Baseline Viral Load

[Trinity4]

Dr. Dieterich,

Thank you very much for you valuable time and effort in trying to help those of us with this disease.  
Diagnosed 10/07 - Geno 1A - VL 1,290,000.  Also had PCT and given a series of phlebotomies to reduce high ferritin level of 783.  Started tx 3/28.  I went for a baseline PCR on 3/25.  Unfortunately, the lab did not do the correct test and the only results given were above 750,000.  By the time my doctor informed me of this I had already been on six weeks to treatment  (peginf and riba) and he did order another PCR,  the results were 100,000.  He told me he would use the Oct count of 1,290,000 as my baseline because we don't have any other number to use.  I must say, I fault him for allowing so much time to pass before notifying me of this error but there was nothing I could do.  I should have had my 12 wk PCR this Thursday, but with my numbers skewed to begin with, I asked him to hold off another 2 wks which is when my group insurance kicks in.  My question is, how much variance can occur in the viral load count during a six month period?   We have no choice but use the initial PCR and is that number relatively close to what I might have been in March of 08?  I know there is a factor missing to this equation - it's because he doesn't do a 4 wk PCR.  I am aware of the fact that if I have not dropped 2 lg by next PCR - not so good.  If not UND by 24 wks I will not continue.  Just wondering if the vl stays around the same over the course of 6 mo.  Thank you so much for you time.
Trinity
  

[Douglas Dieterich, MD]

There is a variation of the viral load of about .5 logs from the test alone. I think you are wise to wait another few weeks for the week 24. To all others out there, insist on week 4 PCR, it is incredibly helpful to predict response! Thanks for your question. DTD

[Kristina538]

Thanks for your comment to insist on a week 4 PCR.  My specialist said that because I was a Genotype 3A the RVR was not an indicator and that they would not do a PCR until end of treatment because of this.  (I'm in little old New Zealand down South - maybe he's trying to save money?).  Is this the case with 3A or would RVR for all genotypes be an indicator of a better outcome?   Thanks so much for being here... you make us brave and informed..

[GoofyDad]

You didn't ask but I'll give my two cents while you're waiting for the good doctor.

I am SVR, having previously treated GT 3A myself. Most 3A's can be expected to RVR - something like 65%-80% if I remember right. So RVR for you is not so much a positive indicator; rather a lack of RVR would be a caution sign. Some doctors will recommend r extending beyond 24 weeks for 3A's who are not UND at 4 weeks. Unless you are completely opposed to considering an extension, I would definitely push for the 4 week test. Most likely you will be clear, and that will ease your mind.

[Kristina538]

Thanks for your comments;  I figured as much which is why I very much wanted a PCR early.  I did the monotherapy in 1994 and while my bloods responded I was PCR postive at 6 months.  This may be the last time they will treat me here in NZ, but the Nurse seems very reticent to do tests that are 'costly' (doh).  I asked about an extension, (given that my odds are lower as a previous non-responder and early cirrhosis to boot), and she was adamant that they 'just had a meeting and decided not to extend any treatments'; full stop.  I'm starting this Saturday, and feel a little pressured - this dipsy nurse is a little like a political brick wall.  I'll definitely push for the 4 week test and then, energy allowing, I can see whether it's possible to transfer to a unit that would consider an extension.  I'll also see my GP - I don't mind paying for the test if someone will allow it (my naturopath also does bloods and I'm seeing him again this week).  Thanks GD :-)