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Help with viral load numbers
I recently started Sovaldi/Olysio. I changed doctors right after I started on the drugs. My problem, because my new doctor uses a different lab I don't know how to interpret my vl results from week 4 of treatment.
My baseline was easy, it was reported as 28000000, (yes, 28 million.)
My week 4 viral load was reported as .3 iu/ml. Undetectable for this test is under .12 iu/ml
Is there a way to convert my week 4 vl to a number like my baseline vl? Also, if the Sovaldi/Olysio combo is going to work for me, should I have been undetectable at week 4?
Thanks!
My baseline was easy, it was reported as 28000000, (yes, 28 million.)
My week 4 viral load was reported as .3 iu/ml. Undetectable for this test is under .12 iu/ml
Is there a way to convert my week 4 vl to a number like my baseline vl? Also, if the Sovaldi/Olysio combo is going to work for me, should I have been undetectable at week 4?
Thanks!
You don't have to juggle with viral loads logarithms, log to IU/mL converters like we did in the old days (last year and before). We also used to crank our cars to start them at one time too...The is thankfully history now.
All people become undetectable on this treatment and it doesn't matter when.
We have seen people become undetectable by week 2, 3, 4, 5, 6, 7, 8, we have seen them all achieve SVR. we have also seen people become undetectable by week 2 relapse after stopping treatment. The terms non-responders, partial responders and viral breakthrough are also history.
To repeat...
"To quote from the COSMOS study..."Rapid virologic response (RVR, defined as undetectable HCV RNA at Week 4 of treatment) was NOT found to be predictive of achieving SVR. In patients receiving simeprevir and sofosbuvir alone for 12 weeks, 93 percent achieved SVR, while 57 percent achieved RVR. "
"Sovaldi/Olysio combo is going to work for me"
"should I have been undetectable at week 4?"
Will it work for you? You mean will you achieve SVR?
No one knows for sure. It all depends on the factors you had before starting treatment as to what your chances of SVR are. Genotype subtype Ia or Ib. Genotype 1 A with the Q80K mutation. Previous treatment with a PI. Cirrhosis. All of these factors affect success rate. Stage 3 trials are being done to learn more about just how these affect outcomes.
"should I have been undetectable at week 4?"
No. (That one is simple to answer since most people in the COSMOS trials weren't undetectable by week 4 yet the vast majority achieved SVR).
I am on the same treatment with ribavirin treating for the 3rd time and this time post transplant. Will I be cured? Hopefully we will both be cured. As to what will happen...I have no crystal ball. I figure if this fails better treatment will be available by then and I will treat with them.
Good luck with your treatment.
Hector
All people become undetectable on this treatment and it doesn't matter when.
We have seen people become undetectable by week 2, 3, 4, 5, 6, 7, 8, we have seen them all achieve SVR. we have also seen people become undetectable by week 2 relapse after stopping treatment. The terms non-responders, partial responders and viral breakthrough are also history.
To repeat...
"To quote from the COSMOS study..."Rapid virologic response (RVR, defined as undetectable HCV RNA at Week 4 of treatment) was NOT found to be predictive of achieving SVR. In patients receiving simeprevir and sofosbuvir alone for 12 weeks, 93 percent achieved SVR, while 57 percent achieved RVR. "
"Sovaldi/Olysio combo is going to work for me"
"should I have been undetectable at week 4?"
Will it work for you? You mean will you achieve SVR?
No one knows for sure. It all depends on the factors you had before starting treatment as to what your chances of SVR are. Genotype subtype Ia or Ib. Genotype 1 A with the Q80K mutation. Previous treatment with a PI. Cirrhosis. All of these factors affect success rate. Stage 3 trials are being done to learn more about just how these affect outcomes.
"should I have been undetectable at week 4?"
No. (That one is simple to answer since most people in the COSMOS trials weren't undetectable by week 4 yet the vast majority achieved SVR).
I am on the same treatment with ribavirin treating for the 3rd time and this time post transplant. Will I be cured? Hopefully we will both be cured. As to what will happen...I have no crystal ball. I figure if this fails better treatment will be available by then and I will treat with them.
Good luck with your treatment.
