TOPIC:

Is undetected when you have no virus left in your body ?
I was undetected near the end of my peg interferon Ribavirin treatment 12 years ago but when I had my post treatment PCR, it came back as detected .
So my question is " How can you be tested to have no virus during treatment & then it starts to multiply" ?
I know we all get very excited with the undetected word early in our treatment & so we should. BUT I can't stop thinking about my past treatment.
I know that these new drugs have been getting very good results.
So I guess if you're undetected by end of treatment & continue to be undetected for the next year, maybe then you can truely say that you've got rid of the virus.
BUT PLEASE feel free to set me straight.

Undetected means they couldn't detect any viral RNA in the blood samples they took. However, there could still be a few stragglers "hiding" somewhere in your body, most likely in the liver. This is one of the reasons those with cirrhosis must undergo longer or stronger or both, treatments. The theory is that the scar tissue of cirrhosis creates a barricade of sorts that the medications have more difficulty penetrating which some of the virions can hide behind and they come back out and start replicating again once the meds have stopped. So you medicate for longer to ensure that the meds "soak" right in and reach and kill those.

Here is data Dr James provided on likelihood of cure based on SVR times. So at 6 months (SVR24) post treatment UND means greater than 99% chance that it is gone for good.

fixhepc.com/forum/experts-corner/364-vir...-vs-qualitative.html

Thanks GAJ,
You explained that well.
Next week when I start my second 12 week of just Sofosbuvir & Ledisbovir , those stragglers hiding better watch out.

I'm not sure it is "just a few stragglers".

I was treated a year or so back with 24 weeks of simeprevir+interferon+ribavirin. At week 4 my VL was <15. At week 12 my VL was undetected and my LFTs were like a teenagers. At that point the clinic said "You're cured. We'll stop the simeprevir and you can have another year or so of interferon+ribavirin to make sure you stay cured."

I wasn't very happy about that, but I couldn't have taken any more simeprevir anyway, the side effects were horrendous. I figured I'd continue the interferon+ribavirin at least to the end of the 24 week treatment. At week 16 (4 weeks after finishing the simeprevir) my LFTs had gone through the roof. At week 24 my VL was 17,000,000. 5 times higher than when I started treatment. At that point I dedcided the interferon+ribavirin wasn't doing me any good at all, and stopped taking it.

So my relapse was so massive and so fast (within a couple of weeks to make my LFTs react like that) that I just don't think a few stragglers could have done it. Even though my VL had been zero or approximately zero for months, there must still have been a massive stock of little virus beasties just waiting to jump out and put the boot in as soon as they got the chance.

Incidentally, the clinic's response to this was along the lines of 'you can't relapse while you're on therapy'. The actual words the nurse used were "We know you didn't take the interferon, you might as well tell us". It's support like this that makes it all bearable.

:
"The HCV turnover rate can be quite high with replication ranging between 10¹⁰ to 10¹² virions per day, and a predicted viral half-life of 2 to 3 hours."

www.medsci.org/v03p0047.htm

Or 100 to 10,000 Billion per day. So it may not take very long at all to get back to high levels depending on how well your immune system is fighting it.

Sorry to hear of another example of 'care and support' as provided by a few who utilise the stigma of this virus to inflict their morality on others!!

Hi PKQ, I read your past experience with sympathy & shock.
Sounds like we're both on the same treatment now,
Are you doing 12 weeks of Ribavirin as well ?
I've just done my 12 week quantitative RNA test yesterday, as my 4 week one was <12 but still detected.
Let's hope my latest test comes back undetected or else I'll be paying for my 3rd one at 18 weeks.
How far into treatment are you ?

"Incidentally, the clinic's response to this was along the lines of 'you can't relapse while you're on therapy'. The actual words the nurse used were "We know you didn't take the interferon, you might as well tell us".

