Viral load

[doc1960]

I have genotype 1a and my viral load is 5,800,000. Is that real bad or normal in this case.

[Stvski80085]

Viral load changes all the time.  I would say just about everyone is normal range of viral load because they change all the time anyway.  My original VL was 1.7 million.  I have see people with 10 million or more.  I wouldn't worry about it that much unless you are on treatment.  Then you start watching those numbers.

Take care,

Steve

[fishdoc]

Average is 3.2 million I think, but there are those at 20,000,000.  MOst important: viral load and amount of damage are not correlated, as anti-intuitive as that seems...

[Mister beagle bailey]

Welcome to the forum, your viral load is about the same as most here, not to worry your in good hands here on the forum.

Beagle

[amirtracy]

hi. i'm 1b and my pre-treatment viral load was 10 million. are you treating? have you had a biopsy?

[sfbaygirl]

Welcome. My VL was about the same as yours pre-tx. I now have an undedectable viral load after 11 weeks of treatment. I think the literature considers this a high viral load, but not as high as some here. I have heard people with 70 million. Don't worry about that, the Stage and damage of your liver is much more important.

[arpren]

your viral load is low. mine was 18000000 before I started drugs

[sugarcookies]

My husbands viral load went from 50 million down to 2 million - His liver ultra sound was perfectly normal - My husband  has been taking herbs  for his hep c - 1a - Viral load keeps going down more herbs he takes yet the doctor says his liver still could be not good  & telling him to get a biopsy ??  His White count is going down to?? He's not sick and looks really healthy - I don't quite understand enzymes being high -

[FlGuy]

The highness or the lowness of a viral load does not necessarily correlate to the amount of damage that hcv can cause the liver.  An ultra sound does not give the down and gritty detail that a biposy does.  Consider liver enzymes like you do mouse droppings in the garage.  By themselves they might not smell and look like a real mess.  However, their presense indicates that there is someting in your house and you should guard the cookies. A full assessment including bloodwork and a biopsy should tell the tail.  Find an expereinced exterminator, I mean liver doc.

[Diane12855]

Your husband does need to get a biopsy. That is the only way to know for sure how much damage there is to his liver, and herbs won't cure Hep c.

[GrandOak]

My pre-TX was 92 million.
Lowest during TX 1.4 million
Pulled from TX at 4 million

Keep in mind VL means nothing other than a unit of measurement to determine if TX is working.  One can have a low VL with substantial damage and/or attack or a high VL with little to no damage nor symptoms.

[chemister]

Your virus cont is not the most important, but how good you respond to the medication.
I had 2 700 000, and after first week with Tx, I had 6300, and 1-2 week later negative of the virus. After that free from virus all the way.
Now 12 weeks after EOT = negative.
The question is, are you a virus responder or no responder to the drugs.

[sugarcookies]

So if you are on the medicine & your  high viral load goes down  to 0  are you then  cured of the hep c virus ??  Also I was reading that  strenuous exercize can give you  really high liver enzymes & my husbands job is very hard work-- Also what is the billirubin ?? His bilirubin is normal as well as all his liver tests except  his viral load 2 million 75 thousand & enzymes alt - ast is 182 H / 100 H - I have all his paperwork but dont understand it and his doc dont explain it in detail - I'm giving him liver herbs and so far viral load dropped from 50 million to 2 million 75,000 and his enzymes also went down some- Is the enzymes the white count ?? Doc says his white count has gone down - He is refusing a liver biopsy because he says his liver gallbladder ultra sound was perfect with no sighn of enlargement etc- Have a nice day !!

[FlGuy]

Generally speaking, and with clearance of viral load fairly early in treatment  a person continues treatment after reaching undetected status. For example, a Geno 1 might reach undetected around week 12 and then will continue treatment another 36 weeks for a total of 48.  It's to get the little buggers that may still be in the blood but sneak by detection in tests or are hiding in nooks and crannies.  I like the concept of time off for good behavior but it's not really part of the treatment sentence.

[Trinity4]

You or your husband really need to do some research about hepc.
Ultrasound does not provide the neccessay analysis in determining the exact heath of a person's liver who is infected with hepc.

My ultra sound and CT scan was normal and my liver stage is 3/4.

Here is a good website to start with that will explain not only the disease but what tests are required as well as what they mean.

http://www.janis7hepc.com/

Trinity

[Diane12855]

I would find another doctor if I were you. There are many doctors out there who haven't learned anything new about hep c since they were in medical school, yet they give out advice as if they were experts. They are dangerous. You really need to go to a hepatologist, but if there isn't one near you at least go to a gastroenterologist. Either one of these would definitely have him get a biopsy just because there is active virus present. Mine didn't even ask me to do an ultrasound... just sent me straight to the biopsy.

