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Previous viral ld pcr undetected but at 36 weeks pcr detected, less than 1.6
My husband is currently in week 37 of triple hcv treatment with peg, rib, and incivek. His initial 4 wk pcr was less than 43, wk 12 undetected, wk 24 undetected, but the recent 36 wk pcr showed detected, less than 1 .6. The dr. Has ordered a repeat lab to double check the viral load and needless to say, we are very concerned. Does anyone have experience with this type of response? The dr. hesitated to label my husband as a "relapser" until we get results from the re-testing.
Hector is right, if he does indeed have a VL, he wouldn't be considered a relapser, it would be considered a viral breakthrough. Glad to hear that your hubby will be re tested. We'll be hoping it was a glitch in the testing. By the tome he gets the results of the 2nd test back, he'll be in wk 38 or 39. Depending on the results, the doc may say "stop" (if the VL has gone up) or he may say "continue" and re test EOT. My hubby had a viral breakthrough at about week 24 and had to stop. If it's not working, it's not working, and more time won't change that. The next test should tell.
Advocate1955
Advocate1955
Should add that the biggest part of time that one has a breakthrough while still treating their viral load numbers would be much higher then your husbands, another good sign...........
Try not to worry, I would bet it was a lab error. We have seen that here before. If by chance it is back then he would be classed as a breakthrough since he is still treating........ My guess is lab error, good luck to you both.
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DDW 2013: Viral Breakthrough May Occur during Interferon/Ribavirin 'Tail' of HCV Triple Therapy
"HCV viral breakthrough is an ongoing possibility during the pegylated interferon/ribavirin continuation phase after triple therapy with telaprevir (Incivek or Incivek or Incivo), especially for difficult-to-treat patients, researchers reported this week at the Digestive Disease Week conference (DDW 2013) in Orlando.
The present analysis included 55 chronic hepatitis C patients who received boceprevir or telaprevir triple therapy at UCLA's Pfleger Liver Institute between June 2011 and July 2012.
Results
9 study patients (16%) experienced viral breakthrough while on treatment.
All these patients were on telaprevir; there were no breakthroughs on boceprevir.
8 of the 9 experienced breakthrough during the pegylated interferon/ribavirincontinuation phase after triple therapy.
The mean time to breakthrough was 21 weeks.
6 patients (67%) who experienced viral breakthrough had harder-to-treat HCV subtype 1a, while 3 (33%) had 1b.
6 of the 9 patients (67%) had advanced fibrosis or cirrhosis (stage F3-F4) according to liver biopsies.
6 breakthrough patients were prior null responders, 1 was a prior relapser, and 2 were treatment-naive.
6 breakthrough patients had ribavirin dose reductions prior to treatment failure, including 2 who also lowered their interferon doses.
6 of the 8 breakthrough patients who underwent resistance testing had telaprevir resistance mutations, all of whom also had cross-resistance to boceprevir.
The 6 individuals with resistance all had subtype 1a, while the remaining 2 had 1b.
"Similar to findings in clinical trials, viral breakthrough with DAA for treatment of chronic HCV infection is associated with genotype 1a, advanced liver fibrosis, and prior null treatment response," the researchers concluded."
"In our study, however, a significant proportion of patients experienced viral breakthrough after completion of the DAA portion of triple therapy," they continued. "More frequent virologic assessments during the [pegylated interferon/ribavirin] treatment phase may be useful in a subset of 'higher-risk' patients to expedite compliance with stopping rules and decrease unnecessary treatment burden."
5/22/13"
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Your husband should do the other 5 weeks of treatment than get retested or wait a few weeks and get retested.
What does he doctor say?
Good luck!
Hector