Hector
Yes, theres a good chance youll reach SVR12 even though your gt1a. Im still presuming your not cirrhotic. This is why I stated, "you can treat again.." just in case you8 relapse within the 12 weeks following EOT. And in the event you do have to treaqt again, it will tax your liver due to the fact of multiple previous tx's. I did err on one point however: .3iu/mL is higher than .12iu/mL .3=30% .12=12% By a thin hair you missed being UND at 4 weeks but the margin is is so narrow that I wouldnt worry about it. As flyinlynn pointed out RVR is not a predicator of SVR, (especially for gt1a's on Sov-Olys). In summary, if your not cirrhotic (F-4) Ill give 7-1 odds youll acheive SVR, not because of the rapid virological response, but due to the fact that RVR occured between 12 mil and .3 in addition to the fact that your not cirrhotic.
Thanks for the replies everyone. I was seeing a doctor for the Daclatasvir/Peg Interferon Lambda/ Ribavirin drug study. In that study my viral load went from 22 million to 550 in 4 weeks time but I never cleared so I stopped taking the drugs, however they kept me in the study to gather data. After stopping the combo my viral load peaked at 60 million!
My last study visit my viral load went down to 28 million and 3 days later I started the new regimen of Solvaldi and Olysio but was being treated by my previous doctor who was not part of the study and uses a different lab. Funny thing about that, my regular clinic's lab did two different genotype tests on me and they both came back 1b. The study lab came back 1a!
At my regular clinic my vl's ranged from 15-22 million, so I know I have had very high vl's for a long time, at least 12 years. My latest biopsy was 2-3, my blood work is fine except for slightly high alt and ast.
My concern is not being undetectable at 4 weeks, during the study I had a massive drop but never went below 550. I was wondering if the same thing might be occurring with the new regimen. I don't know how .3 iu/ml is translated into a whole number. My doctor is out of town until next week and his staff member seemed clueless on how to interpret the results. His nurse said I am still detectable at .3 He said undetectable is under .12
I gather by the replies that I still have a chance at becoming undetectable, thanks everyone. Waiting a week would have drove me crazy. I know my situation is a bit confusing and I'm not that good at writing it out.
Again, thanks.
My last study visit my viral load went down to 28 million and 3 days later I started the new regimen of Solvaldi and Olysio but was being treated by my previous doctor who was not part of the study and uses a different lab. Funny thing about that, my regular clinic's lab did two different genotype tests on me and they both came back 1b. The study lab came back 1a!
At my regular clinic my vl's ranged from 15-22 million, so I know I have had very high vl's for a long time, at least 12 years. My latest biopsy was 2-3, my blood work is fine except for slightly high alt and ast.
My concern is not being undetectable at 4 weeks, during the study I had a massive drop but never went below 550. I was wondering if the same thing might be occurring with the new regimen. I don't know how .3 iu/ml is translated into a whole number. My doctor is out of town until next week and his staff member seemed clueless on how to interpret the results. His nurse said I am still detectable at .3 He said undetectable is under .12
I gather by the replies that I still have a chance at becoming undetectable, thanks everyone. Waiting a week would have drove me crazy. I know my situation is a bit confusing and I'm not that good at writing it out.
Again, thanks.
Kanarstead it looks as if treatment is going just fine. From what you wrote is says you are undectable from this test and your only at week four. As what the above poster means by these two things I have no clue.
"The good news: (presuming you dont have cirrhosis) --you can treat again without peg or rib."
" The bad news: its going to tax your liver considerably to reach SVR. But like all of us with HCV you have no choice but to tx because down the road, should u reach decomp due to failure to reach SVR, a liver transplant is all but impossible if the virus is still present."
"The good news: (presuming you dont have cirrhosis) --you can treat again without peg or rib."
" The bad news: its going to tax your liver considerably to reach SVR. But like all of us with HCV you have no choice but to tx because down the road, should u reach decomp due to failure to reach SVR, a liver transplant is all but impossible if the virus is still present."
Hi
I borrowed this from a post of HectorSF
"Early clearance is no predictor of SVR. That was true with old peg-interferon treatment based treatment with peg-interferon and ribavirin as well as when a PI was added. But, is NOT true for this treatment. In fact most people that treated with this treatment during the clinical trials were NOT undetectable by week 4 during the clinical trials.
To quote from the COSMOS study..."Rapid virologic response (RVR, defined as undetectable HCV RNA at Week 4 of treatment) was NOT found to be predictive of achieving SVR. In patients receiving simeprevir and sofosbuvir alone for 12 weeks, 93 percent achieved SVR, while 57 percent achieved RVR. ""
So not to worry at this point initial viral load is not necessarily predictive of response nor is 4 week test while on treatment and still having the virus.
