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317787 tn?1473358451

HCV UND - SVR NEW INFO

Hi all I found this article and thought it was so interesting and it gives hope to those who may still be detectable on tx.  There is so much new information coming out all the time it is difficult to keep up.  I hope this helps someone.
Dee


New Hepatitis C Treatments and Viral Load Results: Clearing Up Confusion
By Lucinda K. Porter, RN on March 23, 2015 1:39 PM | 12 Comments
HepCvirus.JPG

New hepatitis C medications are changing lives, saving lives, and bringing hope. However, there is some confusion about viral load testing used during hepatitis C treatment. I am aware of this confusion because I am repeatedly asked two questions.

Question One:

"What does this test mean?" This question is accompanied with test results such as:

HCV Viral Load (Log IU/mL)   <1.18 NOT DETECTED

Answer: This is the very best news.

Undetectable means that hepatitis C is gone, and presumably all gone. The confusion over this test is because viral load tests don't measure down to zero. Further, viral load tests vary. For instance, the Abbott RealTime HCV assay (assay is a fancy word for a test that determines and measure the ingredients of something) measures down to 12 IU/mL in a 0.5 mL sample of blood. This means that if you have 12 IU/ml of hepatitis C (HCV RNA) in your blood, the test will detect it and count it. If you have less than 12, the test might not see it, and if it does, it won't be able to count it. .

Each test has its own detection range, some lower than others. The main thing is this:

    "Not detected" = negative for hepatitis C
    "Detected" or an actual number of how much HCV RNA you have = positive for hepatitis C

If you are concerned that you may have some residual HCV swimming around in your body, hoping to set up shop in your liver, rest assured, as this is quite unlikely. Hep C replicates a trillion times a day, so "not detected" might as well be zero. It is extremely unlikely that a small amount of HCV will remain alive in your body without having replicated to much higher amounts. In fact, viral load tends to replicate at much higher numbers when treatment fails.

Question Two:

I am on treatment with Harvoni. My pre-treatment viral load was X million. My week 4 (or week 8 or week 12) viral load came back detectable. I am devastated. Should I be?

Answer: No.

In the old days, back when treatment was long and used interferon, there were clear milestones that helped us know what our chances were of permanently clearing hepatitis C. Ignore all of that. New research funded the NIH Clinical Center showed that low levels of HCV RNA at the end of treatment are not predictive of treatment response among patients with hepatitis C virus treated with interferon-free regimens. (Clinical Infectious Diseases, March 2, 2015) In fact, low levels of HCV RNA detected at the end of treatment, and even post-therapy, do not signify treatment failure.

Here is a bit more information. Sidharthan and colleagues enrolled 114 subjects with chronic HCV/genotype 1 and no prior treatment. Six patients with detectable viral load at the end of treatment achieved a sustained virologic response (SVR12). You can read more about it: Utility of Hepatitis C Viral Load Monitoring on Directly Acting Antiviral Therapy - S Sreetha Sidharthan, et al.

The bottom line is that a detectable viral load at the end of treatment DOES NOT mean that treatment failed when using Harvoni-based treatment.

Important:

    Don't despair if you have detectable virus during or at the end of HCV treatment.
    Be sure your doctor doesn't stop treatment just because you have detectable HCV RNA. The HCV guidelines recommend viral load testing after 4 weeks of therapy and at 12 weeks following treatment completion.  If quantitative HCV viral load is detectable at week 4 of treatment, repeat viral load testing at treatment week 6. If viral load has increased by greater than 10-fold on repeat testing at week 6 (or thereafter), then discontinuation of HCV treatment is recommended. There are no other recommendations to stop or extend therapy based on viral load results.

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1961140 tn?1450738712
Hey, I too obsessed about the diffference between the viral titer result listing first showing "< 15IU/ml", then changing to "TND". This is the acronym some lab in KY Merck used for "totally non detectable". What was the difference, I asked? I never got a consensus answer to that question, so I finally let it go. Since week 5 of tx, I was "TND". I began tx 8-05-14, and my next titer will be drawn on 4-14. The Director of Hepatology wrote me a letter, quoting the relapse rate for persons who were TND 12 weeks post tx as "less than 1%". He feels I am in the clear, I would rather wait to see the result of this upcoming titer. I think the trend of shortening tx periods has become the new holy grail, now that they know how to eradicate it, the race is on to do it faster than the other drug mfr. Hang in there all you GT3s, yours will just be the last one to take a permanent vacation.     mac
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317787 tn?1473358451
bumping up for others to see
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1689583 tn?1387752394
It is the same document I read it states caution should be taken when prescribing 8 weeks. That was my concern. I am sure I will be ok seeing I am below 6 million the relapse was 2% if I remember correctly.
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Avatar universal
I got a similar typing problem on my LG G2  April 11, 21015 ??   couldn't even imagine that far in the future.
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Avatar universal
It isn't an article, it's a living document that can be updated at anytime. The important thing is to revisit before acting on any recommendations.
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Avatar universal
How to cite and request permissions www.hcvguidelines.org:
The website as a whole:
AASLD/IDSA/IAS–USA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed April 11, 2015

http://www.hcvguidelines.org/news/how-cite-and-permissions   Accessed April 11, 2015

For clarification April 24, 2014 in the example,that represents the date that page was updated.  When citing you use date you accessed the website (page).

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This website is constantly being updated. Please remember to always refresh your page.

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"NOTICE: Guidance for hepatitis C treatment in adults is changing constantly with the advent of new therapies and other developments. A static version of this guidance, such as printouts of this website material, booklets, slides, and other materials, may be outdated by the time you read this. We urge you to review this guidance on this website (www.hcvguidelines.org) for the latest recommendations."

The information at hcvguidelines.org is copyrighted and for fair use brief quotes can be used if properly cited,

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I try not to quote hcvguidelines.org material without revisiting site as I did today to be sure it hasn't been updated since my last visit.  When I use April 11, 21015 that tells everyone that I checked today to verify the info I quoted
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1689583 tn?1387752394
I see the date is April the article from I was reading was in January 2015
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