viral load and triple therapy

I was just wondering if anyone has as high of a viral load as mine, and was undetectable at 4 weeks? Mine is 14,900,000 ugh.... I go the 24th to see if I am under 1000 but its scary. I see a lot going undetectable at the 4 week period but I wonder if anyone had very large viral loads like mine???

Maybe I should get a handicap of an extra week LOL

[beeblessed]

Hi dixiechic.  I think my viral load is 15 million (unless I made a mistake and my doc said 1.5 million).  I'm not treating yet so I'm giving you a bump so others will see your post.  Here are some numbers I found for you on viral loads:

200,000 to 1,000,000 low

1,000,000 to 5,000,000 medium

5,000,000 to 25,000,000 high

above 25,000,000 very high

[crossroadsec]

Of course, I'm no expert. So you may not want the opinion of an up-in-the-night itchy girl. But my vial load tripled in a year. My Dr. wasn't concerned. Said the med would do the work if it were going to.
I think they may treat longer??? Just an opinion. I had the same concerns once I went over a million. I finally took a Vistaril. Hope it kicks in. This middle of the night thinking can turn into worry tooo quickly. Take care.. Karen :)

[streamline569]

I thought that as long as you were under 1000 at week 4 you go on to treat and you were undetectable so wouldn't you be clear sailing to continue treatment. I didn't think it could go up to 1000 at week 12 after being undetectable but I'm very far from knowing for sure. Just my assumption.

[shanro]

Before I started treatment my viral load was higher than they measure... it was greater than 69 million... I'm getting my 3rd injection tonight... so, suffice to say, I'm very interested in this post!!

[joemc34606]

My doc said how high the load is isn't important, it's there or it's not. I know I was over two million and cleared in 4 weeks. You'll be fine, yea the worrying su---.joe

[working dog]

my vl was like 10 mil..and if i didn'tget so anemic that i had to stop the riba at week 3 i'm sure i wouldn't havehad any vl...i do have a very ..very low vl...i would say if you stay on the triple you'll kill it off in 4 weeks....good luck...billy

[lynda607]

With Incivek, it is possible to be UND at week 4 and over 1000 IU/mL at week 12.  In that case the patient has developed a resistance to the PI and breakthrough has occurred.  Cessation of therapy is recommended.

If UND at 4 weeks and a viral load is detected at 12 weeks but under 1000 IU/mL continuation of P/R is recommended for 36 additional weeks.  

[EyesofBlue55]

I too have a high Vl but it fluctuates between 8-17 million.Its always different.My brother has a VL of 47 million and starting tx on Friday with the incivek.I will be watching this post as I am interested in how you do...Good Luck  

[shanro]

Ok... I'm getting a little discouraged... Does anyone else have a vl over 69 million???

[hrsepwrguy]

This post is what I needed this morning. Mine is 11,522,000 and I was wonder the same thing as you dixiechickdana, if it was going to be harder to clear in 4 weeks, I  love this place it gives so much hope for the future.


Keith

[brianmo]

I also have what my doctor calls a very high VL but its not to be of concern until I start tx. You will clear....

[eureka254]

Viral load tends to jump around a bit, and it is NOT predictive of response to treatment.  There are some docs who use different guidelines for "low" viral load (which depending on doc could be 400,000 or 800,000) in duration of treatment, but whether your VL is a million or tens of millions is really not anything to be alarmed about.

It's not uncommon for VL within one person to vary as much as a log (10-fold) at different times.  For example, before treatment, my husband had VLs anywhere from a little over 1 million to almost 17.9 million.  Over the years here, there have been folks who have reported numbers in excess of 10 million quite often, though the exact numbers escape me... in the end, it's your VL response to treatment that counts, not what it is on any given day while not on treatment.  Hope that helps. ~eureka

[crossroadsec]

Gosh Eureka - you always put things so concisely! Thanks for that..

[penn1023]

let us know your VL over the next weeks and good luck

[dixiechicdana]

I will go back to the Dr the 24th to see if i am under 1000 and continue or stop treatment. I will keep you guys posted and I will also ask about higher viral loads and treatment for those higher than mine. Thanks for all the input guys :)

[Ajw78757]

http://www.medhelp.org/posts/Hepatitis-C/4-week-RVR/show/1570238

[shanro]

I will def keep you posted... I get my VL checked again on August 31st... Keeping my fingers crossed.....