From what I have seen everyone becomes undetectable on Sovaldi and Olysio the only failure are relapse failures so far.
That being said the only test that truly matters is the 12 week post treatment result.
Yes different labs report the results in different ways so that makes it hard to compare apples to apples when they do that. The important thing is you have had a reduction in viral load no mater how it is quantified. And based on the Cosmos study you should be undetectable at the end of treatment.
Good luck on treatment hope you reach 12 weeks post treatment and SVR
Lynn
I borrowed this from a post of HectorSF
"Early clearance is no predictor of SVR. That was true with old peg-interferon treatment based treatment with peg-interferon and ribavirin as well as when a PI was added. But, is NOT true for this treatment. In fact most people that treated with this treatment during the clinical trials were NOT undetectable by week 4 during the clinical trials.
To quote from the COSMOS study..."Rapid virologic response (RVR, defined as undetectable HCV RNA at Week 4 of treatment) was NOT found to be predictive of achieving SVR. In patients receiving simeprevir and sofosbuvir alone for 12 weeks, 93 percent achieved SVR, while 57 percent achieved RVR. ""
So not to worry at this point initial viral load is not necessarily predictive of response nor is 4 week test while on treatment and still having the virus.
From what I have seen everyone becomes undetectable on Sovaldi and Olysio the only failure are relapse failures so far.
That being said the only test that truly matters is the 12 week post treatment result.
Yes different labs report the results in different ways so that makes it hard to compare apples to apples when they do that. The important thing is you have had a reduction in viral load no mater how it is quantified. And based on the Cosmos study you should be undetectable at the end of treatment.
Good luck on treatment hope you reach 12 weeks post treatment and SVR
Lynn
K: Did you ask either Dr's Ofc for copies of your Lab results? You should get them and can then look at the numbers and how they are explained by the Labs used in each instance. And what the HVC RNA,PCR Quantative ( where the 28 mil came from the first time).
Sounds like the different Offices go by different scores, but poprobably, both are there -- I could be wrong- but it never hurts to look
Like Blue said a drop from 28 mil to .3 IU/mL is awesome, even if it is still detected @ Week 4.
I went from 813'+++ (thousands) to Less than 15 still detected by Week 3 but by week 7 that was Less than 15 UND! A great first step. Oh, in your 2nd Dr's parlance that was from 5.91 IU/mL to Less than 1.18 still detected @ week 3 an to Less than 1.18 NOT Detected (UND) at week 7.
Now the trick, in both our cases is to do everything we can to help it stay UND.
Good Luck. Hope this helps.
Sounds like the different Offices go by different scores, but poprobably, both are there -- I could be wrong- but it never hurts to look
Like Blue said a drop from 28 mil to .3 IU/mL is awesome, even if it is still detected @ Week 4.
I went from 813'+++ (thousands) to Less than 15 still detected by Week 3 but by week 7 that was Less than 15 UND! A great first step. Oh, in your 2nd Dr's parlance that was from 5.91 IU/mL to Less than 1.18 still detected @ week 3 an to Less than 1.18 NOT Detected (UND) at week 7.
Now the trick, in both our cases is to do everything we can to help it stay UND.
Good Luck. Hope this helps.
In the words of our favorite AGT Spice girl--Mel B; That baseline viral load "is off the chain". Twenty-eight mil. Congrats on your survival. The good news: (presuming you dont have cirrhosis) --you can treat again without peg or rib. The bad news: its going to tax your liver considerably to reach SVR. But like all of us with HCV you have no choice but to tx because down the road, should u reach decomp due to failure to reach SVR, a liver transplant is all but impossible if the virus is still present. In any case your question was in relation to understanding viral load..28 mil is listed as very high which is mainly why u failed to clear, even after that good combo (unless your a gt1a in which case no combo is a "good" combo). Everything currently hinges on your next blood test. Dont be too concerned about converting tables or charts. Just hope that .3iu/mL doesnt increase. If it decreases than your on the road to cure. As far as "should you be undetectable at week 4?" The answere is belabored by the obvious-- .3iu/mL IS considered UND. It means that your viral load is so very small that it could still be wiped out by the residual effect of the drug and your own immune sytem which has been strengthened.
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