Help with lab results!!

[Believer7777]

I am 4 weeks into treatment and asked the Dr. to re-run the viral load test to see how I'm responding.  Can you help me with the log10 and vl results- I didn't get much from the Dr. other than it appeared positive.

Pre-tx:  327,000 quantitative
              5.52 log10

4 weeks in:  320 quantitative
                      2.505 log10

What are the log10 results??

[willing]

agreed - since you're close to but not quite rvr cutting it to 24w seem risky. Make sure to track  what week you go und - there's a lot more information about your ifn responsiveness in knowing you were w6 or w8 und than in knowing you were und by w12. Confirming und with a high sensitivity test is likely worthwhile - particularly as und pushes closer to w12. See for example Fig. 4 from (free access)
http://www.ncbi.nlm.nih.gov/pubmed/20398383  

[Believer7777]

Sorry I'm on a PDA- one sentence didn't make sense. I meant to say from my current low vl- being tested a on Friday and having my 5th injections after my test- I could be undetectable right now.

[Believer7777]

Thanks for asking- side effects are managable- not fun but part of it. Weakness, headaches, sensitivity to light, very dry skin, etc. WBC is 2.7 down from 2.8 I'm prior weeks. Nutriphils are 1.5 I believe.

Knowing the treatment is working makes the fight that much easier. I like the sound of only 24 weeks, but since I'm not quite undetectable doesn't sound like an option. From my level- I could be right now since I was tested a week ago.

Oh well - 48 weeks it is!!  

You're a great service to us amateurs!

[Bill1954]

No, I’m just another nut :o). My comment above was mucked up by Medhelp’s software; somehow the ‘greater than’ and ‘less than’ arrows screw up HTML code and delete any text between the arrows. If you browse through the link I provided, you’ll get the whole story.

Thanks again for the kind thoughts and words. Are you managing okay in regards to side effects, etc? Any issues with red or white cells to date?

Stick around if you like; there are a lot of us that have treated previously, as well as many currently in various stages of therapy. Misery loves company and all, hehehe :o)!

Be well,

--Bill

[Believer7777]

Great information Bill.  I'm assuming with your significant knowledge on the subject you are a hepatologist?  Or just a kind man who knows way more than my MD !!

[Bill1954]

It sounds like you’re doing well. The cut off for low starting viral load is now considered to be 400 000 IU/mL identified the greatest difference in SVR rates between patients with LVL and HVL... (70% vs 43%, vs 63% vs 43% for , and...60% vs 43% for )..."

http://www.natap.org/2007/EASL/EASL_41.htm

Low viral load combined with rapid response is a very good indicator; so good in fact that the EU allows for shortened treatment for genotype 1 patients; from 48 to 24 weeks. For this to occur, the patient needs to be fully undetectable for virus at the four week juncture and have started with a viral load <400,000 IU/mL. You didn’t become fully UND, but it’s still very promising.

Good luck, and let us know how things work out—

Bill

[Believer7777]

Bill thanks again. I am being treated privately. I have great insurance and asked my Dr. to run the test as I was anxious and curious if treatment was working.

Labcorp did the test. Lab results listed a scale of 43 to 69,000,000.

[Bill1954]

Um... sort of, yes. It depends largely on the test used; a very popular commercial test that’s commonly used has a lower limit of sensitivity of 43 IU/mL.

This raises questions, of course; how much advantage, if any do ultra-sensitive viral load tests carry. There seems to be a consensus that there is indeed clinical utility for using sensitive methodology at the four week juncture, and perhaps up to the point of undetectable status in therapy. This topic is discussed frequently in here, as you can imagine :o).

Do you know which test your doctor is using? Are you in a clinical trial, or treating privately?

Thanks for the kind words, by the way!

--Bill

[Believer7777]

Your thoughts and explainations are amazing, helpful, and a true blessing!  Thank you.

It sounds like once my vl drops another 318 I would be considered undetectable... Correct?

[Bill1954]

Hi Believer,

If you can access a scientific calculator it’s pretty easy to express numerical value as log-10 value; just enter the number, then hit the ‘LOG’ key. If you have a PC, you probably have a scientific calculator under ‘programs’ or ‘all programs’.

No test can quantify viral load to zero. The most sensitive test reports to 2 IU/mL as its lower limit of sensitivity:

Labcorp’s NGI Quantasure #LC 140639.

Another sensitive test is Quest Diagnostic’s ‘Heptimax’ with a lower limit of sensitivity to 5 IU/mL.

Your undetectable status will be determined by whatever the lower limit of the given test is.

More discussion on this subject can be found here:

http://www.medhelp.org/posts/Hepatitis-C/Lab-Corp-no-longer-offering-10-PCR/show/772286

I just verified that the log-10 value of 320 is indeed 2.5051

Welcome to the discusison group, by the way!

--Bill

[Believer7777]

Thank you very much for the comment-  I appreciate the help.   Does the 320 viral load and  log 2.5 make sense?  Proportionately to the large drop in the quantitative value you would think th log value would be smaller.

Once the 320 viral load goes to 0 does that mean I'm undetectable?  Thanks again!  Sorry for the ignorance. By the way i have genotype 1a with a perfect liver biopsy.

[Bill1954]

There are several ways to express viral load. You’re likely familiar with numerical expression; you’re baseline (starting) load was 327,000 IU/mL. This can also be expressed as a logarithm (LOG) value; in this case, the log-10 value is log 5.51.

At four weeks, you have experienced a very robust response of log 3.01; but you’re still detectable for virus.

Good luck-

Bill