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Hep C Discussion Forum -> On Treatment -> log drop
Post Info TOPIC: log drop
Zlikster


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RE: log drop
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well i am atm @ 1200 (from 1900 to 1400, every 2 weeks less n less)...last 2 weeks i am getting more n more small infections/sores (noste, throat, mouth,etc), i presume it's connected with low neutrophil count?

my doc mentioned Neupogen, but didn;t said at what neutrophil lower limit it's advisable to use it. i am using Vit B12 for now until next blood check.


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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
darkstar


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The issue of low neutrophil counts is complex.  Neutropenia is defined as an absolute neutrophil count < 1500.  However, significant increased risk of infection does not occur until ANC < 500 and goes way up with ANC < 100.  Duration of neutropenia is also a risk factor.  So one day at 100 is lower risk then 5 days at 100.  Neupogen (filgrastim) can be used to raise the ANC.



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Zlikster


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thats the prolly mixup between LLOD and LLOQ terms...i remember she said log 1.2 (that shoudl be 16ui/ml) what they consider limit for UND.

just got back from my doc. As i thought, only UND counts for RVR, but still she said my result is still good and that if i am really keen on getting less interferon than supposed to, couple of shots less than 24 won't make a difference (she had patinets who took 22shots instead 24 with no difference in SVR rates). So i might go for 21shot if i am UND @ week 8 and 12 of course. If there will be still some viral load on week 8th i wont say a word anymore about shots reduction.

my blood is getting worse tho (neutrophiles espec)

WBCC 3,0
Neutrophiles 1,2 (not sure when it gets really serious, at 0,9? i already have constant infections in mouth and throat)
RBCC, Hgb is low but still got room to fall more

liver enzymes are great tho!
AST 23 (11-38 ref)
ALT 21 (12-48)
GGT - 21 (11-55)
ALP - 74 (60-142)

she told me start taking strong Vit B12 dose (2x500mg), and that there are options with meds to force neutrophiles production when it gets really bad. I have also asked now that i lost so much weight, shall i receive less dosage of Interferon according to my new weight, but thats really not advisable, even if i loose more weight. I must stick to initial dose (tho it was higher dosage for my initial weight). I don't get this around dosing PEGylated interferon alpha 2b vs PEGylated interferon alpha 2b

i talked with her in case i relapse. I am ready to save money to obtain sofosbuvir from USA on my own when it hits USA market in 2014. (or daclatasvir or Abbot's meds, but seems Sofosbuvir will be first on market) and she will gladly be my doc with it. She is also very excited about it's potential, but jokes we will get it here in 2057 year. Still no Boceprevir or Telaprevir here and no sign where will it be available, so situation with new meds arriving here is really bad ;/



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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
mallani


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Hi Zlikster,

Just a quick one. The previous Abbott PCR tests quoted a LLOQ (Lower Limit of Quantification) which was higher than the LLOD. The newer tests, from both Abbott and Roche, have the same LLOQ and LLOD. The older Abbott tests quoted a LLOQ of 43, 25 or 15. All of these then quoted a LLOD of 10. This is why I was confused- I am so used to the newer tests with the same values that I forgot there was often a marked difference in the older versions. Cheers.

 

 

 

 

 



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Zlikster


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They said 10 IU/ml LLOD and they consider everything below 16 IU/ml (log 1.2) UND. Who knows are those exact figures, maybe they do not know exact equipment specification ;) but they were really kind n showed me lab and gave me some tips for diet etc (compared to busy docs, lab techs are usually really open to talk). I am waiting for my blood tests (wbc/rbc/alt/ast etc) and i am off to see my hepa doc ;) Thanks again for support folks ;) means really much to me. I hope i am not too much annoying with all these questions n posts.

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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
mallani


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Hi Zlikster,

See what your doc. says. To me, 51 i.u./ml positive means Detected, but it's still a great result.

I have a special interest in the different VL tests, and Abbott have received approval for their latest HCV PCR test, which has a LLOD of 12 i.u./ml. Abbott claim this is there most accurate version ever. If Bosnia has an Abbott PCR with a LLOD of 10 i.u./ml, I'm confused. Perhaps I should find another hobby. Anyway, you're doing very well and be guided by your doc. Cheers mate.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Caryn


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Good News!



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1a, CT. Incivek triple 1/2013, vl 810 @ 2 weeks, 610 @ 4 weeks, 3000 @ 8 weeks, tx stopped. 

4/2014 - tx with Sovaldi/Olysio/Riba. VL 39 mil. - VL 230 @ 1 week, VL 40 @ 3 weeks, 5 weeks UND, EOT - UND, EOT @ 4 weeks UND, EOT @ 12 weeks UND!
Zlikster


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Hi Malcolm, just got back from the lab. They were super kind to me. They are using Abbot PCR with LLOD of 10 UI/ml. They do consider negative if it's below 16 UI/ml (log 1.2), but said my result almost good as negative. I will check with my hepa doc today whats next. My result is: 51UI/ml log 1.71 positive My baseline viral load was 25.037 UI/ml 4.40 log, so aint bad for a drop of 2.69 log. Thanks for help!