Hi PKQ,

This nurse would be WRONG. You don't get viral breakthroughs on Harvoni but people can and do get viral breakthroughs on interferon-based therapies.
There is a genetic marker called IL28B which is one of the predictors of success on ifn-based therapies. If your IL28B is a CC then your chances are good. If it is a CT then your chances are below average and if it is a TT then don't even bother, you could be a null responder.
I have long thought that anybody receiving an IFn-based therapy should test this marker before starting. I sure wish it had been known about before I did my first Ifn-based tx. I am CT, so I wouldn't have done the tx if I had known that. Private genetic testing has come way down in price and this test is now accessible, at least in US and UK.

I should probably stress that the IL28B test only applies to ifn-based therapies, NOT TO THE DAA's.
It indicates how effectively your body will use the interferon to clear the virus.

I have had 2 viral breakthroughs. You go from 'UND' to up in the 100,000's within a few days and the sky is the limit from there. The speed of viral replication is astronomical and shocking.

Just to be clear, a viral breakthrough is when the virus resurges from UND while you are still on tx.
A relapse is when the virus resurges after you finish all the drugs.

dt

Hi Hamilton,

Your VL was denoted as "Detected" at your paper test? Or only <12 IU.

thanks

GAJ,

I think you put your finger on it. With a replication rate like that, the little horrors could go from a few stragglers to an invading horde in a matter of days - or even hours.


Hamilton,

It looks like we're both going the same path. According to the EASL guidelines I should be taking 24 weeks of ribavirin, but opinion seems to be growing that ribavirin has big side effects but little effect on the virus. Since the last time I took it, it seemed to have no effect at all, I've decided to give it a miss this time, and just take sofosbuvir+ledipasvir.


dointime,

Thanks for clearing that up. I've seen the term viral breakthrough in the literature and wondered if that was what I had. I think if I had been treated just with interferon+ribavirin I would have been a non-responder, but the addition of simeprevir made it look as if the therapy was working. Still, its all academic now.

Hi Enkel,

My paper work said :-
Hep C RNA NAA (quan). < 12
Log 10 IU/ml <1.1
Comments :- A result of <12 IU/mL indicates HCV RNA was "DETECTED" but outside the linear range.

PKQ

I totally agree with you about the Ribavirin , as the finger is pointing out that it may not make any or little difference in the treatment outcome.
But my good Doctor James Freeman wanted me to have the best chance of clearing this virus & precribed 1200mg Ribavirin for my first 12 weeks of my 24 week treatment.
So , good or maybe not needed, I've persevered with the terrible RIBA side effects & have just got 6 days left to go.
Like a lot of us here, we've faile past treatments & would do anything to make this treatment successful .

Hi Hamilton,

Like you I'm also doing the hard yards with the Riba. As you say past failure, plus my liver is made of old boot leather apparently.

Well, after a 3 week wait due to the hols I got my 4wk RNA result this morning. I have Hep C....well, who'd of thunk it?
Apparently the lab only ran the basic qualitative for detected/undetected so now need to rerun with quantitative to see what level I reached.....sigh!

No way GAJ! How frustrating! Hopefully the quantative test doesn't take too long to come back!

I've just got back my 6 week results.
Started treatment with 6.5MM IU/ml load. Gen 1a
Sof/Led from China.

Good news-bad news?

Hepatitis C Quantitation <12 HCV RNA detected - Bad news?

HCV log10
Unable to calculate result since non-numeric result obtained for component test. - Good news?

So if I read this right, I am still infected but the level is low enough that it is below the measurable range?
Does this bode well for SVR?

Dont worry.

I have seen many people on hepmag forum being detected up to 6 weeks with original Harvoni and then achieved SVR 12 and 24.

The quantity is so small and even the test is not so accurate at these levels

here the data of one person that took Harvoni, and achieved SVR 24:

Started Harvoni 12/08/2014 (12wks)
Finished Harvoni 3/1/15
5wk lab detected <15
8wk lab UND
EOT lab UND!
12wk post lab UND!
24wk post lab UND!