What day to test?

[jelise]

I just read an old post that said blood tests should be taken right before the weekly shot (it didn't say why - is it to check for the virus at lowest inf?).  My doctor wants to test soon after the shot to make sure and see all of the bad effects on blood counts.  

Which should it be?  

Thanks :)

[FlGuy]

A little off topic, but you are a little hdifficult to catch these days.

In  comment somewhere (don't know where) you wrote that just coffe cane raise blood glucose by itself.  Can you give some ide to what extent, maybe in a couple of scenarios.  After 10 hours of otherwise fasting and two hours after a meal.  Thanks

[CoWriter]

"It truly doesn't matter which day you test.The Pegasys peaks approximately 72 hours after the injection and the ribavirin stays steady in the blood stream for a long time. Procrit works rather slowly so you will not see the hemoglobin increasing right away. Even the neulasta/neupogen takes some time. I don't know how the rumors about this kind of stuff get started."
-----------

They get started by hepatologists like Dr McHutchison, Dr Flamm and Dr Kugelmas who created the "Side Effects Management Handbook".

Page 87 Chapter on Neutropenia says.......

"Assess for neutropenia by monitoring the WBC count with differential at baseline and
weeks 2 and 4 and then monthly in all patients receiving anti–HCV-treatment. Note:
lower neutrophil counts will be recorded if the blood for the CBC is drawn within 24
to 72 hours of peginterferon administration. Consider drawing the CBC 1 to 2 days
before peginterferon administration."

http://www.projectsinknowledge.com/Init/G/1628/1628-Handbook.pdf


Isn't Dr Kugelmas one of the HCA's advisors?  Surely you'd want to follow his recommendations.

Co

[Isobella]

I bet you got more info than you expected on that one ;)

But that's what makes this place so special.....lots of information.  Most of it good, too.

I wish you the best.  Please keep us posted.

Isobella

[jelise]

Wow - thanks for all of the information.  It is much appreciated.

[JennyPenny]

I think your logic is right on that point. It is much more important to know the highest your VL is during treatment. But, all the publications on viral kinetics have been saying that the injection does not change those numbers after the first week or two of treatment. To me, the bottom line is it doesn't matter. What matters is the 4 week PCR, the 12 week, the 24th week, EOT and 24 weeks post treatment. And we all agree on that point.

[Marcia2202]

It would make sense to take the PCR on the day there is least peg in the blood, at least that's what I had understood. You would get the potential highest reading on VL, the 'worst' result. Not a possibly masked result.

[becksta29]

my doc told me to tk riba every 12hrs cos it starts to run out (well it peak does) then yes it stays in body 4 while i believe,not sure exactly how long but tx works beta 12hourly from what i hear,but tx still works for peeps who dont take em ev 12hrs too,but just a bit higher chance ev 12hrs,i always forget to take em exactly 12 hourly but only usually by an hour or 2,iv only forgotten one dose all together so far thank god cos that would not be good to forget a whole dose all time cos my doc did tell me not to double dose on riba to make up 4 it.
my doc didnt tell me nothing about which time i get blood tests but my doc hasnt got a lot of time he is so busy with all his patients,iv found out so much stuff from this site its awesome,my doc hasnt even told me my vL or told me i can get tested at 4wks to see vL,i cant wait to c him next to ask all this stuff.man i wish i had of studied b4 going on tx.

[ladybug52]

This is where I got my info re: test day. At the time another member (who will remain nameless) chined in"Yes, that's the way we do it here."

by jmjm530, Jan 07, 2007 12:00AM
If your injection day is Friday you could take your viral load test either Thursday or Friday, just as long as it's before the Friday injection. A conservative "trough" reading refers to the trough in terms of the interferon. In other words, the interferon will be working stronger after the injection and the weakker right before the next injection. You were using the term undetectable correctly, it's just that undetectable is always in terms of the sensitivity of the test you're taking. In your case the sensitivity was 50 IU/ml. In the case of Heptimax, the sensitivity will be 5 IU/ml.

-- Jim

Thanks ML for your explanation. I'm not trying to argue with anyone on the best day to do a shot,just explaining where I got my info initially

Bug

[JennyPenny]

Thank you ML. Also, did you know in the beginning when people only had 3 million units of Intron A 3 X week, those doses were picked because....well....those doses were picked. It was totally arbitrary. And patients, like myself, stressed over doing that injection 15 minutes late. Who knew?

As you stated, consistency is much more important most of the time rather than the particular day related to the injection. I don't know for sure how it works with neupogen and procrit, where it might matter to know the lowest numbers, but I do know it does not matter for PCR. For example, if you need a two log drop to continue treatment at 12 weeks, and there was a way to know which day would show the lowest point, hoping for a 2 log drop, what good would it do to think you have a two log drop, if they next day it wouldn't really be a 2 log drop?? Oy, nevermind, it's too hard to explain.

I really appreciate the way you explained it. Thanks again.

[Mr Liver]

The highest plasma levels of IFN are 72-96  hours after administration . This is true at week one and will be true during the last week of treatment. After the first week of tx
( 2-4 days in most people) the free circulating virus found in the sera is virtually eliminated or for some greatly reduced ( >3 log). Even those who will not go on to SVR wil have this dramatic drop. The virus found in the blood after that first week is primarily being released from hepatocytes since the previous shot. This is what is measured to determine vl throughout tx. Since IFN does have a direct antiviral effect on circulating virus your lowest viral reading would correspond with this peak.of appx 74-96 hours post-injection.

The peak to trough plasma levels difference is slight with peg to be sure, and this most likely would be reflected by a corresponding slight change in vl. Let me stress that point---the peak to trough variablility with peg is very slight.

