viral load spike

[Laura217]

My Hep C viral load was decllining for the past few tests over 5 years.  8,000,000 to 6 million to 4 mil and now my most recent test came out 15,600,000.  Is this so significant that I have to be treated?  My liver enzymes are always normal.

[orphanedhawk]

This topic always drives me nuts since I was diagnosed with decompensated cirrhosis, ESLD and my viral load was only 750,000.

Viral loads are not what is important. The health of your liver is important.
Some with high viral loads have no liver damage.

[Advocate1955]

I just read your profile and I see that you're Genotype 1.  Have you had a liver biopsy?  The fact that your viral load has been declining over the years does not mean anything.  What is significant is that you have Hep C, regardless of low or high viral load, and it's presence may be damaging your liver.  I know it's scary to think about treatment, since you saw how hard treatment was for your husband, but it's really important for you to see a doctor who specializes in Hep C and have a liver biopsy and find out whether or not you have damage, and if you do, what stage of damage you have.  This information will help determine whether you should treat now or if you have time to wait for the new all oral interferon free treatments that are currently in clinical trials.
Keep us posted.
Advocate1955

[Advocate1955]

As others have said, your viral load doesn't matter, other than in terms of measuring progress in treatment.  Also, although normal liver enzymes is a good sign, liver enzymes do not tell us whether or not you have liver damage or how extensive your liver damage might be.  
If I were you, I would ask for a referral to a gastroenterologist who is familiar with Hep C treatment, or a hepatologist as soon as possible.  You should have further testing to determine what genotype of Hep C you have, as this matters in terms of discussing treatment options.  You should also have vaccines against Hep A, and Hep B, and be tested for HIV as any of these can cause additional burden on your liver.  You should also have a CT scan or an ultrasound of your liver to screen for liver cancer.  Your doctor may also recommend a colonoscopy to screen for other digestive problems and/or colon cancer.
Given your age of 59, your risk of having developed liver damage due to your Hep C is higher, so my recommendation is to find out more about the health of your liver.
Let us know what you decide to do.
Advocate1955

[HectorSF]

There is essentially no different between 4, 6, and 8 million. Viral load is measured in log numbers because only exponential changes make any real difference. For there is be a substantial change it needs to change by at least 1 log or 10 times the current value or 1/10 the current value.

So for 8,000,000 to have a significant change downward your viral load would have to drop by 1 log to 800,000 IU per ml. As you can see 8, 6, 4 million are all roughly the same. So don’t panic over fluctuations in your viral load numbers that might appear to be quite large. If they don’t reach the level of a ten-fold (log 1) change or greater. Even then, it may not be signaling a major change in your illness, but if it doesn't even reach that level, it probably means little or nothing at all…

Once you are chronically infected with hepatitis C it never goes away on its own. It has to be treated. Liver enzymes can be within the normal range for many patients. ALT and AST doesn't always elevate when a patient is infected. I had early cirrhosis and had normal ALT and AST levels. Also most people infected by hepatitis C have no symptoms. That is why proper testing is so important and needs to be performed by a knowledgeable doctor to tell if someone is infected with the virus and has liver disease.

Good luck with your treatment.
Hector

[Idyllic]

Greetings and welcome to the forum
As others will attest viral load and liver enzymes are not reliable indicators of how far fibrosis progresses. I shared a post a few weeks ago about an acquaintance who consistently has a low viral load and normal liver enzymes who is the picture of health so she has done nothing since she found out she had HCV. Over the summer (and at the pleading of her husband) she finally had a biopsy and discovered she is stage 3.

HCV can be asymptomatic and apparently hers is. On the other hand certain little unexplained maladies we develop over the years and perhaps attribute to aging can turn out to be associated with HCV.

[can-do-man]

Your viral load doesn't really mean a whole lot until you start treatment, it can and will change at any time... As for normal enzymes, one can still have a lot of damage so you can't read to much into that. A biopsy is the best way to tell your liver damage......... Good luck to you.