I am interested to know if following conditions are possible or have been observed during Hepatitis C virus treatment:
1. Is it possible for HCV patients to have higher viral load as compared to baseline/per-treatment viral load after completion of first month of interferon plus ribavirin therapy? Usually a drop is seen in viral load once interferon is started but is it possible for some patients to show increase in viral load while still taking interferon?
2. Is it possible that a patient appears as RVR after first month (undetectable HCV) but at the end of 3rd month, HCV is detected again via PCR ? Although viral load appears to be less than baseline viral load.
Can anyone share views and links of any published data if any which may be covering above mentioned conditions in HCV.
I'm plaised to discuss with you this point. As I have contributed in the monitoring of 100 patients in a moroccan prospect study (data not published). We find that Real time PCR at S4 is a decisive tool for prediction of response to Peg Interferoin plus Ribavirine.
Dear Benani and Kakharman, thank you for your replies!!!
@Benani, I don't understand what you mean by S4 in your above post.
@ Kakharman, Since this is still unpublished data, we can discuss more in message if you like...So you are saying that it is possible for patient to become RVR at first month but again become HCV positive at the end of 3rd month or 6th month while still being on interferon therapy?? I am looking for any published data on this but unable to find any so far....Regarding group of patients, these are randomly selected patients and I have been following them since diagnosis of HCV upto end of treatment. Most are G3 but some are also G1.
I am going to give an example here. Patient is HCV G3. Baseline viral load : 909863 IU/ml, At the end of first month: 3467494 IU/ml and at the end of 3rd month: 21308 IU/ml.... So is it possible? At each step, same extraction and PCR kits and machine was used.
Hmm, well this is strange to me as well. Because there are more than 5 HCV patients who have this variation in viral load while being still on INF therapy. Yes the therapy is still in process and as listed in my previous post viral load at the end of 3rd month is 21308 IU/ml. I also have archived serum samples of these patients. I have re-performed PCR from samples at W0, W4, W12 and results are showing similar pattern of differences in viral load.
1. The difference in results from week 4 and week 12 is less than 0.5 log so that could be accounted to the variability of the test. Viral load tests have a variability of up to 0.2-0.5 log. The spike at week 4 predicted failure and obtaining a less than 2 log drop by week 12 is considered treatment failure. It would be interesting to see why they're failing. Was a lower dose of Ribavirin used because they had genotype 3 or was it weight based? I would also check to see if they're insulin resistant.
2. That's breakthrough. There are also cases of transient reappearance of virus, which indicates a high likelihood of relapse (see link). However, I have seen a few patients who became undetectable, than a later test showed detectable virus with a number under the lower level of detection (using a sensitive test) and they still obtained SVR.
http://www.journalofclinicalvirology.com/article/S1386-6532(10)00007-7/abstract
Here's another paper on sporadic reapearance of minute amounts of virus....
http://www.gastrojournal.org/article/S0016-5085(10)01586-6/fulltext?articleId=S1386-6532%2810%2900007-7&articleTitle=Transient+reappearance+of+serum+hepatitis+C+virus+RNA+observed+by+real-time+PCR+during+antiviral+therapy+with+peginterferon+and+ribavirin+in+patients+with+HCV+genotype+1b&citedBy=false&isTabularSearchRequestOnSearchResultPage=no&medlinePmidWithoutMDLNPrefix=&overridingDateRestriction=&related=true&restrictdesc_author=&restrictDescription=&restrictterm_author=&search=&search_area=platform&search_articletype=&search_currenturl=http%3A%2F%2Fwww.journalofclinicalvirology.com%2Farticle%2FPIIS1386653210000077%2Frelated&search_datecombo=&search_dateradio=combo&search_doi=&search_federated=no&search_hits=26360&search_id=&search_issue=&search_issue_pii=&search_language=&search_medline=no&search_monthendcombo=&search_monthstartcombo=&search_operator1=&search_operator2=&search_OrderBy=descending&search_preview=no&search_query=Related+to%3A+Transient+reappearance+of+serum+hepatitis+C+virus+RNA+observed+by+real-time+PCR+during+antiviral+therapy+with+peginterferon+and+ribavirin+in+patients+with+HCV+genotype+1b&search_reqcount=20&search_reqfirst=1&search_sort=relevance&search_source=All+Periodicals&search_startpage=&search_tabularSearchValue=&search_text1=&search_text2=&search_text3=&search_text4=&search_volume=&search_within1=&search_within2=&search_within3=&search_wordsexactly=no&search_yearend=&search_yearstart=&searchDisciplineField=all&terms1=&terms2=&terms3=
To Dr Azeem butt, S4 means week 4 ! Sorry for this french word !!
N'est regards
Dr hazeem, i would like to tell you that the example of viral load you give is impossible! So what kind of molecular test is used for HCV viral load?
Article Assessment of Spontaneous Fluctuations of Viral Load in Untr...