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Is Less than 10 Viral load undetected?

by kciav, Nov 27, 2008 08:50PM
Hi,
I am new here and my 21 year son acquired hep c as a newborn from a blood transfusion for heart defect surgery... He started peg inferferon and ribavirin 5 weeks ago and just had his 4 week blood work done.  He is genotype 1a and his viral load before treatment was 402,000 4 months before treatment and 392,000 2 weeks before treatment. His biopsy showed early bridging fibrosis (stage 2-3).   The nurse called yesterday and said his viral load was less than 10, it looks like 10 is the lowest number detected on their blood test.  Does that mean virus is undetected?  I am wondering if he has had a rapid viral response and what does that mean?  Shorter treatment or better chance at SVR?  Also is his viral load considered high or low?  I have read 400,000 is cut off reading.

Thank you for any advice...
J's Mom
Member Comments (19)

by jmjm530, Nov 27, 2008 09:19PM
It appears he's undetectable yes, but check with doctor. Given his rapid response, low pre-treatment viral load and age, he definitely is  candidate for a shorter 24 week treatment course with probably better than 80% chance of success.

Jim

by Trinity4, Nov 27, 2008 09:19PM
To: kciav
Yes, his viral load was low and he is considered undetected at this point.  There are more sensivitve tests, but it is safe to say he has no detectable virus.  Given his low viral load prior to beginning treatment and the fact he cleared the virus by 4 weeks, you may want to discuss treating for 24 wks as opposed to 48 wks with his doctor.  Current studies show geno 1's with a low viral load and a rapid virological response as is the case with your son, have the same odds of achieving SVR with 24 wks of treatment as those who do 48 wks.  Certainly discuss this with his doctor.  The only thing I see that could deter shortening treatment is the stage of liver disease.  If he is closer to stage 3 than stage 2, the degree is fibrosis could be a factor and his doctor may take that under consideration. Good Luck to you and "J".
Trinity

by PegOnPeg, Nov 27, 2008 09:21PM
To: Mom
Hi, Mom. Let's see..where to start...The viral load.  400,000 is not high..that's considered a relatively low viral load. My VL before treatment as 13,500,000...others here have been higher. I, too, am G1(a).

A load of less than 10 is NOT undetectable...there are different sensativities for these tests...others will post here for you, they'll know which test that you have to ask for, but you'll need to ask for a higher sensativity test..

Keep checking back here...someone will be able to tell you the name of that test...

Good luck, mom.
*peg*

by PegOnPeg, Nov 27, 2008 09:23PM
oops...my bad....I thought ,<10 was no good....I apologize...that's why I love you guys...you know it all!!
Peg**

by jmjm530, Nov 27, 2008 09:27PM
"Based on these findings, the investigators concluded, "This prospective study confirms that a 24-week regimen of peginterferon alfa-2a plus ribavirin 1000-1200 mg/day is appropriate in genotype 1 and 4 patients with a low baseline HCV RNA level who achieve an RVR by week 4 of therapy."


http://www.hivandhepatitis.com/hep_c/news/2008/101408_b.html

by epiphiny, Nov 27, 2008 09:28PM
To: J's Mom
Yes, that means his Viral Load was undetected to the lower limits of the test, in this instance 10IU/mL.

Yes, that means he has had a Rapid Viral Response, which is the greatest indicator of achieving SVR.

As far as I understand his Viral Load is right on the borderline of what is considered low.

All of this bodes extremely well for your son (yay!!) however I really don't know what the implications of these results will be on his treatment length.  As far as I know Geno1a usually treat for 48 but there has been talk recently of that being shortened to 24 weeks with the presence of certain predictors such as you have mentioned.

The best thing will be to talk it through with your Doc and I am sure others will chime in with more info.

In the meantime tho, congratulations to you and your son.  You have got the best possible result for where you are in the treatment process.  Well done!!!

Epi :)

by Trinity4, Nov 27, 2008 09:33PM
To: Peg
My last PCR was Labcorp TMA <10 and I am considered UND because the test does not calculate under 10.  If that is the test J had, he is considered UND.

by kciav, Nov 27, 2008 09:56PM
Thank you all for the great advice and quick postings.
I was excited to hear that the viral load had dropped so quickly but the nurse did not tell me much over the phone.  We did have to FedEx blood samples overnight to get to clinic for same viral test as the beginning test.  We live 250 miles from the clinic.  

The test sheet summary said the dynamic range of this assay is 10 IU/mL to 50,000,000 IU/mL.  Testing done by PCT method using the TaqMan HCV analyte-specific reagents.   The test developed and its performance by Laboratory Medicine and Pathology, Mayo Clinic.  Not sure what this all means but it is on our first copy from the clinic.

He has not been feeling well, but I guess that is to be expected.  It was hard to decide to treat but it seemed like the damage was starting to get worse so we felt there was not any choices.  He did not qualify for any trials because of heart defects and is being followed by cardiologists.

I am so happy to hear goods result, it has been heart wrenching to watch and we knew geno 1a was harder to treat.

It is a great Thanksgiving gift for us.

by HARRYBEADS, Nov 27, 2008 10:09PM
To: kciav
  Congratulations your son has cleared the virus in the first four weeks, this is not uncommon in SOC now a days and is an indicator that the treatment is working. My four week test result was from a different test and was < 600, this is concidered a clearance, it depends on the lowest limits of the test not it's accurasy. If you want to understand it more phone the nurse back and have her explain it and send you copies of everything. Tell him to keep up the good fight and we are all rooting for him. There are many 1 a'ers here that have cleared and are here to help.

harry

by jmjm530, Nov 27, 2008 10:19PM
To: kciav
kciav: He has not been feeling well, but I guess that is to be expected.
------------------
If his hemoglobin is below 10 or it has dropped more than 2-3 points from pre-tx levels your son may need the helper drug Procrit (epo).

by CMcH, Nov 27, 2008 10:53PM
From what I understand 1a's that are UND at 4 weeks increases your odds of SVR from @ 40-50% to 90%. My first test was >600 the limit of the test. I was upset that they didn't do the >5 test and they said that one was more expensive? They have used the >5 on me for the 12 week and 24 week. My VL was 345,000 so I have been trying to follow the threads about RVR w/low VL chance is 80-85% SVR at 24 weeks.
Please excuse me if my #'s are off the fog has been rolling in for a while.
My NP wanted to drop my Riba from 1000 to 800 because of low RBC & WBC requiring almost weekly Procrit & Neupogen. I finally did drop it down at 6 months and I do feel a little better lately.
As others mentioned I hope he is getting blood work done every 2 weeks or so if his counts are low and to check on Thyroid etc.
The rescue drugs do help.
Plenty to be thankful for today.
Connie

by kciav, Nov 28, 2008 07:06AM
His hemoglobin looks fair at 13.4
White is 2.4, Platelets at 157, Neutrphils 1.27.
His next blood test is 8 weeks.  Should it be checked sooner?
I don't think they've checked his thyroid.
He has a bad stomachache much of the time and is taking prilosec.  Do any of you have a problem with your stomach?  He does take his pills with food.
He is also on lexapro.  Very tired, achey, headaches.
He is taking 1000 Riba, he has lost a few pounds, down to 149.

Jim,
Thanks for sharing the study, it looks encouraging. I will ask the Dr about shorter treatment.

Connie & Harry,
Are you done with treatment?  How many weeks are you going to do?
24 weeks sound so much better than 48, but we don't want to lower the odds of having it sustained.  48 weeks seem so far hard and far away.  We don't see the Dr. again until January, when they will do the 12 week viral test.  They never mentioned shortening treatment time but that was before the 4 week result.

by HARRYBEADS