question regarding my viral load results

[Javi1962]

my question is how far do I have to go to get to UND? my nurse called and told me my viral load is now at 36.

baseline:  1980000
72 hrs:           418
1 week            36
2 week          still waiting on results

I know this is good news, just curious to know how much further to go to undedected, do I have to go to 0?
my understanding from what I am reading is most pcr test won't take you that low?

[Aquisi]

"In order to SVR you will have to have 0 viral load in your blood"

Hi Dave, just to put my no cents into this we would all love to have a zero detection, but as you stated the lowest is 2 iu/ml. This is the FDA's standard I'm wondering if there are any others.

clinicaloptions.com/hepatitis

Understanding the Optimal Use and Interpretation of Assays in HCV

Use of HCV RNA Assays to Assess SVR
With BOC or TVR-Based Therapy

SVR to pegIFN/RBV previously defined as
– Absence of detectable HCV RNA in serum using assay
with sensitivity of at least 50 IU/mL 6 mos after EOT[1]
SVR defined by FDA in BOC and TVR package inserts as
– HCV RNA < 25 IU/mL (LLOQ) 6 mos after EOT[2-3]
1. Lindsay KL, et al. Hepatology. 2002;36:S114-S120. 2. Boceprevir [package insert]. May 2011.
3. Telaprevir [package insert]. May 2011.

[Jestewart]

Thanks javi
Take care and good luck

[Jestewart]

Thanks for your comment, and I am sorry for the miss spelled words
I am in bed on an iPhone, damn keys are to small

Good luck to you Javi
Jeff

[Javi1962]

I am currently on all oral medication, no PEG, therefore the side effects are minimal, no hair loss or flu like symptoms or any of the side effects that come with PEG injections, sorry to hear you are having a rough time at it.

[Jestewart]

Opp's my teeth  feel like chalk
(had to correct an error from above)
I am in bed typing on an iPhone, sorry for the mistakes

Jeff

[Jestewart]

Hey everybody
I started my hep c treatment on sept 20, 2011
My VL was 658,059, I am geno 1 and late stage one, I was diagnosed June 2000, after one week my VL was 39 and after 10 days it was undetectable.... Cool, wait read on, this crap is so brutal

I am a guinea pig (and was, kinda still am.
Greatful) for Merck pharmaceutical, I have been undetectable for (as of my next Doc appointment which is Jan 10th, 2012) for 14.5 weeks
I am stopping treatment

Hears why, I am so fuc- en sick (24/7) all the time, loss 15lbs, lost 70% of my hair, my Heath feel like chalk and are about to crumble, my head aches are so severe I want to rip my eyes out

I am 53, I don't drink and eat well, no drugs, if I stop treatment at my age and being a low level hep c'er I will with out question live a very productive 25 years, I will be 80, and in all likely hood I will live longer, and die of a 100 other thing other the hep c,

Taking or getting treatment is not a cure, and if you study, read, ask and look at all the angles and your situation you will see that treatment is nor always ( in my case) the best option, if I was 20-30 sure it would be, but for me now at my age and my situation it is not, plus with such a "very rapid response" I may stay undetectable, who knows? But if I don't, as long as you rest take care of your self, don't drink,  or smoke, limit salt and sugars, take milk thistle, I will die of old age or so something else, this medication is with out the worst thing I have ever done to my self,.. Ever!

Loss of weight, body musle, loss of hair, no sex for ever, I am so white I am almost purple,

Remember, treatment is good at the right time
in the right situation, but it is not alway a "cure"
And treatment is not always the answer at that moment, you have to study
For me this is a very brutal, very distructive move I did and did with out a full understanding of the "complete picture"

God bless you all and good luck
Jeff Stewart
Vancouver canada



I do my shot (0.5) once a week, and MK-5172 (google it) and Ribo

[TDM62]

This is what I meant...I first did treatment with Dr Lok 2000-2001 with the old Interferon/Rib...(3 shots per week)...treatment was 11 months.
I lost 50lbs (never overweight)...was bed ridden for a year.
Since Vietnam my liver enzimes had been slightly elevated.
Being a non-responder I quit drinking, watched diet and avoided anything that could impact liver function.
Dr Lok did not say this to me about viral load to gage TX, this was about not getting too alarmed about viral load when liver function is withihn normal ranges.

[orphanedhawk]

I'm not great at viral loads but I know you that you are doing great.
If you are doing this well at 2 weeks, you will be UND before long.
Advice~ relax, its working!

[Javi1962]

my nurse called yesterday and told me my viral load for 2 weeks is below 25, I asked her what that means? and she said your somewhere between 1 and 24, not und yet there still a little there, I asked well will I get to 0 and is that UND she said yes, Im confused with this result and advise?
thanks

[TDM62]

Thanks...counting down CL1

[curiouslady1]

Hi TDM,  

I am afraid that you misunderstood what Dr. Lok has said to you.  First, Dr. Lok is not an oncologist. She is a gastroenterologist.  She is well known among researchers and was one of the three principal award winners at AASLD.  In my view she is speaking directly to you about your particular condition related to all of the many numbers we are given when we are in one of her trials.  She is showing you how the numbers like your ALT/AST goes down as the inflammation goes down just as she showed me.    