[sugarcookies]

Yes I think maybe we should find a new doctor when we can - This doctor gets  so angry when I ask him questions rather than my husband  who kind of just sits there because thats my husbands personality laid back kind of a guy - Doctor said  I cant go in the exam room with my husband anymore because wives aren't suppose to ask the questions only the patient - Well my husband just listens and answers just yes  or no to the doctor and  ends up knowing nothing at all about his health so I asked for copies of his med paperwork and I dont understand it at all - So for now I will continue with his herbs because they  are making him  much better than he was until we can go to a new doctor- I wonder if we need a referral to go to a gastroenterologist -

[Diane12855]

I know what you mean about men not talking to their doctors. Mine is like that too, but luckily our doctor doesn't mind my questions. Sometimes I think it is just that the "man" doesn't like a "woman" questioning him... especially if he is a little insecure about his knowledge.

My insurance company let me just call a new doctor when I told them that my old doctor made me feel like I wouldn't get good treatment when I started treatment. By the way, my insurance company WANTED me to do the treatment. They even called me and sent me letters until I ordered my meds. They know it is cheaper in the long run to treat before the liver is ruined.

Good luck with whatever you decide.
Diane

[nygirl7]

herbs  for his hep c - 1a - Viral load keeps going down more herbs he takes yet the doctor says his liver still could be not good  & telling him to get a biopsy ??  "

Some herbs can actually cause more liver damage then help.  As said above the ultrasound doesn't show how far his liver damage has progressed, just that he does not have tumors or cancer that can grow from the HCV.  Mine too was perfect and I was biopsied at stage 3 when I was diagnosed (out of stage 1-4 with 4 being cirrhosis).

If you are still going to a general practitioner you need to upgrade now to a hep doctor. You need one with knowledge of this specific disease - most  GPs do not know as much as they pretend. Mine said I was fine and did not have any damage and did not need treatment. As you can see my hep doctor ordered the biopsy and already my liver was almost damaged to cirrhosis.  

Also VL does not matter very much as it jumps up and down all the time.  His liver enzymes (ALT and AST) can be of more use to see what is going on but even they are not truly reliable as a well to see what is happening at that moment......the biopsy is the only way to know.

Good luck.

[GrandOak]

VL needs to goto 0 and stay at 0 through end of TX, 6 months after TX, and 2 yrs after TX to be "cured" of the disease.  HCV is a nasty little bugger which can hide, but also an impatient one which will not hide for long.  Given the sensitivity of today's test, the 0 mark will quickly pick up if the virus has gotten impatient and is replicating at levels to become detectale again in very short order if it is still present.

Ultrasounds and CTs generally can only see the surface of the liver, not internally, and so only can measure the extent of scarring present.  The scarring can show if there is an increase of damage as attacks on the liver often is reflected by an increase in the scarring.

If there is an increase, another biopsy may be necessary to examine the extent of internal damage.

The one caveat to the Ultrasound is if it is actually a Fibroscan, which is a newer non-invasive technique to guage extent of damage that is something akin to an Ultrasound.

Keep in mind that HCV is only one of many things which can result in damage to the liver.  So increase LFT's are not always directly correlated to HCV.  But if a person is HCV pos, it more often than not is a case where increased counts is related to the cause.

[Deb9991]

Hi to everyone on this post.  I have had Hepatitis C for 19 years.  During those 19 years, my doctors all said that there was no reason to treat due to all the liver function tests that I was given, however, I went a couple of months ago for a checkup and it was discovered that I had cryoglobulins in my blood and it would be best to treat.  I have a liver biopsy schedule in June of 2010.  Also, I was told me my viral load was 4.7 -- in the medium range.  Does that mean 4,700,000?  I'm confused about viral load.  I do know that it is not relevant to liver damage.  I had a C-scan and my liver showed no cirrotic enlargement and appeared normal -- but, I now know that only a biopsy will tell the tale.  I am also a genotype 3a, a 56 year old woman, and of average to low weight for my height.  What are my chances for success -- if that can be predicted by every thing I have mentioned above.  I just want to tx, get on with it and get it over.  I would appreciate any information about my potential for sustaining SVR and especially the 4.7 number.

