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TOPIC: Baseline VL below detection

Baseline VL below detection 5 years 10 months ago #19344

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In case that the results of quant test are below detection limit before treatment (< 250 IU/ml), how should we monitor viral load during the treatment? Qualitative test?

G1a, 2005/06 peg int + riba, UND during the therapy, UND after 24 weeks, 4.000 IU/ml in 2010. 5.5 kPa fibroscan 2011.

Re-genotipisation in progress...
Fibroscan in progress...
G1a 2004.
Peg/riba 2006, SVR 24.
Control PCR in 2010 - around 4.000 IU/ml.

Confirmed genotype 1a. Fibroscan F0-F1 (2011).
PCR between 10 - 250 IU/ml (July 2016)

Ledifos (SOF/LED) September 2016
ALT/AST 20/21
08th October - 4 weeks ALT24 AST18
05th November - 8 weeks ALT17 AST16
29th November - EOT :) AST 20 ALT 41
22 February 2017 - SVR 12!
ALT 14, AST 14
Last Edit: 5 years 10 months ago by 1a2x. Reason: wording
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Baseline VL below detection 5 years 10 months ago #19360

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<250 seems rather vague ?
My local tests are <12.
Can you get a more accurate test in a different lab?
GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 'In the slow lane'
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
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Baseline VL below detection 5 years 10 months ago #19361

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Hi LG, I will check whether there is more accurate test available - but I doubt its sensitivity will be close to 15 IU/ml limit, even if there are such tests here...
I guess that idea behind your question is to see more accurately the drop of VL after 4 weeks, correct?

In case that more sensitive tests are not available, is qualitative test the correct tool for tracking the VL during the therapy? It should tell us detected/undetected instead of giving us the exact values, right?

These questions are probably for the specialist, but I wanted to hear opinions from people from here. I could not find similar case in other topics.
G1a 2004.
Peg/riba 2006, SVR 24.
Control PCR in 2010 - around 4.000 IU/ml.

Confirmed genotype 1a. Fibroscan F0-F1 (2011).
PCR between 10 - 250 IU/ml (July 2016)

Ledifos (SOF/LED) September 2016
ALT/AST 20/21
08th October - 4 weeks ALT24 AST18
05th November - 8 weeks ALT17 AST16
29th November - EOT :) AST 20 ALT 41
22 February 2017 - SVR 12!
ALT 14, AST 14
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Baseline VL below detection 5 years 10 months ago #19362

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Hey :- )

Yes, guess I was surprised at <250 test.

I can only tell you what the current trend is here, (UK)... The quantatitive are much cheaper than the Qualititive so they mainly use that. From what I am told, they are phasing out the Qualititive tests as they consider <12 as the aim. This is the public health authority view , privately after much searching, I found a Qualititive test privately ( <4-6 ) but is was tied in with alot of other tests for Hep A & B , HIV etc and very pricey. All a bit of a hassle and slow for results to come back, so not easy. Others have persuaded their GPs to get one done, but with the current NHS struggles, it's not easy. However, it may be different where you are?

Worth looking for better Quantatitive or Qualititive privately if your specialist is unforthcoming?
GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 'In the slow lane'
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
Last Edit: 5 years 10 months ago by LondonGirl.
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Baseline VL below detection 5 years 10 months ago #19364

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Guys/gals I have yet to have an appointment with a doctor about VL tests and all. One of the good things about living in TH Was that I could walk into a lab and order tests, they then send results to my email and it's then on to Dr. Google and of course this site to try and figure it out. No idea what they do in the US yet but here is a snippet from pre meds and four week post mess VL tests in Thailand. I understand that 147 is a lot less than 4.48 million, log equivalent I really do not understand. At some point I hope to see a doc here but it is all out of pocket so am trying to go as far as I can on my own knowledge and with help from here. :) :)

Baseline VL before tx > HCV RNA (quantitative) 4480000 IU/mL
Log Equivalent 6.65

VL now > HCV RNA (quantitative) 147 IU/mL
Log Equivilant 2.17
GT 1a
VL 4.9M
F0-1
Since Late 60's
Meds Cipla SOF/LED
Start June 7, 2016
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Baseline VL below detection 5 years 10 months ago #19366

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It is quite different here in Serbia and it surely is not better than in UK. I've sent a query to other laboratory to tell me the lower limit for their test.
From what I've heard, that laboratory is subcontracted to the laboratory where I had my test done. However, the same test is almost double in price (app. 80 EUR Vs. 170 EUR) so I believe it could be more accurate. In that case, I will have to do another one.

