question for everyone

[annajustanna]

Drummerman - Congrats on the great news that you are now UND. I am hopeful I will hear that soon too. I have a question for everybody - I am still trying to figure out. My Viral load went down from 9110000 to 31. This is a drop of over 5 logs - Right? And it is my understanding that they look for a drop of at least 2 logs to measure a positive response when going through treatment. The PA I saw talked about me continuing on treatment beyond the 12 weeks. I think that I had a good response at only 24 days after treatment began. What do you all think. I would not mind extending as I am having little difficulty with it besides the headaches. its just I am not sure my insurance will pay for it.                      thanks for your insight

[Lynn K]

The 2 log drop was used with the old interferon based treatments it is not really looked at now as nearly everyone is either not detected or nearly so very early on treatment.

I am not a math wiz but from a web site I checked 9,110,000 = log base 10 of 16.02 and 31 = log base 10 of 3.434 so that would be a 12 log drop if I am figuring right. And 31 is actually just barely above detectable for most tests. Most of the tests I have seen say the LLOQ (lower limit of quantification) is 15

http://ncalculators.com/number-conversion/log-logarithm-calculator.htm

In fact on treatment testing is of very little value it only really confirms patient compliance as someone who does not have a significant drop on treatment would probably not taking their meds

Per the Harvoni prescribing information sheet

http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/harvoni/harvoni_pi.pdf

The recommended course of treatment for treatment experienced without cirrhosis is 12 weeks. I have no idea why your doctor would consider treating you for longer than that. For patients who are treatment experienced with cirrhosis the recommendation is 24 weeks but not for those without cirrhosis. I tend to doubt your insurance would approve as that would be off label usage and a bit difficult to find a supporting argument.

Really the only blood test that matters is the 12 week post treatment test to see if the virus has returned or if you have had a sustained viral response and are cured.

You have a very high probability of cure with a 12 week regimen but this is all just my laypersons opinion I am not a medical professional. It is always best to go with your medical professionals opinion

Good luck to you on treatment
Lynn

[gnatcatcher]

Hi again, annajustanna --

Google says the log of 9,110,000 is 6.9595, and the log of 31 is 1.49, so, yes, your VL took a (better than) 5 log drop. Your lab result printouts may indicate the log values, too -- when my VL was 9,490,582 the log on my printout was 6.96.

I hadn't realized looking for a 2 log drop or better was for older treatments, but the article I read was written prior to Harvoni and Viekira Pak, so I stand corrected.

Yes, a drop to only 31 after just three-and-a-half weeks of treatment is a good response. Lots of people have gone from a small amount still detected at week 4 to becoming cured (SVR12). As Lynn indicates, your insurance company probably follows Gilead's treatment protocol as shown in the link Lynn included.

Glad things are going well for you.

Gnatty

[annajustanna]

Thanks Lynn Thanks Gnatty,
My fear is as I am sure many peoples. That if I cannot achieve a sustained VR that I could become resistant to this new antiviral that stops the replication process. I had achieved a SVR only to relapse after stopping treatment against medical advice after enduring 5 months of interferon and riba. I gotta stop worrying and start being more positive. Thank you both for your help and sharing your knowledge with me. The best to all- 

[annajustanna]

Lynn - thanks for file from glead - really informative!!!!!

[Lynn K]

Well we all fear that on treatment but really your odds are good.

The information is the prescribing information sheet that you should receive with every prescription of any drug.

Mine were attached to each bottle of Harvoni the folded up thin paper that everyone throws away. Lots of good information including clinical trial results and common side effects as well as how to contact the FDA or Gilead to report a serious side not listed.

(correct with glasses on lol)

[Joe NM]

It's rare to develop resistance, and 12 weeks really should be fine, sounds like you're responding to the medication just fine. Keep it up!