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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
Zlikster


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thanks for explanation...so for undetected, in the lab using LLOD assay with thershold of 50UI/ml, it is less than 50UI/ml or in logs that would be less than 1.7 log? If they are using Rosche Cobas assay treshold is at 10UI/ml or log 1.0? correct me if i am wrong I think they are using Rosche's, and they prolly meant i am log 1.x (10-90UI/ml) which means detectable, so i guess that doesn't counts as RVR. My doc will prolly know better regarding that definition of UI/ml treshold for RVR candidate..anyways, better 3.x log drop, than no response

thanks!





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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
darkstar


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RVR = undetectable at 4 weeks

EVR = at least a 2 log reduction at 12 weeks

The lower limit of detection depends on the method used by the lab



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mallani


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Hi Zlikster,

1 log unit is 10 i.u. It's really odd (and inaccurate) to report such a low number in Log. format. You'll need to wait to see your doc to get the full result.    In Bosnia I would expect that the Lab is using an assay with a LLOD of 50. Your result should say ' <50 Undetected'.  Try to find out the exact wording. For an RVR, you need to be Undetected at week 4- the log drop is not relevant. Sounds good. Cheers.

 



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Zlikster


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funny thing was, when i called microbiology dep @ hospital to check is my VL test done...they called main doc there to tell me result, since they thought i was not on riba/peg therapy. I've paid for test, so they thought i was healing myself with some alt therapy or something ;-D silly





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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
Cinnamon Girl


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Hi Zlikster, sorry I`m not Malcolm!  wink  But yes you`re right, RVR means that there`s no detectable virus @ 4wks.  I can understand you being so anxious, but you haven`t seen a copy of your results or spoken to your hepatologist yet, so try not to panic.  The main thing is the meds are working, and that`s a huge drop in viral load! smile Hang on in there...Jill



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Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 
Zlikster


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just called hospital to check is my PCR done (4th week VL check). Technician didn't said how much in UI or copies,  she just said  less than/log 1. My VL base was 25k UI (Log 4.4), so does that makes 3.4 Log drop? I am glad to see drop like this, on other hand i am not that happy since this means i am not RVR which i hoped for so that at least i get few shots less of interferon (and spare my audiotory system more damage).

I will prolly do VL check again on my own on 8th week (insurance covers only 1 VL check @ 12th week)...hoping for UND ;/



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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
Zlikster


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Hi Bouba

yeah log 1 is from 10 UI/ml to 90 UI/ml...Not sure whats the treshold or type of VL test they use @ hosptal. I still dont get RVR definition, somewhere it says <50UI/ml, then again <20UI/ml or UND @ 4th week...

i'll try to subdue my anxiety until Tue apt


cheers!



-- Edited by Zlikster on Friday 8th of March 2013 04:49:22 PM

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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
Bouba


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log 1 is is very very low. nothing to worry about.

I dont even know how low. 100'000 IU is log 5, 75'000 - log 4.875.

1 should be the same as undetectable.

my labs show < 15 IU, which my liver doctor said was negative.

15 IU is a threshold of a detectable limit here.

 



-- Edited by Bouba on Friday 8th of March 2013 04:35:50 PM

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58 yo male, HCV since 1981. Gen 1B (IL28B, CT). Diagnosed 1999,  VL before tx 100'000. Biopsy A2, F3 fibrosis. Naive, SOT (with Incivek) Oct 26, 2012. UND @ week 4, 12, 18, 24, UND 12 and 24 weeks post-RX
Cinnamon Girl


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It`s very confusing when they give out the viral load result in log numbers, I wish it would be standardised.  Treatment certainly is a roller coaster ride, and I know you`re concerned about the duration with your tinnitus problem.  That`s a good result at this stage anyway.

ps - I can understand what you`re saying ok, no prob!  wink 



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Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 
Zlikster


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Hi Jill i know, i just can't wait for Tue's apt with my hepa to arrive )...they said over phone i am log 1, that could be somewhere 10-90UI/ml, i was too dumb not to ask in UI...and i find when i look for RVR defintion as UND or <50UI/ml

sorry for typos and bad grammar, i am just in weird combination of excitement and anxiety )



-- Edited by Zlikster on Friday 8th of March 2013 02:46:05 PM

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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
Zlikster


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can anyone explain me is RVR defined as UND @ 4th week VL check or <50UI/ml? Malcolm help! anxiety is killing me (i got hepatologist apt on Tue! until then i am uberanxious about results)



-- Edited by Zlikster on Friday 8th of March 2013 02:13:55 PM

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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
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