Unfortunately, it is very hard to reach my specialist (or any other for that matter). I have to wait the end of this month to call them and schedule a meeting for September, if I am lucky. Even after that, it is very unlikely that they can order PCR HCV - they do it only in case when somebody is on treatment (budgeted by NHS, lets call it that way).

So, I decided to have all tests prepared (as if I am starting with Redemption), and I will decide which way to go.
G1a 2004.
Peg/riba 2006, SVR 24.
Control PCR in 2010 - around 4.000 IU/ml.

Confirmed genotype 1a. Fibroscan F0-F1 (2011).
PCR between 10 - 250 IU/ml (July 2016)

Ledifos (SOF/LED) September 2016
ALT/AST 20/21
08th October - 4 weeks ALT24 AST18
05th November - 8 weeks ALT17 AST16
29th November - EOT :) AST 20 ALT 41
22 February 2017 - SVR 12!
ALT 14, AST 14
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Baseline VL below detection 5 years 10 months ago #19372

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The problem with the lower level of detection of 250 is that when you clear the virus the result will say <250, same as what you have now.

P.
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Baseline VL below detection 5 years 10 months ago #19373

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Cheese,
Wow, what did you do to make it go down?

Logs is just a different type of measurement. We look at the the number with IU...international units.

P
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Baseline VL below detection 5 years 10 months ago #19396

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One a day Indian Generic Sof/Led by Cipla. Purchased for THB 42k (approx $1200 US) in an arranged meeting at a Starbucks on Sukhumvit Road Bangkok, TH. :whistle: :whistle:
GT 1a
VL 4.9M
F0-1
Since Late 60's
Meds Cipla SOF/LED
Start June 7, 2016
Last Edit: 5 years 10 months ago by cheese. Reason: Add smiley
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Baseline VL below detection 5 years 10 months ago #19415

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Hi Price,

shouldn't it say UNDETECTED in case it is 'cleared'? Talking about quantitative PCR...

In my case, negative qualitative PCR 6 months after the end of peginf/riba treatment. 4 years after that, quantity was between 3-4.000 IU/ml (detection limit is not stated in results!) and now, 10 years after the therapy it is <250.

From what I read, quantitative results are stated either as undetected, <lower limit, any figure within the range of test, or >upper limit.
fixhepc.com/forum/viral-load-and-svr/364...-vs-qualitative.html

I just had a call from a doctor who performs these quantitative tests. She said that <250 means that they cannot say either positive or negative. There may be a small quantity of virus present, but it could be that it is not there. (excuse me, what am I paying for??) I will call her tomorrow when she is in the lab again, so she will take another look at my results. She says that some conclusions can be drawn from 'appearance of curves or whatever she looks at'. (that is my interpretation, I could not listen scientific rationales, I wanted a clear statement)
She suggested to do qualitative test to be sure. I will, if she pays for it :)

Now, my specialist says that result <250 means that the virus is still present. I trust this doctor and I feel that she is right. I feel it right below my right set of ribs...

Anyway, I gave blood sample for genotype test today, expecting results in 7-10 days. Does anyone know, would testing of genotype result in (conclusive) determination of genotype, in case that the patient was previously treated and reached SVR52, for example?
G1a 2004.
Peg/riba 2006, SVR 24.
Control PCR in 2010 - around 4.000 IU/ml.

Confirmed genotype 1a. Fibroscan F0-F1 (2011).
PCR between 10 - 250 IU/ml (July 2016)

Ledifos (SOF/LED) September 2016
ALT/AST 20/21
08th October - 4 weeks ALT24 AST18
05th November - 8 weeks ALT17 AST16
29th November - EOT :) AST 20 ALT 41
22 February 2017 - SVR 12!
ALT 14, AST 14
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Baseline VL below detection 5 years 10 months ago #19416

