HCV UND - SVR NEW INFO

[Dee1956]

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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[Dee1956]

Along the lines of information. I just saw the first commercial from the CDC re HCV.  It is the Know More HCV Campaign.  It said that people born between 1945 and 1965 are FIVE TIME'S more likely to have HCV.  They are now saying there are more than 4M in US with HCV.  3 out of 4 infected were born during those 20 years.  I hope people get the word. 75% of people infected don't know.

[Dee1956]

Thanks so much, I thought it was interesting, Dee

[AWorriedMom]

Great article, Dee. Lucinda is amazing. Thanks for posting it.

[JimmyMose]

" I hope those heppers whose Drs cut them off at 8 weeks because not UND will show this article to those same Drs"

Are you referring to patients who were prescribed and started 12 or more weeks of the new drugs then having their tx stopped at week 8 if VL detected? Except for a 10 fold increase in VL.  

Where there any members who posted that this happened to them? If so what did they do?

I know there are member here with GT1 VL under 6M who started 8 week tx. and are trying to get 4 more weeks.  This article wouldn't support that in my opinion.

[printze]

I am on the 8 week tx did a viral load at 3 weeks was 108 doing another viral load Tuesday that will be week 4 for me my doctor told me I will be fine and will need the additional 4 weeks my pre tx viral load was 2million so it dropped from that to 108 Does this make sense?

[printze]

Corredition doctor said won't need the additional 4 weeks.