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Viral Load threshhold for treatment?
The never ending emotional roller coaster seems to keep on going! Hubby had a last minute scheduling for a Hep C class about managing side effects, medications etc...
The pharmacist has been really great with assisting us and making sure the appropriate meds, dosing, and schedule is set in place. She has been talking a lot with the hepatologist to make sure there is no confusion about his treatment etc.
But she did bring up a point that she's not sure why they are all of a sudden wanting to start treatment when the hepatologist originally wanted to wait until late April. She mentioned that they don't normally treat with a low viral load as it is below the treatment thresh hold? Has anyone heard of this. I'm not entirely sure what it is currently at as of the last blood draw. But I do know that it was down to 100,000 from the 1.2 previously.
Anyone have any insights? The pharmisist is thinking that waiting 2 weeks to see would be appropriate and would give him some time to talk with the @ssholes who decided to change his position at work on Tuesday. They don't understand the whole treatment thing and all the time it is going to require him to be gone. Granted it is set hours, in an office (although they don't know what he is going to be doing since he'll be an extra) but I think the stress level is going to be higher.
The pharmacist has been really great with assisting us and making sure the appropriate meds, dosing, and schedule is set in place. She has been talking a lot with the hepatologist to make sure there is no confusion about his treatment etc.
But she did bring up a point that she's not sure why they are all of a sudden wanting to start treatment when the hepatologist originally wanted to wait until late April. She mentioned that they don't normally treat with a low viral load as it is below the treatment thresh hold? Has anyone heard of this. I'm not entirely sure what it is currently at as of the last blood draw. But I do know that it was down to 100,000 from the 1.2 previously.
Anyone have any insights? The pharmisist is thinking that waiting 2 weeks to see would be appropriate and would give him some time to talk with the @ssholes who decided to change his position at work on Tuesday. They don't understand the whole treatment thing and all the time it is going to require him to be gone. Granted it is set hours, in an office (although they don't know what he is going to be doing since he'll be an extra) but I think the stress level is going to be higher.
It did dawn on me last night that perhaps he meant that because of his platelet levels being so low. It's been ranging between 40 and 50 since December when we first found out.
Incivek is usually taken every 8 hours. You may want to double check with the doctor about the doing schedule.
"How should I take INCIVEK?"
"Do not take INCIVEK alone to treat chronic hepatitis C infection. It must be used with peginterferon alfa and ribavirin to treat chronic hepatitis C infection.
Take INCIVEK exactly as your healthcare provider tells you. Take 2 INCIVEK pills 3 times a day, 7 to 9 hours apart, with food. Eat a meal or snack containing about 20 grams of fat within 30 minutes before you take each dose. Talk to your healthcare provider about examples of foods you can eat.
If you miss a dose within 4 hours of when you usually take it, take your dose with food as soon as possible. If you miss a dose and it is more than 4 hours after the time you usually take it, skip that dose only and take the next dose at your normal time. Do not stop taking INCIVEK unless your healthcare provider tells you to. If your healthcare provider tells you to stop, you should not start taking it again, even if the reason for stopping goes away. If you take too much INCIVEK, call your healthcare provider or local Poison Control Center, or go to the nearest emergency room right away."
http://www.incivek.com/
I know there have been studies of taking Incivek twice daily, but the recommendations still state every 8 hours.
"How should I take INCIVEK?"
"Do not take INCIVEK alone to treat chronic hepatitis C infection. It must be used with peginterferon alfa and ribavirin to treat chronic hepatitis C infection.
Take INCIVEK exactly as your healthcare provider tells you. Take 2 INCIVEK pills 3 times a day, 7 to 9 hours apart, with food. Eat a meal or snack containing about 20 grams of fat within 30 minutes before you take each dose. Talk to your healthcare provider about examples of foods you can eat.
If you miss a dose within 4 hours of when you usually take it, take your dose with food as soon as possible. If you miss a dose and it is more than 4 hours after the time you usually take it, skip that dose only and take the next dose at your normal time. Do not stop taking INCIVEK unless your healthcare provider tells you to. If your healthcare provider tells you to stop, you should not start taking it again, even if the reason for stopping goes away. If you take too much INCIVEK, call your healthcare provider or local Poison Control Center, or go to the nearest emergency room right away."
http://www.incivek.com/
I know there have been studies of taking Incivek twice daily, but the recommendations still state every 8 hours.
