Falling Viral Load??

[Vasi]

On January 4, I had my first quantitative viral load measured. It was 9,240,000. Then on Jan 20, I had it tested again. Same lab. It had fallen to 5,000,000. I go to my doctor this coming Wednesday. Harvoni has been approved and I am assuming he will give me a scrip at that time. But since the viral load fell 4,240,00 in just 16 days, do you think my body is trying to heal itself? It will have been another 25 days since last viral load test. Should I request another test to see if it has fallen further, and thus, give my body a chance to finish ridding itself of this virus, rather than consuming chemicals? I am 64....and concerned about recovery after the 12 week treatment is over.

[Mugwump]

I do not want to discourage you Vasi, but a falling viral load means very little unless you are under treatment. It is not know exactly how aggressive the disease can become for those who clear the virus naturally after an initial infection. 

What is known is that viral loads during a chronic long term infection are all over the map. It seems the disease goes through cycles. Because new liver cells are constantly being infected by viable virus particles and it takes time for the liver cells to die and release billions of new virions into the blood stream. Remember that your viral load is calculated in small units of blood and we then have to consider the entire blood stream and how many billions of copies of that little beasty are there waiting to get back into a liver cell and make billions more copies.

One month you can have a viral load per milliliter of blood down in the hundreds of thousands, the next up close to the maximum that can be detected and quantified by PCR RNA testing.

You may very well be fighting the disease better at this particular time, but the problem is the disease only replicates in liver cells. A place that is not one that the immune system attacks vigorously unless you develop an autoimmune disease that kills liver cells.

Much about how exactly HCV cycles in aggressiveness during replication has been examined by researchers over the years. And the only reason why the subject is not  understood better is because observing HCV replication in a controlled laboratory situation that simulates the constraints of a human liver is very difficult to achieve.

The specialist that I dealt with for many years before being cured of HCV did not even bother doing viral load tests, except when the insurance company insisted upon establishing a base line load to qualify me for treatment. The most important tests are how well the liver is hanging in there during infection not how many virions are in the blood stream at any given time during infection. 

[Vasi]

Thank you for your quick reply.

[gnatcatcher]

Vasi, for a real-world example, here are my viral loads (same lab) in chronological order before treating with Harvoni:
3,162,278
2,760,000
6,298,860
3,968,634
7,656,922
2,101,571
956,096
954,515
946,493
551,111
9,490,582
Needless to say, I was elated by the four test results below a million, especially the one around 1/2 million, but my ALT and AST numbers were continuing to rise, proof that my liver was still getting worse. When I was tested after the first 4 weeks of Harvoni treatment, my viral load was "not detected," and it has stayed that way.

I was slightly older than you when I started Harvoni. I felt better on it than I had in many decades, because it gave me energy. (Not everyone gets this "Harvoni high.") The extra energy went away when the Harvoni left my body, but there was nothing to recover from.

Best wishes,

Gnatty

[Vasi]

Thank you Gnatty!

That's really encouraging. My only enzyme that is not in normal range is ALT. Was 46 in 2016, 48 in November 2017, and in January was 42. All other blood work is normal except for RBC, Hemoglobin, and Hemocrit levels which are slightly elevated.

My worse thing right now is emotional swings. I wake in tears most mornings. Am working full time, but everyday feel like I can't make it and exhausted totally. Break into tears sometimes at work, but is easy to cover since I am an English teacher and there are some heartbreaking events in the novels I am teaching. LOL!

Did anyone else have these emotional issues prior to meds....? Does it get better??

Thanks so much! Have a great day!

[gnatcatcher]

Yeah, the fatigue/exhaustion of HCV is a real bear. I remember back in my 40's getting totally wiped out just putting the laundered sheets back on the bed. I can definitely do more after the cure than before, and Mugwump has a far more dramatic before-and-after story.

You have a great sense of humor. You'll do fine (and I'm rooting for you to get the "Harvoni high").