiejames1973]

thank you for your comments and advice, i hope to find out genotype soon and after that see a specialist will keep you posted
thank you
JJ

[epiphiny]

"Treatment duration did not have a significant effect on virological response for patients with genotype 2 or 3."

I refer to the study you posted at the beginning of this thread.  Could you post the link to the study, please?  It occurs to me that it may be somewhat out of date as thinking has moved on from the above quote.

Genotype 3 is no longer seen as the tx 'walk in the park' that it used to be and is now more closely aligned with tx protocols for Geno 1, depending on your initial response to the Interferon and Riba.  Extending treatment past 24 weeks is becoming common nowadays.

In the not so distant past Geno 3 was lumped in with Geno 2 and results were therefore skewed. At this stage 3 is thought of the second hardest to beat, after 1.  2 is currently regarded as the easiest. Not sure where 4 fits in!

Things change so quickly in HCV treatment that it is important to make sure you are getting the most recent info you can.  Often times obsolete information hangs around in cyberspace despite newer studies and info being available.

[Rockerforlife]

Geno 4 is a  very  tough monster


http://www.hcvadvocate.org/news/NewsUpdates_pdf/News_Review_2008/HJR-5.1.pdf



"A bodily disease, which we look upon as whole and entire within itself, may, after all, be but a symptom of some ailment in the spiritual past"

[jessiejames1973]

hi
link as requested


http://www.ncchta.org/execsumm/summ1111.htm

[nygirl7]

When I first came on to this site what five/six years ago geno3 was indeed considered a "lucky" geno along with geno2 but that indeed has changed. It appears with geno3 you either hit the lotto or you don't - one way or the other it's either easier or tougher.

When I went to my appt. with Dr. Jacobson I had asked him at the time about geno 3 because WE in HERE had noticed how tough it could be and he told me that he had just had two relapses that day and he was going to start treating it as a geno 1 disease.  I remember getting pretty beaten up about it but in the end - this man did prove 100% on the money about everything he said to me.

[jessiejames1973]

hi nygirl7

i dont know what geno iam as the clinic wont tell me! they told me ALT, and VL, but keep saying wait till i see specialist! in 6 wks, sounds wierd to me , probably dont want to give me any more bad news
lol ,