The pharmasist actually talked to my husband over it so I did get it second hand from him. I know that he's already been dealing with insomnia and hasn't even started treatment yet. There are some times when his brain seems foggy already and some of the stuff that he tells me doesn't quite seem right. Part of me is wondering if he miscommunicated something she had told him.
His medications should be arriving by UPS sometime this morning. He is supposed to start the Pegasus (135mcg) and the Ribavirin 2x a day (1000mg total). After 4 weeks then he'll start the Incivek 2x a day (2250 mg total).
Both of us have done a lot to try and educate ourselves. I figured if there is any virus present, it can replicate itself so it wouldn't matter how high or low the viral load is. However, reading and hearing is a lot different than actually experiencing all of this.
His medications should be arriving by UPS sometime this morning. He is supposed to start the Pegasus (135mcg) and the Ribavirin 2x a day (1000mg total). After 4 weeks then he'll start the Incivek 2x a day (2250 mg total).
Both of us have done a lot to try and educate ourselves. I figured if there is any virus present, it can replicate itself so it wouldn't matter how high or low the viral load is. However, reading and hearing is a lot different than actually experiencing all of this.
This is interesting. Most pharmacists I have come across usually know their stuff, but "treatment thresh hold" for a viral load?
Actually in fairness I Googled the term before out and out totally discounting it what resulted was a study (from 2012) that stated it is unclear whether the current threshold for ‘high’ hepatitis C virus (HCV) RNA level (800 000 IU/mL) is optimal for predicting sustained virological response (SVR).
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2012.01624.x/abstract
I would continue to value the insight and opinion of the pharmacist and be grateful she is collaborating with the Hepatologist. But when it gets down to it if my hubby were stage 4 cirrhosis (as you state in your profile) I would heed the hepatologist.
If and when he treats you are going to want copies of all your hubby's labs and keep an eye on his Hgb, platelets & ANC to name a few as well as understand possible interventions for each.
Actually in fairness I Googled the term before out and out totally discounting it what resulted was a study (from 2012) that stated it is unclear whether the current threshold for ‘high’ hepatitis C virus (HCV) RNA level (800 000 IU/mL) is optimal for predicting sustained virological response (SVR).
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2012.01624.x/abstract
I would continue to value the insight and opinion of the pharmacist and be grateful she is collaborating with the Hepatologist. But when it gets down to it if my hubby were stage 4 cirrhosis (as you state in your profile) I would heed the hepatologist.
If and when he treats you are going to want copies of all your hubby's labs and keep an eye on his Hgb, platelets & ANC to name a few as well as understand possible interventions for each.
See hepatitis.va.gov. This site can give you some much needed info.
It's my understanding that your hub is stage 4 cirrhosis. It would be very benefical to you to read the hepatitis c education program about test, viral
load and what to expect from treatment.
Best To You
It's my understanding that your hub is stage 4 cirrhosis. It would be very benefical to you to read the hepatitis c education program about test, viral
load and what to expect from treatment.
Best To You
I gree with pooh on both counts, also when it comes to treating take the advice of your Hepatologist, your pharmacist is over stepping his knowledge
Your husband has had 2 different VL results, one at 1.2 million and one at 100,000. Viral Loads fluctuate daily. They do not correspond with liver fibrosis stage or amount of liver damage. Some people with high VL do not have advanced fibrosis and some with low VL do have advanced fibrosis.
There is not a "treatment threshold." People with VL of 800,000 or below are considered to have a low VL. Those with VL above 800,000 are considered to have a high VL. But people with either "low" or "high" VL can and do treat. People with lower VL do have a better chance for SVR.
Starting treatment now or waiting until April makes no difference. I don't know why your pharmacist even brought that up. It is only a month difference.
You may be interested in this article.
http://www.webmd.com/hepatitis/c-hcv-viral-load
Best of luck
There is not a "treatment threshold." People with VL of 800,000 or below are considered to have a low VL. Those with VL above 800,000 are considered to have a high VL. But people with either "low" or "high" VL can and do treat. People with lower VL do have a better chance for SVR.
Starting treatment now or waiting until April makes no difference. I don't know why your pharmacist even brought that up. It is only a month difference.
You may be interested in this article.
http://www.webmd.com/hepatitis/c-hcv-viral-load
Best of luck
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