viral load numbers and what they mean

just got the results of my 12wk blood test back and not good news the virus isnt undetected in my blood but it is down to 4,736, at my 8wk my viral load was 41,000, can anyone tell me what this may mean, are they going to stop treatment since im not undet. at 12 wks.

[Bill1954]

Ktee, can you refresh our memory; what genotype are you? It might help if you jump over to your profile, and edit it to include basics like genotype, starting viral load, liver stage and grade, etc.

If you have baseline/pre-treatment viral load, and any subsequent viral load testing, post them here for now,

--Bill

[ktee319]

okay im genotype 1a and i dont know why its not logged anymore, it was well my starting vl was like 6.72 and then it went to 4.62,  and now to the 4,736, I did not have a biopsy before starting treatment.

[Bill1954]

Okay, from previous posts I see you’re genotype 1. It’s not required to be undetectable for virus at week 12, only that you achieved a 2 log reduction at this juncture. This can be calculated by taking your starting viral load, and moving the decimal to the left by two places:

Starting viral load = 1,500,000
1 log drop =                150,000
2 log drop =                  15,000
3 log drop =                    1,500

Etc….

If you haven’t achieved a 2 log reduction by 12 weeks, then other steps need to be taken to ensure your best odds of success. This can include increasing treatment duration, changing up medications, etc.

If you have your initial viral load handy, someone will help interpret it for you,

--Bill

[Bill1954]

Our posts crossed, I guess. Okay, your starting load (as expressed in log value) was 6.72

Now, your load at 12 weeks is 4,736; that translates to a log value of 3.68.

Subtracting 3.68 from 6.72 leaves us a reduction of 3.04. While it’d have been nice to see an undetectable viral load, a 3+ log drop is still fairly robust. I think you need to sit tight, continue doing what you’re doing, and keep an eye out for your 24 week VL results.

If you aren’t undetectable for virus at 24 weeks, then all bets are off. Otherwise, hang on for the ride, and good luck to you,

--Bill

[ktee319]

thank you!!

[copyman]

not to discourge you but I would stop treatment if you have minimal fibrosis. I would wait for the new drugs.

Something just isn't working with the drugs you are on. Did your HGB drop at all? Do you have any anemia? Usually if you are getting enough ribavirin then you will almost always become anemic. Not enough ribavirin is usually why people don't respond.

Of course this is just my opinion. Please consult with a doctor, perhaps a 2nd opinion with a hepatologist is in order.

Best of luck

[spectda]

Why wouldn't it be worth upping the Riba if he shows no sign of distress rather then quit?

[Bill1954]

Copyman, a 3.04 log reduction at 12 weeks ‘just isn’t working’? What the heck? And what confidence do you speak that ‘new drugs’ will be offered, and when?

[tashka]

I agree with what copyman says. It is not that the treatment is not working, but that it is not working well enough. You odds of success are greatly reduced if you are not UND by week 12. In general, earlier you achieve UND result-better chances of SVR. Our hepatologist stops treatment for patients who are still detected at 12 weeks. 4,700 is a substantial viral load.

With this kind of result the doctor probably will want you to extend treatment to 72 weeks or longer if you are UND at 24 weeks. And even then, the likelihood of you relapsing is very high.

New protease inhibitors are going to be approved very soon. Considering how hard this treatment is on the body and mind, I would advise you to stop, wait for PIs approval, and do another attempt with them. It is much more effective approach for genotype 1 virus. Addition of PI to interferon and ribavirin helps slow responders to respond much earlier-at 4 or even 2 weeks. Of course, it is your decision only, and your doctor should also advise you. Nobody here wants to discourage, but saying that everything is great would be wrong too.

Of course, in the past when nothing besides standard treatment was available, you would want to continue no matter what and just hope for the best. But today, when approval of PIs is so close, I think it is better to stop and wait for treatment that will have much higher odds of success.

[Bill1954]

Ktee, you’ll need to discuss this thoroughly with your doctor. He/she has your medical history, and will be able to counsel you as to your options. Give them a call tomorrow, and see what they suggest.

Good luck and let us know what you decide,

--Bill

[copyman]

most "up to date doctors" are using the 4 week test as the predictor of TX success. The 12 week test is becoming a thing of the past. Most hepatologist are suggesting the patient stop and wait for the new drugs if not UND by at 12 weeks. This was told to me by a leading Hepatologist and discussed at EASLD.

Unless of course the patient has remarkable fibrosis then treating can be beneficial even if they dont clear.

Treatment options are changing fast with this disease. There is no sense in someone with minimal liver damage extending to 72 weeks! The damage these drugs can do just doesn't make sense.

Rather then looking at 12 weeks as a failure because you are still detectable I would look at it as a positive. You are finding out early on that you are not responding very well. It could be worse that after treating you relapsed. At least this way you can stop and regroup.

Whatever you decide I wish for the best.

[ktee319]

lots of different opinions here, I thank you all for your input and I have an appt on monday of next week with my dr.  I will let you know the outcome.  Thanks again to all of you.

[Cory255]

You're 12 weeks into treatment, your viral load is 4,736.  I wouldn't jump the gun just yet.  It seems to me as if you are responding to the medication just not as much as you had hoped.  At this point I would say to consider extending treatment to 72 weeks if you're UND at week 24.  Treatment can be beneficial regardless.  

SLOW RESPONSE which means that you get a 2 log drop in viral load by week 12 and you clear by week 24....and increasing the tx to 72 weeks gives you better odds.

Non-response otherwise called a NULL RESPONSE means that you don't get a 2 log drop by week 12 and tx should be stopped.

[Trinity4]

It's really all up to you ketee.  I was a slow responder, vl of 719 at wk 13, extended 72 wks and relapsed.  The only reason I extended was because my liver stage is 3+.  

In my opinion, I don't think 48 wks of treatment will produce SVR.  You up the odds minimally by doing the 72 wks but it's very difficult so you must be mentally prepared.

Spectda,

Upping the riba now would be pointless.  Even though we need riba throughout our entire treatment it is most effective very early in our treatment.

Trinity

[jusjames]

not a great response but its possible to achieve svr, its a difficult desision

[nygirl7]

My VL was only 411 at week 12 and I had to extend to week 72 (I was UND at week 24 but I was also stage 3 like Trinity) fortunately i did achieve SVR.  While the log drop is good you should have been UND by week 12 - I agree with that, it changes the entire complexion.

Has your HGB dropped? If not I do agree with Copyman that this could be the problem. You don't complain of anemia at all....I have to agree if you haven't had any significant reduction it could be one of the problems.

It's a big decision but the rule of thumb kind of has been not und at 12 do 72 if Und at 24.  I think you have to see where you stand at week 24.