Aa
12 Quantitative
I got good news this wk. I'm 2B and started tx in Nov 07. My VL pre-tx was 10,220,00 and when they did my 4 wk qualitative I was boarderline positive. I was hoping for a 2 log drop but instead I dropped to < than 10. Am I almost undetectable at 12 wks???????
"My VL pre-tx was 10,220,00"
I figure you mean 10,220,000 IU/ml? This would equal log 7 and is a somewhat high viral load, which might very well explain why you were not entirely UND by week 4.
I figure you mean 10,220,000 IU/ml? This would equal log 7 and is a somewhat high viral load, which might very well explain why you were not entirely UND by week 4.
RVR means Rapid Viral Response which means being undetectable at week 4.
Accelerate is a large study of genotype 2s and 3s, if I remember correctly.
Well, the information your GI has been giving you is not up-to-date. For geno 1s a 2-log-drop at week 12 is acceptable although not desirable (UND being what you want), but as a geno 2 one definitely wants an undetectable result at week 12, or rather at week 4 according to newer studies. Lately I have even seen a study mention week 2 as the time geno 3s preferably should be UND. You generally expect geno 2s to respond better than geno 3s, so I figure this goes for them as well.
http://www.hivandhepatitis.com/2007icr/easl/docs/050107_b.html
(Read the second section "What about Slow Responders?".)
http://www.hivandhepatitis.com/2007icr/aasld/docs/110907_d.html
So forget about looking at week 12. The interesting result is your week 4 viral load. And here I think you can apply the logic in my earlier response to you about borderline results. If you want to play it safe, try and persuade your doctor to let you extend treatment to 48 or at least 36 weeks.
It might interest you that my ex, Comeagain, relapsed as a geno 3 not weight based dosing doing 24 weeks. He is now doing his second treatment, this time with weight based dosing (although his interferon was reduced for one shot at week 2). Yesterday he got a borderline result of his week 4 test. I believe there is reason to be cautious with these borderline results. They are trying to tell us something. Maybe they are saying that we just need that little extra extended time to reach SVR (sustained viral response).
Accelerate is a large study of genotype 2s and 3s, if I remember correctly.
Well, the information your GI has been giving you is not up-to-date. For geno 1s a 2-log-drop at week 12 is acceptable although not desirable (UND being what you want), but as a geno 2 one definitely wants an undetectable result at week 12, or rather at week 4 according to newer studies. Lately I have even seen a study mention week 2 as the time geno 3s preferably should be UND. You generally expect geno 2s to respond better than geno 3s, so I figure this goes for them as well.
http://www.hivandhepatitis.com/2007icr/easl/docs/050107_b.html
(Read the second section "What about Slow Responders?".)
http://www.hivandhepatitis.com/2007icr/aasld/docs/110907_d.html
So forget about looking at week 12. The interesting result is your week 4 viral load. And here I think you can apply the logic in my earlier response to you about borderline results. If you want to play it safe, try and persuade your doctor to let you extend treatment to 48 or at least 36 weeks.
It might interest you that my ex, Comeagain, relapsed as a geno 3 not weight based dosing doing 24 weeks. He is now doing his second treatment, this time with weight based dosing (although his interferon was reduced for one shot at week 2). Yesterday he got a borderline result of his week 4 test. I believe there is reason to be cautious with these borderline results. They are trying to tell us something. Maybe they are saying that we just need that little extra extended time to reach SVR (sustained viral response).
OK now I'm concerned!!!!!! and confused?????? I have no clue what RVR is. Or what Accelerate is?????? My GI was simply hoping for a 2 log drop at 12 wks and I'm und at less than < 10IU Meaning the lab stated there was no virus found in my blood????? My Dr did not order any other quant or quali tests!!!!!! Maybe there's no reason to be excited?
Thanks for all input
B
Thanks for all input
B
If it were me i would have prefered the Qantative at week 4 and a qual at week 12.
I would have also pushed for a week 8 Qant PCT test.
