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Viral load
Sep 16, 2008

Clearly, your readers are keeping you busy on this site! I already contacted you about a few issues I had regarding the overall treatment that I was receiving from my physician, an infectious diseases specialist working primarily with the gay community, over the last 20 years. I have since changed doctor and am very happy that I finally had the guts to do so. Regardless, the straw that broke the camel's back had to do with results of the HCV viral load at the time of diagnosis. At diagnosis, they found that there was viral replication and that it was type 1 HCV.....but no viral load, although it had supposedly been requested at the same time. I had to have my blood drawn three additional times, specifiying each time that I wanted an HCV viral load, before I got any indication what it was - the reason?... the lab kept loosing my blood. My former physician finally informed me that the HCV load was 3 million copies. By this time I had already been to see my new physician who requested a HCV viral load while I waited for the results from the liters of blood that my former physician had lost. The results from my current physician indicated that the viral load was at 4.3 million copies. The time frame between blood draws for these results was perhaps 3 weeks. Is it normal for HCV results to vary by such a wide margin(25% +) between labs? Could the viral load have increased by this much in such a short time frame? In view of the low level of inflammation (2+) and fibrosis (1+) observed at the time of my biopsy in April, what recommendations are there in terms of starting therapy with a viral load at either 3 million copies/ml versus 4.3 million copies/ml? Thanks again for your attention and your very helpful responses.

Response from Dr. McGovern

Yes this is a busy website with lots of great questions, such as yours.

Viral load: There may not be a major difference between the 3 million and 4 million copies if the tests used to measure them were different.

The more important issue is whether the viral load impacts decisions on treatment. A few points should be made:

1. The viral load does not correlate with the amount of disease. Your case is a perfect example. Your level of scarring (fibrosis) is low.

2. The viral load is more helpful as a measure of response. I would favor trying therapy for 12 weeks. If you attain a non-detectable HCV RNA level, then I would finish the course. If not, I would stop.

3. The only way to know if you will respond is to do a trial of therapy. However, it is fair to say that in general high viral load and genotype 1 infection combinations are more difficult to treat.

In the meantime as you consider these options, I would avoid alcohol and be uptodate on any needed immunizations to keep yourself as healthy as possible.

Best of luck and I am glad I came across your question this time. Thank you for your patience.



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