Question about 2 log drop and my 3 mon. PCR

[susan400]

Can somebody, once again, explain to me the 2 log drop and what exactly is a 'log'?  I have brain fog because I can't remember.  I just got the results back from my 3 mon PCR and I'm at 100,000 copies still.  I can't figure out, though, if this constitutes a 2 log drop.  Back in May, the last PCR that I had before I started treatment in July, I was at 6,900,000 copies.  Can anybody help me out here?  I see my doctor next week, but I want to know NOW.  

Thanks.

Also, I'm getting a flu shot later today, I hope that it won't effect my CBC/LFT's that I'll be getting drawn.

Susan

www.HepCandme.com

[cuteus]

great suggestions by DD, I hope it pans out for you. At least you are definetely a responder, it just seems that you need a longer time to reach your goals. It looks like you might be joining Sandi and Ina in the multiple year trip.  I hope the GI is open to suggestions also.

Jodi; darn it! we did not get that trip together to 6 flags this year.  I did make it to the Frightfest, though. Good luck on the college hunting. Hopefully, she will stay close by and her health will hold at an acceptable level.  She too needs a break.
You never talk about your health, how are YOU?

[mikesimon]

I see your name and I feel better. Hello back. Mike

[susan400]

Hey there Jodi.  How is Amanda doing?  I've thought of her often.  I hope that she's doing better.

Susan

[TravelGrl]

Hi Susan,

You are really close.. Each zero you drop off of the  6,000,000 represents a log...one log would be 600,000 and a 2 logs would be 60,000... You are almost there and if I remember correctly, you have not responded to anything before.  You are on daily infergen right?  Keep going!!  Good luck, looks like you are definitely responding.

Keep us posted,
Your Friend,
Jodi

[cougareyes]

A log is a decimal point. A 2 log drop would contitute dropping 2 zeros of the end of your baseline vl. You started at 6,900,000, you would want to be at 69,000 for your 12 wk pcr. Not quite a 2 log drop but close, I sure your doctor will go over the specifics as to what these readings mean as far as tx and svr.    Good Luck

[jmjm530]

You're pretty close. Are you on daily shots? If not, maybe you want to up the dose/frequency and re-test in another 30 days. At this point you want to get non-detectible as soon as possible.

-- Jim

[GoofyDad]

Sorry I don't have refs handy, but when I was researching bdna vs PCR the other day, I generally took this away from what I read. bdna seems better for quantifying. PCR is better for verifying negativity. In any case, .5 log was the margin for error in quantifying.

The information could have been a few years old. But it left me with the impression that we don't need to split hairs on the 2 log drop. That's just the impression I had at the time, I wouldn't stand by it.  

[mikesimon]

I just want to queue up get into your rooting section. You've been an inspiration to many, myself included. I wish you the best of luck Susan. Mike

[DoubleDose]

Yes, you are very close to a 2-log drop, which would indeed be 69,000 copies.  I think the real issue at this point is the forward-going viral reduction curve.  The absolute viral count for 12 weeks, at 100,000 copies, is higher than you would wish in order to be prime for SVR.

MY opinion, and I stress, my opinion, is that a dosage increase on the infergen, either in quantity and/or frequency, would allow for a better chance at achieving the goal.  The concern at this point is that the tx you are on is acting too slowly, and might need to be extended for several years or more, in order to get to absolute zero,(not just undetected) on the viral eradication scale.  You really need to become undetected as soon after 12 weeks as possible, for a solid chance at SVR.  They are using log drop at 12 weeks now, AND ALSO the absolute viral load count, in order to determine feasibility for SVR, and the odds of achieving it.  Right now you are on the right track to a degree, but just not fully there.  

Please remind us again, what your exact regime consists of currently.  What dose infergen, how frequently, how much Ribavirin, etc.  Was your PCR done exactly at 12 weeks (actually three months is more like 13 weeks)?  

Would you consider higher doses, or frequency of both or either drug going forward.  You know you will still need to extend for minimum 18 months, regardless, since you were not undetected at 12 weeks.  If you can get undetected in the next 4-8 weeks, and keep it there, you stand a good chance of reaching SVR, over an extended course.  A friend of mine , who had relapsed on 18 month tx previously, just finished a 2 year course of high dose Peg-Intron and Ribavirin, and just got his 6 month post-tx PCR back:  UNDETECTED!!!  So it can be done.  

