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Avatar universal

Why does the virus come back with vengeance after

a relapse occurs in most patients and what could be done differently to change the out come?
63 Responses
Avatar universal
I've heard that the virus usually comes back with a vengence, but for some reason mine was "only ?" 87,000 at around 8 or 9 weeks post. My baseline VL was over 8 million so I was surprised when I relapsed that it wasn't around 8 mill when tested. But now it has climbed back up and the last test it was 7 million - that was about 5 months post or so - now I am 6 months post and I'm curious as to what it is at this point.
Avatar universal
I wondered if maybe mine wasn't real high and thought that maybe my body was trying hard to fight it. I don't know I am only guessing, but since the body DOES try to fight it, this was my first thought when the doctor first read the lab to me - the dreaded day - yuk.
Avatar universal
WOW! it took 20+ years for most to get to that viral load and then 48/72 weeks to knock it down or to get to UND, Ok, and so it only takes 6 months to re-replicate back into the high numbers??? I don't understand why this happeneds.

Avatar universal
I am 2b so I only tx 24 weeks not the 48 - next time 48 though. But ya know what I have read that for alot of people the high numbers come back immediately if they relapse.

I was UND at 4 weeks post tx and being I was RVR my particular situation is kind of hard to understand. My doctor thinks that its just a matter of txing longer. IMO its a real cr@p shoot when a geno 2 has a high VL cause 24 weeks just might not do the trick - though it has for some even at 16 weeks. I would have rather have gone to 48 weeks (hindsight is 20 -20)...and now that I have to tx for 48, I would actually like to go longer if it were possible with insurance and if I don't have difficulty with sx.

Happy New Year. And I hope to hear great news of your SVR this year.
Avatar universal
Happy New Year to you too.  

“MY doctor Thinks”, this in it self is the scariest part of all… I have thought a lot in the last 43 weeks and have learned a lot more about what this virus has in tailed for me and am in just as much a flux as treating doctors which leads me to the next thought.

While dropping back and regrouping from the disappointment of relapse what do we turn our minds to? Is there a should of, could of, and if I had only done things differently, what would you have changed as far as your treatment, diet and life style? With what you know about HCV at this point and/or have learned over the past weeks, years here on this board about the treatment process and monitoring stages during the course of treatment, what would you try to change in that process or bring up in a conversation with your old/new doctor before retreatment?
Would you go into a consultation armed with the knowledge learned and debate your points and back them up with data and research to get the doctor to take you more seriously about your treatment and recovery?
It seems quit obvious that most doctors (GI), and specialist are following a standard play book (inside the box), so to speak; as far as SOC treatment and are less likely to listen to a patient who has done research on their illness and in most cases have more up to date information available to them to aid in there own recovery but as with most doctors will not listen to what their patients have to say even tho the patients are the ones who have to endure the treatment with a 50/50 chance of SVR at the end of 24/48/72 weeks or longer of treatment.
Avatar universal
To simplify -- and there will be some speculation in this post -- the virons replicate quite rapidly, but they are also killed quite rapidly by the immune system.

The viral load numbers you are left with on testing, represent let's call it "last virions standing" from this continuous battle. And while viral load itself does not correlate with liver damage, studies do suggest that lower viral loads are easier to treat.

Is this because there are less virons to kill, or perhaps because fewer virions indicate that the immune system is stronger at that particular point in time and therefore will be more likely to succeed once the interferon is added?

If you buy into the latter scenario, then it's reasonable to speculate that someone with a lower viral load is showing a stronger natural immune response than someone with a higher viral load.

And because viral load can significantly fluctuate over time, it seems reasonable to explore  coordinating the start of treatment with a viral load "trough", i.e. when VL is very low.  Of course this has a number of logistical issues including frequent VL tests and the fact that some may need to treat right away as opposed to waiting, not to mention that some people may never have their viral load go into the low zone.

This also brings up the issue of exploring ways to reduce viral load prior to treatment, but to my kmowledge no reliable path has been demonstrated to date. For example, several devices report lowering viral load by treating the blood with some sort of light source, but no follow-ups I know of either to colloborate the findings or to show how this technique might translate into higher SVR rates. It could in theory, but on the other hand, if it doesn't affect the immune system, it might not.


In your case, what your low post tx viral load may have meant is simply that your immune system was doing a pretty good job of killing or supressing (pick one depending on your orientation) the virus -- just not good enough job. So, if you decide to re-treat, your doctors advice to treat longer with the same drugs seems reasonable.

Curious, what weeks did you test for viral load during treatment, and what was the sensitivity of those tests? If I remember correctly, you might have missed the week 4 test? It's also becoming apparent, that testing periodically after UND using sensiive assays is also becoming increasingly important to predict SVR.

-- Jim
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