I think you are right in a sense about the viral load.  Those double digits can linger for quite awhile.  Some of my fellows had double digits for a couple weeks further after an initial dramatic drop and one I can think of had <43 for some time as well.  I think she is telling you not to worry much about it for now.   Once you are UND there is no number on our print out to worry about.  If one should show up;  it really matters not a wit what that number is, it likely means you have had a breakthrough.  Then you can worry.  Welcome to the forum fellow Michigander and Go Blue!

[Javi1962]

thanks everyone for your feedback on this, I know not to look for LFT as a gauge for this, my LFT has always been in normal range and I still have virus and can go to cirrossis with normat LFT, my concern is the oral drugs are so new so not much data on it, for example with Interferon/Riba we know that if you are UND at 2 weeks your chances of staying that way and being cured is GREAT and it is reason to celebrate, but with oral drugs since it is not proven yet with longevity, I hear of others who have gone to UND in a week, but on the 7th week it came back, so I wish the data was there, but for now, I am going to stay optimistic, and hey it's a trial so I guess my case will help in those future statistic, I am doing 24 weeks of giliead trial GS 5885, 9451 and Riba (placebo) or Tigobuvir (placebo) or all 4 pills, there are no side effects but slight headaches, so I did'nt think they were working, was very pleasently surprised to find that they were giving this virus a BEAT DOWN in my system without me knowing it, these are NINJA pills, lol

[spectda]

as Will mentioned your liver enzymes are not the indicator of how well you are responding. Many factors can cause your enzymes to be elevated including your liver having to deal with the very drugs that are being used to eradicate the virus. Some of the trials have been stopped because the drugs that may be able to stop the virus are also causing injury to the liver.

[spectda]

In order to SVR you will have to have 0 viral load in your blood, but the most sensitive tests only measure at best to 2 iu/ml. If you have 1 iu/ml your body will still have approximately 12,500 copies of the virus in your body. (1 iu/ml equal approximately 2.5 copies of hcv virus in an ml of blood
you have approximately 5000-6000 ml of blood in your body)

The hope based on past trials and experience is that if your are undetectable by a sensitive test that you are truly undetectable, at least when you are through with treatment and beyond.

The trials for Incivek and Victrelis used the roche taxman test that can quantify virus to 25 iu/ml and can still detect the virus to but can not quantify it to 7.1 iu/ml  (LabCorp Hepatitis C Virus (HCV), Quantitative, Real-time PCR #550080) This test takes only 2-3 days for a result unlike the TMA or NGI quantisure which can take some time.

the labcorp test will clearly state if you are und by their test limitations unlike the quest PCR which seems ambitious and confusing as it will never use the term und from what I have experienced.

Regardless at 1 week you have amazing results and should be jumping up and down cheering yahoo, yippee and hooray

congrats,
Dave

[willbb]

I should add that if liver enzymes spike to excesive levels it is something  the doctor should watch for  as there may be something going on as a result of treatment or another medical factor.
They are not what is used to gauge success or failure of virus eradication
Will

[willbb]

javi1962:  Great result ! Good advice on the testing from fret  and flcyclist

TDM62:
These new drugs wipe out the virus within one month, my oncologist Dr Lok, MD University of Michigan said not to pay to much attention to viral load, more importantly watch your liver enzymes ALT,AST to see how well your liver functioning and is holding up to the  virus, viral load  is secondary.
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This is a totally false and misleading statement ,that your "oncologist " has given you. The "Viral Load" is the ONLY level that should be paid attention to when doing treatment therapy for HCV. Liver enzymes  as cyclist mentions are  secondary and of really no significance.

Being that his specialty is cancer treatment ,not that surprising ,he is misinformed about HCV therapy. Always best you get your info. from  a doctor experienced with HCV and it"s treatment.

Best...
Will

[flcyclist]

There are many things that can cause fluctuations in liver enzymes so I'm surprised your doctor is using this as a gauge of how you're responding to trt.    The viral load (VL), measured via PCR has been the standard protocol for determining if the trt is working, how quickly you are responding to trt and ultimately 6 months EOT to find out if you are SVR.  Some people's liver enzymes stay within normal range prior to and during trt.

Response guided trt and decisions to continue or stop trt are clearly based on PCR (VL) as stated on their labels.  I'm not sure of many that are using an oncologist to guide them through trt, but if you are receiving this advice, you might want to consider seeing a qualified hepatologist.  Just my opinion.  

[TDM62]

These new drugs wipe out the virus within one month, my oncologist Dr Lok, MD University of Michigan said not to pay to much attention to viral load, more importantly watch your liver enzymes ALT,AST to see how well your liver functioning and is holding up to the  virus, viral load  is secondary.
She also said non-responders of Geno 1 had 86% chance of clearing virus using Incivek/Rib/Interferon

[fretboard]

"The two most sensitive tests I'm aware ofare the Labcorp NGI Quantisure (2 IU/ml) and Quest Heptimax (5 IU/ml).  Best of luck to you."
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True, you won't have to go completely down to zero.  One test  will only go down as far as 2 and the other 5 IU/ml.  That said, hopefully you get one of the test mentioned above.  good luck!!  

[flcyclist]

This is great news and a great response for a 1 week PCR.  I'd be very surprised if you don't see a UND for the 2 week.  The two most sensitive tests I'm aware ofare the Labcorp NGI Quantisure (2 IU/ml) and Quest Heptimax (5 IU/ml).  Best of luck to you.