It matters much more to test on the same day, e.g., the same day relative to shot day
to receive the most accurate comparisons. It doesn't matter if its one day after the shot or three days before.

In trials I know they pick the same day for everyone because they want consistency and as an added benefit it helps to staff accordingly to prepare for a day of testing.

Pure speculation on my part, but I think there would be fewer no shows for labs if it was done on shot days. I don't believe many people forget which day they take their shot and an association with labs may reduce those who forget their lab appt.

ML

[Isobella]

Just to clarify....are you saying you got your PCR's the day before your shot because the meds would be lowest in my system and a true viral load would be calculated?

Isobella

[copyman]

had a top hepatologist tell me the same thing so it is not MH rumor. i don't use internet forums to make decisions on TX. I listen to what my Hepatologist says.

[Marcia2202]

Well, I guess my hepatologists also got rumors started...

They wanted me to come in on the morning of my shot. I just happened to be treated in Denmark's biggest teaching hospital.

[JennyPenny]

When I first asked when to have my viral load done, I was told to do it the same way you said. One member even commented;"That's the way we do it here on the forum"...as if it were a group mindset that couldn't be disputed.
...............................................
You just answered my question about how rumors get started. LOL.

[ladybug52]

Hey, love you man, but just because it's been discussed here before, that doesn't mean it's right!!

If you read the previous posts, the discussion centers on whether the peg has peaks and troughs after beginning treatment. I was always told to do the shot before injection so that the meds would be lowest in my system and a true viral load would be calculated.

The flip side of that theory is that if you have the pcr done while the meds are at their peak stage in your bloodstream, you might have a lower viral count, but not as accurate of a reading.

As JennyPenny stated, there's published data that contradicts the whole theory of peaks and troughs, since after the second week of injections, the peg stays at a pretty consistent level in your blood.

When I first asked when to have my viral load done, I was told to do it the same way you said. One member even commented;"That's the way we do it here on the forum"...as if it were a group mindset that couldn't be disputed.

I'm glad that it has been disputed because it led me to do some reading on my own.

Bug

[copyman]

This has been discussed many times here on MH. The best day to test VL and give most accurate result is day of injection but BEFORE injection is done.

[ladybug52]

I thought that testing  right before your shot was trying to get the meds at their "trough" which means, to me, that the person is trying to get the most accurate level of viral load, with the least medicine in the body.
That's the way it was explained to me. Not to show a lower viral load, but the most accurate.

[JennyPenny]

Neulasta didn't work on me at all after my count dropped to 0. I was lucky I had a hematologist who was willing to try everything. I took the neupogen and that worked. But, it took many days after each injection to see the counts start to go up. Then once I stabilized around 200 ANC it worked faster. It was really scary.

[JennyPenny]

Ya know if you want to get your shot the day before the next one is due, it sure can't hurt. If it makes you feel more confident, I say go for it. But, to me, the bottom line is, if you have to do something like that to show a lower viral load, you probably are not going to clear. As for the test being called a 4 week PCR not a 3 and 1/2 week PCR, that makes no sense at all. Where is the analogy in that? And as Ladybug says, the published data all says after the first week or two it doesn't matter at all. It was different when we were doing treatment with 3 mil units of Intron A in the early 90's. The half life then was 3-4 hours.

Newleaf, AASLD starts on Oct 30 this year. We will be going. The best sites for AASLD news are natap., hcv advocate and hivandhepatitis.

[ladybug52]

I know! I thought the same way, but it seems that the peg has a half life only during the first week and after that the serum levels remain constant. I was sure that JmJm was right about this, as he's the one who advised me and others to get the viral load test right before the next shot. I started reading up on it last night, and everything that JennyPenny says is consistent with the published data I read.

I had my first pcr on a Moday and my shot day was Friday and I was und 3/12 weeks after starting tx. Jim said that it would be a "3 week" pcr since it was before my 4th shot.

Old Jim....(sigh) I sure do miss him!

Take care,
Bug

[Marcia2202]

I think that one of the main reasons for taking the PCR as close as possible to the next shot is because of determining RVR, EVR etc.

After all it is called a 4 weeks PCR and not a 3 1/2 week PCR.... etc.

[Isobella]

In my study, they did the PCR's before I took my shot.  If it made sense for them, it made sense for me.

I was under the impression that because the Peg had a half life of aprox 72 hours that was why we felt so much better the day or so before giving our shots.  That held true for me, especially at EOT.

[newleaf09]

I really never thought it made any difference when you took the blood sample.  It doesn't really matter to have a picture of a particular day; it's about the big picture.

The Neulasta (filgrastim, same as neupogen but pegylated) induces increased neutrophils overnight (maybe even in a few hours).  I was not allowed to use it and the peginterferon on the same day and was required to have a white count the day after the Neupogen shot, before they would allow me to take my peg shot.  Certainly worked well on me; I'd get neutrophil counts up to 12 or 13 and could hold normal or above for up to 2 weeks.

Do you happen to know when the next liver specialist meeting is?  Is it the AASLD meeting around the 1st of November?  I look forward to all the new info that gets reported at those.

[JennyPenny]

In 2000 Dr Teresa Wright, hepatologist, discussed a study of viral kinetics and the comparison of pegasys and peg-intron on the peaks and trough of interferon. This talk was given at Digestive Diseases Week in San Diego.She stated that "Peg Intron had a maximal blood serum (no cells) concentration approximately 24 hours after a dose." And, "Pegasys has a half-life ("terminal elimination") of 50-80 hours. Whereas, due to it's shorter and linear-chain, Peg Intron has a half-life of 30-50 hours." She also discussed that after the first couple of injections the serum blood levels are high enough that the medication stays pretty much even as time goes by. This makes it likely that it will have no bearing on how much virus is showing the day before the injection.