Anyway using Accelerate study data G2s who are detectable at week 4 only have a 53% SVR rate.
The issue with this is that Accelerate only dected down to 50IU. So if you were in Accelerate you would be RVR and thus have an 85% SVR rate.
Being RVR is therefore good. Neverthekess those who RVR still have a relapse rate and although only a guess being detectable at around 10 might be a reason for this.
Unfortunately this is only a guess because no studies have been done for G2s comparing the positive predict values of various sensitivity PCR tests.
There is one for G3s done in India or Pakistan that compared SVR rates when detectable at >50IU and >600IU. The SVR rates were 44% vs 33% or there abouts.
It would not be drawining too long a bow to conclude that being detectable at around 10 would produce higher SVR rates but lower than true RVR which for G3s is also around 85%.
In short you are in a similar situation as zazza was. Being borderline detectable means that you probaly will have a lower SVR rate than a true RVR but higher than the 53% Accelerate achieved for non RVR G2s.
Personally I would discuss whether you should extend with your Dr. The reason is that your best shot at SVR is on your first attempt.
You would have been undetecable by week 5 btw.
All the Best
CS
I would have also pushed for a week 8 Qant PCT test.
Anyway using Accelerate study data G2s who are detectable at week 4 only have a 53% SVR rate.
The issue with this is that Accelerate only dected down to 50IU. So if you were in Accelerate you would be RVR and thus have an 85% SVR rate.
Being RVR is therefore good. Neverthekess those who RVR still have a relapse rate and although only a guess being detectable at around 10 might be a reason for this.
Unfortunately this is only a guess because no studies have been done for G2s comparing the positive predict values of various sensitivity PCR tests.
There is one for G3s done in India or Pakistan that compared SVR rates when detectable at >50IU and >600IU. The SVR rates were 44% vs 33% or there abouts.
It would not be drawining too long a bow to conclude that being detectable at around 10 would produce higher SVR rates but lower than true RVR which for G3s is also around 85%.
In short you are in a similar situation as zazza was. Being borderline detectable means that you probaly will have a lower SVR rate than a true RVR but higher than the 53% Accelerate achieved for non RVR G2s.
Personally I would discuss whether you should extend with your Dr. The reason is that your best shot at SVR is on your first attempt.
You would have been undetecable by week 5 btw.
All the Best
CS
no other labs except every 2 wk CBC with diff, LFT's, 4 wk qualitative & 12 wk quantitative........next wk CBC, LFT, TSH, and creatinine level.
Boni
Boni
Ok.... I'll try this again. I'm a geno 2B which means generally 24 wks of tx. At wk 4 I had a qualitative RNA that this lab ran 4 times......seems they were confused too! Twice I came back positive and twice I came back negative......So they determined I was boarderline Positive since the virus could still but barely be detected. My 12 wk quantitative is < than 10 which means they could not detect the virus at all according to what the lab stated. From what I understand as of right now I have only 10 injections left after tonight. I hope this clears things up and ya all give me a high five :)
That is where one has to use one's own judgement. Most studies have used tests with a sensitivity of 50 IU/ml (or higher). The tests used nowadays often go down to 10 IU/ml. So how does one interpret a borderline result with a test of 10 IU/ml? The virus is detected, but the studies do not give you a clue how to interpret a result like this.
I decided to play it safe and extend. Of course hoping that my borderline result would give me better odds than if I had had a quantifiable viral load at week 12.
I decided to play it safe and extend. Of course hoping that my borderline result would give me better odds than if I had had a quantifiable viral load at week 12.
You said......As a genotype 2 one wants to be undetectable by week 4, at the latest. Otherwise the odds of getting SVR fall drastically...........
....If you had this boarderline result week 4, you will most certainly be entirely undetected by week 5 or 6. There is just a shade of difference between these two results.
Meaning SVR rate not drastically reduced??
LL
....If you had this boarderline result week 4, you will most certainly be entirely undetected by week 5 or 6. There is just a shade of difference between these two results.
Meaning SVR rate not drastically reduced??
