PCR/12 weeks: the VL drop rate is slowing down!

[HassanHelmy]

Dear All
Genotype 4, week 12 of tx; Pegasys (180 mg)/week and 1000 mg /day riba, F0, A0 (fibro and Actitests).
.
I got my 12 weeks PCR results, the virus still alive! The VL is 51 IU, (my 8 weeks VL was 238 iu; 4 weeks was 17,851) down from 4,450,500 IU before tx.
I expected that after more than 4 logs drop after 8 weeks tx that I will be undetected! But the drop rate in the VL during the last month is getting slower! What does it mean? Is the virus getting more resistant! Should I change the dose?

Another point, I know that the machine detection limit is important parameter of being undetected or not! The lab I am using has a more advanced machine with a 12 IU detection limit. (the result could has been UNDETECTED if I use another machine which has a higher detection limit; 100 IU for example). Can I consider this 51 IU VL as "undetected" taking in consideration that all may agree that UNDETECTEd does not mean 0 iu!.

Waiting for your advice, should I continue tx and for how long?
Hassan

[anwaar]

Hassan
I have not started treatment and fairly new to this information here.  Your VL is going down.  You need to ask your doctor these questions.  Ask if it is possible, and in your best interest, to treat more aggressively and for a longer period. Good Luck.

[jmjm530]

I don't think there's a clear cut answer to your question. Studies suggest 72-weeks for those who have under a two-log drop by week 12 but are still detectible. But how many of those have such a low viral load (51) is a good question, so you may indeed have a decent shot with 48 weeks.  Also, some of those studies used flat riba dosing and I assume you are on weight based. The other question is that if you are F0, does 72 weeks really make sense? How are you tolerating treatmen btw? In any event, if you do decide to continue, you want to get to UND as soon as possible. Are you on Pegasys or Peg Intron? What is your height, weight and ribavirin daily dose? Do you know your pre-treatment hemoglobin and what it was on treatment? Possibly Depending on these and other factors, discussing a dose change with your doctor may make sense. Also, can I ask the name of the viral load test you're taking?

-- Jim

[cruelworld]

if i was you i would try to up the doses to knock out that last little bit of virus.
for example, you could take a shot every 4 days and an extra riba pill a day.
dont let that little bit of virus hang around any longer.
your viral performance is pretty good overall if you reach und soon.
your doc will approve this but you may have to convince him.
go to work on that immediately.

as far as which machine for vl test. at least get the one down to 12 detection limit.
once you reach "und" with that test, there is another one by labcorp that has a test with a detection limit of 2. (if you want the best)
see what happens and then decide 48 or 72 weeks.

[HassanHelmy]

Jim, Thanks, I always respect your replies. I am on Pegasys interon, my hight is 170Cm, 140 pounds. Until now the side effects are not very bad, only being tired most of the time. My hemo droped from 15.8 (before tx) to around 11 during the last month.
I am afraid to increase the riba dose (to 1200 mg/day), this may sharply decrease, the already low hemo, what do you think?
My doctor recommend 48 weeks of tx.
Have a nice day
Hassan

[HassanHelmy]

Thanks, I am using pegasys interon, so shot every 4 days is not possible, also I am using 1000 mg riba /day which is already high (relative to my weight 140 ponds), I am afraid to increase to 1200 mg as my hemo is low (around 11 down from 15.8 before tx).

[frijole]

Watch it, my friend.  I had 40 IU/mL at week 12.  Had I had the standard <50 test, I would have shown to be clear.

Based on the Drusano model, I decided to treat for 36 weeks after my first clear test by sensitive PCR.  That was at week 20, so I treated for 56 weeks, all clear after 20.  At my 3 month post PCR test the virus was ragingly back.  There are some quaisi sub species of virus that are exteremly virulent or able to adapt.  It takes more than 36 weeks to stop its replication.

Oh how I wished I had gone the entire 72!!!!!!!  I think the goal should be to only do this treatment one time.  I believe anyone who has even a tiny amount of virons at week 12 should treat for 72 weeks.   My suggestion for you is to get PCRs as often as you can.  Once a week if the insurance will pay for it so that you will know when you do clear.  

Now I know there are some who clear even with virons present at week 12.  My doctor - a GI - thought my test was great at week 12.  It ws only by reading in this forum I realized that was a falicy.  It is a hard decision and you have a lot of time to make it, but after (or if) you have convinced yourself, you may have to work on your doctor to extend.  Other options to consider are uping doses now for a few weeks.

Good luck on a hard decision.
frijole