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Here in Brisbane Australia, the VL is measured either by Quantitive or Qualitative.
Our Medicare system pays for 2 Quantitive & 4 Qualitative tests per year while on HCV treatment.
The Quantitive test is more expensive then the Qualitative.
I had read a post on this site from Dr James Freeman, saying that during treatment you need to do Quantitive until Undetected then all you need is Qualitative to know if you're Positive or Negative.
Australian
Geno type 1a
Fibrosis 3-4
Treatment experienced Peg-Interferon Ribavirin (Relapsed)
Started 22/10/15 DAA's 24 weeks Sofosbuvir Ledisbovir & 12 weeks Ribavirin
Viral Load at week 4 <15 Detected
Viral Load at week 12 Undetected
Viral Load at week 24 Undetected
Viral Load SVR4 Undetected
Viral Load SVR12 Undetected
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Baseline VL below detection 5 years 10 months ago #19437

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Although I believe Qualitative is still not zero but 4-6 / 8 ? ie lower detection than the Quantitative ?
GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 'In the slow lane'
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
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Baseline VL below detection 5 years 10 months ago #19731

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I had cancelled genotype determination (the lab cannot guarantee readable results with such low number of copies). Instead, qualitative test was done and it showed positive result. The limit is 10 IU/ml for qualitative.
G1a 2004.
Peg/riba 2006, SVR 24.
Control PCR in 2010 - around 4.000 IU/ml.

Confirmed genotype 1a. Fibroscan F0-F1 (2011).
PCR between 10 - 250 IU/ml (July 2016)

Ledifos (SOF/LED) September 2016
ALT/AST 20/21
08th October - 4 weeks ALT24 AST18
05th November - 8 weeks ALT17 AST16
29th November - EOT :) AST 20 ALT 41
22 February 2017 - SVR 12!
ALT 14, AST 14
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Baseline VL below detection 5 years 7 months ago #21804

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Hello everyone,

an update, as I had found many useful info by reading other people posts (thank you all :)), so mine could be of help to someone..
Started with generic Harvoni three weeks ago. Very mild sides, random neck, muscle or joint pain. If so...

Beside that, feeling excellent most of the time. More chatty, energized, maybe even high at the moments... Hope it is going to last during the whole therapy :)

More important, I hope that this drug will do what it was invented for. Although my LFT was good since INF/RIB therapy (never had higher AST/ALT in 10 years, checked at least annually; other results OK too, only slightly higher cholesterol), I didn't feel good at all last couple of years. That's what brought me here, two or three months ago when I felt more crappy than usually. I wanted to check if something has changed in HepC world and discovered this wonderful world of generic DAA's.

Anyway, because of my odd baseline scores (very low VL, normal blood results) and due to the fact that I could not reach my doctor to tell him about the therapy and ask for opinion, I've decided not to test VL during the treatment. It is going to be hard not to see the progress in written, I can only hope that ALT will show some good signals. Slim chances tho, steady 17-21 last couple of years.

The only thing that bothers me is that Fibroscan is not up to date. Makes me a bit uncertain if 12 weeks is going to be sufficient.

To whom it may concern:
- taking the meds 1-2 h after the dinner. It makes me wanna eat, and eat, and eat some more...
- strange feeling (numbness sort of) in my hands circa 10th day of therapy. After that, I started feeling hands like they are mine again. Somebody wrote similar in other post, I think
- smoking, well I am vaping! E-cigs! I know it is not wise, but it seems I cant get rid of it...
- reduced coffee to two cups per day, and one cup of green tea in late afternoon
- avoiding carbohydrates as much as possible (sweets, pasta etc.) Eating better ones.
- enough water, not drowning in it. around 2.5-3 l
- Vit D, vit B
- alco free, of course

Take care, everyone :)
G1a 2004.
Peg/riba 2006, SVR 24.
Control PCR in 2010 - around 4.000 IU/ml.

Confirmed genotype 1a. Fibroscan F0-F1 (2011).
PCR between 10 - 250 IU/ml (July 2016)

Ledifos (SOF/LED) September 2016
ALT/AST 20/21
08th October - 4 weeks ALT24 AST18
05th November - 8 weeks ALT17 AST16
29th November - EOT :) AST 20 ALT 41
22 February 2017 - SVR 12!
ALT 14, AST 14
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Baseline VL below detection 5 years 7 months ago #21814

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Hello,

With such a low viral load, and normal AST/ALT if your platelets on your blood count are > 150 you're definitely not cirrhotic and 12 weeks should be more than enough.

Sofosbuvir + Daclatasvir would have been better given the ??? genotype question, but chances are that you're GT1 and Harvoni will work fine.

I notice you are using the handle 1a2x - you weren't 1a2b coinfected prior to Interferon were you?
YMMV
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