LL
You just got good news. You started tx in Nov '07. Shouldn't you have gotten the result from your 12 week viral load test by now? The mystery deepens. I agree with Lady Lauri, which week did you get your test done?
Rereading your post, I am a little confused as well. Did your doctor say you were "borderline positive" or did he say you were < 10 ? I see you had a qualitative not a quantitive test?
My viral load test had both a qualitative and a quantitive part. So with my test I could get either one of these results:
- Undetectable < 15 IU/ml
- Borderline positive
- A viral load greater than 15 IU/ml
A qualitative test usually says just undetected or detected. At least that is what I thought. Correct me if I am wrong.
My viral load test had both a qualitative and a quantitive part. So with my test I could get either one of these results:
- Undetectable < 15 IU/ml
- Borderline positive
- A viral load greater than 15 IU/ml
A qualitative test usually says just undetected or detected. At least that is what I thought. Correct me if I am wrong.
Boarderline positive is when the virus is detected by the test but in such a small amount that it is impossible to quantify the viral load. What was the sensitivity of your viral load test?
I myself was "boarderline positive" at week 12 with a test of the sensitivity of 15 IU/ml. That means the test could detect the virus but that it most likely was below or just around 15 IU/ml.
This kind of result makes one have to do a judgement call. Lately it has been shown that even a small remnant at week 12 for genotype 1s might indicate that 48 weeks is not enough. I choose to extend to 72 weeks, but the opinions differ if this was necessary or not.
As a genotype 2 one wants to be undetectable by week 4, at the latest. Otherwise the odds of getting SVR fall drastically. You are almost there. Only you can decide if this result is good enough for you. I think most doctors would consider it good enough. (Remember I am just a patient.)
If you had this boarderline result week 4, you will most certainly be entirely undetected by week 5 or 6. There is just a shade of difference between these two results.
Best wishes, Zazza
I myself was "boarderline positive" at week 12 with a test of the sensitivity of 15 IU/ml. That means the test could detect the virus but that it most likely was below or just around 15 IU/ml.
This kind of result makes one have to do a judgement call. Lately it has been shown that even a small remnant at week 12 for genotype 1s might indicate that 48 weeks is not enough. I choose to extend to 72 weeks, but the opinions differ if this was necessary or not.
As a genotype 2 one wants to be undetectable by week 4, at the latest. Otherwise the odds of getting SVR fall drastically. You are almost there. Only you can decide if this result is good enough for you. I think most doctors would consider it good enough. (Remember I am just a patient.)
If you had this boarderline result week 4, you will most certainly be entirely undetected by week 5 or 6. There is just a shade of difference between these two results.
Best wishes, Zazza
As Lauri said I didnt quite understand borderline positive?????
what did your 4, and 8 week show?? A little confusing.
But a sensitivity of <10 would be UND. Im sure your Dr. had to tell you or give you some direction. If you just became UND as Lauri just said you would be looking at a longer tx.
Keep us posted.
Inquiring minds want to know.
what did your 4, and 8 week show?? A little confusing.
But a sensitivity of <10 would be UND. Im sure your Dr. had to tell you or give you some direction. If you just became UND as Lauri just said you would be looking at a longer tx.
Keep us posted.
Inquiring minds want to know.
What did your Dr. say? I believe you are.
If they Dr. said you were UND CONGRATS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
If they Dr. said you were UND CONGRATS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Not understanding you?
At 4 weeks you were ?
What was the actual VL results?
Did you do 6, 8 week VL test? Have you actually gotten your 12 week test results?
Don't mean to worry you, and can't make out what your saying, but if you just became UND at week 12, you would need to discuss with your Dr. extending your tx to 48 weeks.
Please explain that more.
LL
At 4 weeks you were ?
What was the actual VL results?
Did you do 6, 8 week VL test? Have you actually gotten your 12 week test results?
Don't mean to worry you, and can't make out what your saying, but if you just became UND at week 12, you would need to discuss with your Dr. extending your tx to 48 weeks.
Please explain that more.
LL
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