I think you just need the right horsepower, AND duration.  I truly hope you can get undetected soon!  There are many medications, as you know, to help you get through the rough spots, especially if you bump the dosages up.  Talk to your doctor to set a plan of action.  You are TOO CLOSE to let it slide.   Best of Luck!!!!  Please keep us up to date on the issues discussed above!!!!  

DoubleDose

[susan400]

Thanks everybody so very much for your encouragement and cheering me on.

Just to reiterate:  I've been on daily Infergen 15mcg and increased Ribavirin (8 pills a day).  I've already tried everything else, all the other available treatments.

I'll let you know what happens with my doctor next week.  I hope he doesn't stop my treatment or cut back on my dose.  I want to at the very least, run it out to 6 mon. and then, re-evaluate my decision.  I've already done several full year treatments without SVR.

Susan

[cuteus]

the two log drop from the May PCR would have been 69,000, if I remember correctly. yours is pretty close.

[susan400]

Jim,

I know MK Andrews (Miles).  In fact, I've met him in person before, we're friends.  

Susan

[susan400]

Amantadine is the one thing that I haven't tried before.  That is a thought to consider and I'll mention it to my doctor next week.

Susan

[susan400]

Amantadine is the one thing that I haven't tried before.  That is a thought to consider and I'll mention it to my doctor next week.

Susan

[DoubleDose]

Susan,

Please note the link to a very comprehensive article about the pros and cons of Amantadine therapy in combination with various combinations.  I hope it is helpful.

http://www.natap.org/2005/HCV/090505_08.htm

DoubleDose

[TravelGrl]

Amanda has been taking a rest and holding her own since January.  We thought about trying daily infergen again, but decided against it for now...We are hoping to get into some sort of trial with one of the new protease inhibitors that should be hitting trials some time in 2006.  She will be turning 18 so we will push to get her in.  The problem is that she has cirrhosis and some of these trials will exclude her for that reason..

We don't know much more at this point..but she continues to be active and enjoy her teenage years...we started college hunting and it is a very exciting time for her, so we really would love to beat this virus so she can heal and move on with her life..

I am hoping this time around for you Susan will be the charm...you have been through as many treatments as Amanda...and I admire your courage and continued strength..

Stay well,
Jodi

[TravelGrl]

Mike!!

I owe you an emial....Hope you are well and recuperating from your bike accident.. Just wanted to say hello.

Hope all is well.

Always,
Jodi

[DoubleDose]

Susan,

You may want to have your doctor read the multi-trial analysis of Amantadine's impact on non-responders, provided in the link in my last post above, in this thread.  The doctors providing the analysis are pretty well known, and knowledgable.  Bottom line, the Amantadine seems to improve odds of SVR in many, (especially in your case), and also seems to improve quality of life while on interferon and riba therapy!!!  An added bonus.  

If you were to add the Amantadine, get to undetected before 26 weeks, extend therapy significantly, etc. you could most likely achieve what you have been shooting for all these years...SVR.

Here is the link again:

http://www.natap.org/2005/HCV/090505_08.htm


Let us know your doctor's reaction.   Best wishes.

DD

[DoubleDose]

Maybe this is also the time to add the good old controversial drug:  Amantadine.  Although it is considered to be ineffective in most of the rigorous trials, there have been some trials, mostly European, that have demonstrated some additive effect for relapsers, and prior non-responders, when used with high dose interferon and ribavirin.  It probably would not hurt at this point, to see if it has any effect in a triple therapy regimen.  If you get undetected before 26 weeks, you MAY be in business.  I still believe that you would need about 2 years total tx to provide good odds.  First things first though.  

Sounds like your dosing is already pushing the outer limits, right now as it is.  I am not sure how much more you could increase either component???  
Maybe a PCR in 4 weeks, then 8 weeks from now, to see what is going on.  You still might get undetected fairly soon.

Try a google search on "triple therapy using amantadine".
There are a couple of studies showing synergistic effect...though most studies show no effect by adding it.  
Maybe discuss with your doctor....  Good Luck!

DoubleDose

[jmjm530]

That's a lot of meds. I'm assuming you're a stage 3 or 4 to be putting yourself through all this?

If not, like DD says, I'd watch my regression curve very carefully. If you can't get non-detectible at 24 weeks (or whatever the Infergen equation is) then I'd consider making a strategic retreat
to fight another day with another drug. Some people just don't respond to Inteferon -- any type of inteferon. In particular, one hep c blogger, MkAndrews comes to mind who tried very high doses of infergen and still no response.

Hopefully, your next PCR will make all this academic and we'll see the drop you want.

-- Jim