Thanks greatly, D

[Deb9991]

Hi to everyone on this post.  I have had Hepatitis C for 19 years.  During those 19 years, my doctors all said that there was no reason to treat due to all the liver function tests that I was given, however, I went a couple of months ago and it was discovered that I had cryoglobulins in my blood and it would be best to treat.  I have a liver biopsy schedule in June of 2010.  Also, according to the nurse practitioner that I spoke to, told me my viral load was 4.7 -- in the medium range.  Does that mean 4,700,000?  I'm confused about viral load.  I do know that it is not relevant to liver damage.  I had a C-scan and my liver showed no cirrotic enlargement and appeared normal -- but, I now know that only a biopsy will tell the tale.  I am also a genotype 3a, a 56 year old woman, and of average to low weight for my height.  What are my chances for success -- if that can evey be predicted by every thing I have mentioned above.  I just want to tx, get on with it and get it over.  I would appreciate any information about my potential for sustaining SVR.

Thanks, D

[Bill1954]

Hi Deb—

Before I forget, good luck with the biopsy results; that should yield some important info for you.

The viral load you mentioned needs clarification from the doctor; it could represent 4.7 million IU/mL, or it could also indicate a logarithmic value; log 4.7 would translate numerically to about 50,000. Either way, it doesn’t tell much about disease progression. It will come in handy if treatment begins, then it can be used to gauge response to the meds.

With genotype 3, I’d guess that your odds for successful treatment (achieving SVR) are roughly 70%; assuming you complete your treatment, and manage to remain fully compliant throughout. Be sure to discuss weight-based drugs, particularly the ribavirin; they used to flat dose GT-3, and relapse occurred rather frequently.

For more info on interpreting viral load, see:

http://janis7hepc.com/Viral_Loads.htm

(You’ll need to scroll through that page, but there’s lots of information available there.

Best of luck to you—

Bill

[Deb9991]

Bill, thanks for that information.  I will certainly check out the web site you suggested so I can ascertain a more clear picture of what my viral load (4.7) means.  I do know that it has no bearing on liver damage, but could have some bearing on SVR.  I also know there are several factors to look at when considering patients who may have a better success rate at responding and others who may not.  In many ways, it is a throw of the dice.  I will tell you this, and everyone one who reads this, I deeply regret not getting treated before now.  I know that doctors have been of two thoughts on hepatitis C -- that being not to treat if there are no problems, and only treat when problems arise.  In my own opinion, treat the minute you hear you have hepatitis C for a variety of reasons.  The earlier you treat, the better your chances of SVR are and also if you don't respond, you do have time to wait until a better anti-viral product becomes available.  Also, the longer you wait, the more damage that is likely to occur from this hideous virus.  Also, and perhaps most importantly, getting rid of this virus is a tremendous load off your backs.  Your mental health improves along with your physical health.  It has been a kind of hell the past 19 years wondering when and if I would develop liver disease and, possibly, liver cancer.  Hepatitis also effects all the organs of the body, just not the liver.  Living with hepatitis is no picnic -- I can honestly say that since I contacted this virus, I have not been in optimal health.  I just never feel great and when I do, it doesn't last long.  

I can't wait to get the liver biopsy, and then start treatment and get it over with and, hopefully, achieve SVR.

Also, I would like to ask people how they have coped financially.  I have insurance, but until I reach what is called "catastropic coverage ($4,000)," I have to come up with over $4,000.  I have good insurance, but the hep drug is considered a "Tier 4," which is really expensive and will cost me about $800/mo.  After paying and reaching the $4,000, the pegasys/ribavarin will only cost me a few buck -- it is just getting to $4,000 that is going to be challenging.  How do people without insurance get the drug?  

It infuriates me that there are drugs available with medium and high cure rates for people suffering a disease but are so expensive that many people can't afford them, thus their lives are threated and perhaps even lost.  

Deb

[Bill1954]

Hi Deb, you’ve apparently done some research and are doing a good job of keeping informed.

I agree wholeheartedly; there are two schools of thought involved in HCV management; and both have their own merits. It seems to boil down to doing what we feel is right, and hope for the best outcome.

I had genotype 1, and treated twice for a total of 152 weeks before I was finally successful; I’ve been SVR now for nearly two years.  It’s a chore, but it can be done :o).

If you run into trouble financially, even with insurance, you can call the manufacturer’s patient assistance programs and see what they have to offer. I used Schering-Plough’s Commitment to Care program even though I had Medicare coverage; they took care of both interferon and ribavirin 100%, with no copays or any other related charges. They’re a very good outfit; Roche pharmaceuticals has their own program as well:

Pegassist (Roche Pegasys system): 1-877-734-2797

Commitment to Care (Schering- Plough PEG-Intron system): 1-800-521-7157

Good luck as you move forward, and let us know how things proceed—

Bill