[mlkinmb]

Was over 25mil at start. Using Pegintron/Rebetol, adding Victrelis next week. 4 week labs will also be done next week. I'll post when I know, Take care.

[shanro]

Exciting update!!!
I got my four week results and I'm down from over 69 million to under 1000 in just four weeks of triple therapy with incivek!!! So for everyone with high vl there is hope!!!

[pommes]

The things that get me about the VL are
1) if there is so much fluctuation in the measurements, how is it possible to apply the stopping rules so strictly?   In other words, if you're looking for a 2-log drog, but the error can be as much as a log here or there, how can you be sure whether to stop or not?
2) will the relation (or rather, lack of relation) between VL and SVR hold even with the new drugs?     Or could it be that with new antiviral mechanisms, the viral load will become an issue?
Just wondering.   Am stuck in the waiting-for-biopsy game myself right now, so my thumbs have nothing better to do.

[lynda607]

Viral load prior to treatment does not have as much significance as it does when the patient is actually undergoing treatment.  A lower viral load is considered a positive factor prior to starting therapy but with the DAA's, many with a high viral load are UND or below the futilty rule at 4 weeks.  A PCR is a very accurate gauge of how the patient is responding to treatment so there is no error if a 2 log drop is not achieved with SOC.  

Triple therapy (SOC and a protease inhibitor) is a response guided therapy based on many years of trial data.  If the PCR indicates the patient has failed to meet the response guided criteria set forth by the manufacturer then the futility rule applies and treatment is stopped.

[pommes]

Lynda,

Sorry to be dim but I still don't get it.     Why should the PCR during tx be any less "noisy" than the PCR before tx?    Everyone says that the PCR before tx can be off by a log or so;   if the same is true during tx, then you are taking the ratio of two very noisy numbers.    So isn't that ratio also going to be noisy and hence inaccurate?

[FlGuy]

It's like the National Hurricane Center's cone of uncertainty for hurricanes, you want to know the general direction and speed but landfall can't be predicted with precision until it's a little closer to shore.

[lynda607]

PCR's aren't off pommes and I don't know where you're getting the concept that everyone says they can be off by a log. Viral load fluctuates but PCR's are a very specific and are an accurate measure of how much HCV RNA is in the blood.  For instance, you could have a PCR done this week and the results come back 600,000 IU/mL.  Then you have another done in a month and the results are 1,600,000 IU/ml and then a year later the results are 16,000,000 IU/mL.  Each PCR is accurate, it's just that the viral load may increase or decrease according to the body's immune response.

While treating, the viral load or lack there of shows exactly how the patient is responding to the medication.  Again, the PCR is very specific, no noise involved and is a true indicator of response with SOC and triple.  That is why triple therapy is response guided and the 2 log drop with SOC is in place.  A favorable response is necessary, the criteria should be met and if it is not many times the patient does not achieve SVR.

[willing]

good point - sort of of an 'emperor's new clothes' issue - how did imprecise  VL measurements suddenly get so reliable? The machinery behind PCRs is actually quite accurate - the chemistry will accurately report the number of RNA molecules detected in the serum sample. The uncertainty comes mostly from fluctuations in the steady-state kinetics of the viral population: virion production/elimination are linked by  high-level constraints, but these are imprecise and variable.

It's a bit like trying to accurately  measure unemployment rate.

The reason we tend to have more faith in VL decline numbers during tx is simply that the data points are collected in close succession - so the uncertainty that contributes to broad variation in viral population shouldn't come into play (but you're right that there is  room for suspicion about what the emperor is wearing).

Back in the bad old days of soc the futility criterion was a 2 log drop spread over 12 w - so noise in VL drop was more of  factor - and good heppos took that into account.

[GoofyDad]

I thought the cone of uncertainty debuted in Maxwell Smart. Hurricanes, unemployement... where's the meteor analogy guys? Are we a little storm-sensitized down there FLguy? No hurricanes here in the land of Birkenstocks and earthquakes... but ya got us demos to contend with.