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Avatar universal

Relapse hcv 1b

I was treated for hcv 1b, with pegylated infereron and ribavirin  for 48 month. Ending  April 06. I was found clear of virus. I took a test in June of 07 and the Dr. not the Hepatology, informed me I was still virus free. In Dec 07, I took another test, because of  some of the HCV symptoms. The MD said I was within the serum. what is the reference range?  Not being sure I had an appointment with the HCV Dr. In Mar 08, I was told that I had relapse with a HCV RNA by PCR: detected (932,000 IU/ml). I under stand that a person who has relapse had a low SVR when retreated. What does this mean and should I try a new treatment?
6 Responses
Avatar universal
This is quite a kettle of fish and I am not in a position to answer you. I'm sure the more authoritative people in the forum will chime in.

For the first issue, your relapse, this is confusing. Most people relapse quickly if they're going to relapse, so it's a puzzle. Could you have been newly infected? Could your doctor have misinterpreted your results in June 2007? Were you tested between April 2006 and June 2007. I am more asking myself these questions than helping you and I'm sure you've already asked yourself these same questions.

As to your question itself, I have read of many people who have treated more than once and finally cleared the virus. You may not be aware but just yesterday, there was a lot of exciting treatment news in the press (shares rose!) about the Vertex trials, which right now may be the hottest thing on the table. You can see the links posted from yesterday's input.
Avatar universal
It would be very helpful if you could locate the test results for the June 2007 labs.

First question will be:  Were you given a PCR test?  and secondly, if you were, what was the sensitivity level of the test.  If it was a quantitative PCR (viral load test), you will have a threshold in IU's or viral copies, which will indicate how low the test measured in terms of viral load.

If it was a qualitative PCR test, the result would be given as either positive, or negative.  Usually the qualitative tests are pretty sensitive.   Then, the third question is, what were the results of the test, as indicated on the lab results forms?

If you did not have PCR testing done, you were likely still harboring virus after ending treatment.  The virus may have been undetectable at the end of treatment, but would have come back in three to six months, and in most cases within a month or two.
If you were undetected by PCR in June 2007, then you would be a rare case indeed.  Possibly hidden virus that was very delayed in resurfacing (that's a stretch to imagine), or it may have just been lurking at extremely low levels, but not really gone.  

For more helpful responses to your questions, you will want to present a much more detailed history, with lab results, etc.  How soon were you undetected after you STARTED therapy?  That correlates highlt to potential relapse, or breakthrough.

I look forward to hearing more on you situation.

DoubleDose
Avatar universal
After going back to the lab,I located the June 07 lab test. There were two reports for June. 08 June 07.HCV AB PENDING;HCV RNA 6.143 IU/ml; HBs POSITIVE H; HBs AG NEGATIVE; 25 June HCV RIBA POSITIVE H; HCV RNA 6.143 IU/ml.

I started a Peginterferon 180 mcb SC each week in combination with Ribavirin 1000 mg daily for 48 week in April 05.  In Jan 06, my qualitative HCV RNA had No detectable virus.  In May of 06, after finishing my antiviral therapy, I rechecked a HCV qualitative RNA by PCR to see if I had remained clear of virus and it came back undetectable. Oct 06 through June 07, My AST (SGOT); ALT (SGPT) were all normal. My HCV RNA was pending and after a week, the Dr. informed me that it was normal.  Taking the Dr. for his word I did not get my Lab results.  Dec. of 07, I requested for another qualitative RNA by PCR. It was hard to get the results from the Dr.  I got the lab result for the last year. The June 25 07, results showed HCV RIBA positive H; HCV RNA 6.143 IU/ml. The result for Dec 17 07 HCV RNA SRL; Result HEP C QUANT = 808,000 IU/ml. HEPTATIS C RNA-PCR = POSITIVE.  

I requested to see a Hepatology. 03/21/08, the lab results from this was HCV RNA BY PCR detected (932,000 IU/ml).
Avatar universal
I think you mean you treated for 48 weeks not 48 months.
The key record is your viral load after 12 weeks treatment.
All genotype 1 patients who have detectable viral serum at that point,no matter how low,will inevitably relapse if they cease at 48 weeks.
You can treat again but for 72 weeks.
Alternatively you can wait for the new drug Telaprevir which is now being tested on relapsers,so there is plenty of hope for the future.
Avatar universal
It sounds like you may have never really fully cleared all the HCV virus from your body.  Your three month and six month PCR results are not able to be verified, and possibly were really positive at that time.  Your 2007 results showed that the virus was definitely there again, The 6.143 IU/ml. result most likely was a log expression of the viral load, which would have translated to somewhere in the low millions range, or log 6.  

As someone asked above, do you know when you first cleared the virus during treatment?  If January was your first clear PCR that means 9 months into tx!  You could never become SVR by only going a few more months, to complete 48 weeks, with that history.  Your original doctor needs to provide the lab test data that is missing...like the actual PCR readings after you finished tx, and when they were done, etc.  You also need to know your initial date of becoming undetected while on tx.  If it was after 12 weeks, as suggested above, then you really needed to do 72 weeks (as I did, and many others on this forum) in order to achieve a permanent SVR, rather than just an End of Treatment undetected.  The virus usually comes roaring back in those cases, after several months.....even up to six months later in some cases.  Yours may be one of these unfortunate cases.  Did your doctor have a known history of successfully producing SVR's in those with genotype-1, HCV?  You need an experienced Hepatologist, or Gastroenterologist.  Its a tricky formula to get a high rate of SVR's..especailly for late responders!!!  

DoubleDose
Avatar universal
Sorry about your not being clear.  What did your original biopsy indicate?  Perhaps you will consider another biopsy, finding you may not need to treat (depending on the results).  Having the virus isn't the end of the world if your liver is in decent condition.  I know I'm more healthy being HCV positive than the average Joe that is HCV negative.  Diet, exercise, living well and monitoring the condition of your liver might be your best route.  How are you feeling?  
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