There are reports that patients with Detected virus at EOT can still go on to SVR 12 and 24.
I found myself wondering 'how'.
My searches show that has only been reported in treatment regimes containing Sovaldi (Sofosbuvir). Please correct me if I am wrong.
In the very early Trials, almost all patients on Sovaldi monotherapy became Undetected within a few days. But most relapsed. This can only mean RAVs develop at the nucleoside NS5B site. However deep sequence testing did not reveal many consistent RAVs apart from S282T. It seems the Sovaldi RAVs are very short-lived, and maybe they are unfit variants i.e. can't replicate.
My take on this is that the detectable virus at EOT may consist of variants that may be defective. They may not be able to replicate or enter cells. Thus they may 'die-out' by EOT +12.
Remember that viral load testing measures all 'in the wild'-type virus and all viral variants.
This only applies to the Sovaldi regimes. I have yet to see this reported for Viekira Pak patients, and doubt whether this would be possible.
coolheat said
Oct 23, 2015
Hi Max, I might be a good one to watch on this issue. I was detectable all the way through tx, I was not told that, but, my 4 week EOT VL test was also detected. On both of those VL tests, I was unquantifiable, like Tig was saying. Below 12 viruses to detect. Mid Nov. I will have another VL test, a 3 month VL test done. I will be interesting to see where the virus is then. If it comes back, I am willing to do another one of Gileads new protocols for GT 1 ab, or open to another for that GT. Take care. This site is very helpful for all those warriors who want to a part of their healing and health. Marsha
Max said
Oct 23, 2015
It does help. Thx for the time and info. BTW first day on treatment. I feel no difference. If anything a little better that Yesterday. What a difference from this and int/riba.
Tig said
Oct 23, 2015
Hi Max,
The new DAA reports are indicating that some patients are presenting a detected result at the end of treatment, yet go on to SVR 12. The old protocols required us to be undetected by a certain point during treatment or they considered you a non responder and stopped treatment. Not anymore. While the large majority of people on the new protocols are undetected at some point during their treatment phase, some simply aren't. We are hearing more often that some doctors don't want to even do the EOT viral load test and opt to wait for the EOT +12 time frame. It's all a money thing. I don't agree that waiting that long is a best for the patient. I remember how anxious I was to know what was or wasn't going on during and right after treatment ended. That's why you'll hear us recommending a test during, at EOT and at EOT +12. The former may not be absolutely necessary, but they darn sure are telling and can be a big morale booster during the treatment process, in my opinion. But I also tell people to not be discouraged if they aren't undetected early, because they may very likely go on to achieve it later. It's just the way these new treatments are working.
The action of these drugs is entirely different from the old drugs. They work on different viral proteins. Those terms are things like the NS3/4 and NS5A and B proteins. All HCV drugs attack the virus ability to replicate by interferring with these proteins. By inhibiting the virus ability to replicate, it dies and frequently drops to an undetectable level, or very close. You may remember discussion on viral load tests that come back as "Detected, not quantifiable". Most tests now have a sensitivity down to 12 IU/ml or less. That's 12 viral particles or less. Below that number, these tests will detect the virus, but aren't sensitive enough to count below that. If you started treatment with a viral load (like me) of 5 million, you can see how small a number of <12 really is. Once the virus had been either eliminated (undetected) or reduced to an extremely low count, the body's immune system takes over the fight. If an individual is still detected at EOT, it's important to note the actual viral load. If it's quite low, then it's entirely possible that the body's immune system will continue to mop up the rest of it. That's why we're seeing people test positive at EOT, yet go on to SVR at the EOT +12 test. Hope this helps....
Max said
Oct 23, 2015
(The incidence of detected viral counts (albeit low) at the end of treatment is increasingly documented and SVR is still achieved at EOT +12. These new drugs have a completely different action and shouldn't be compared to the results of the old Interferon/Riba +\- PI protocols. The good news is it happens, the majority of the time.)
TIG56, Could you expound on this. How does the body handle the virus at EOT?
This is an interesting topic.
There are reports that patients with Detected virus at EOT can still go on to SVR 12 and 24.
I found myself wondering 'how'.
My searches show that has only been reported in treatment regimes containing Sovaldi (Sofosbuvir). Please correct me if I am wrong.
In the very early Trials, almost all patients on Sovaldi monotherapy became Undetected within a few days. But most relapsed. This can only mean RAVs develop at the nucleoside NS5B site. However deep sequence testing did not reveal many consistent RAVs apart from S282T. It seems the Sovaldi RAVs are very short-lived, and maybe they are unfit variants i.e. can't replicate.
My take on this is that the detectable virus at EOT may consist of variants that may be defective. They may not be able to replicate or enter cells. Thus they may 'die-out' by EOT +12.
Remember that viral load testing measures all 'in the wild'-type virus and all viral variants.
This only applies to the Sovaldi regimes. I have yet to see this reported for Viekira Pak patients, and doubt whether this would be possible.
Hi Max, I might be a good one to watch on this issue. I was detectable all the way through tx, I was not told that, but, my 4 week EOT VL test was also detected. On both of those VL tests, I was unquantifiable, like Tig was saying. Below 12 viruses to detect. Mid Nov. I will have another VL test, a 3 month VL test done. I will be interesting to see where the virus is then. If it comes back, I am willing to do another one of Gileads new protocols for GT 1 ab, or open to another for that GT. Take care. This site is very helpful for all those warriors who want to a part of their healing and health. Marsha
Hi Max,
The new DAA reports are indicating that some patients are presenting a detected result at the end of treatment, yet go on to SVR 12. The old protocols required us to be undetected by a certain point during treatment or they considered you a non responder and stopped treatment. Not anymore. While the large majority of people on the new protocols are undetected at some point during their treatment phase, some simply aren't. We are hearing more often that some doctors don't want to even do the EOT viral load test and opt to wait for the EOT +12 time frame. It's all a money thing. I don't agree that waiting that long is a best for the patient. I remember how anxious I was to know what was or wasn't going on during and right after treatment ended. That's why you'll hear us recommending a test during, at EOT and at EOT +12. The former may not be absolutely necessary, but they darn sure are telling and can be a big morale booster during the treatment process, in my opinion. But I also tell people to not be discouraged if they aren't undetected early, because they may very likely go on to achieve it later. It's just the way these new treatments are working.
The action of these drugs is entirely different from the old drugs. They work on different viral proteins. Those terms are things like the NS3/4 and NS5A and B proteins. All HCV drugs attack the virus ability to replicate by interferring with these proteins. By inhibiting the virus ability to replicate, it dies and frequently drops to an undetectable level, or very close. You may remember discussion on viral load tests that come back as "Detected, not quantifiable". Most tests now have a sensitivity down to 12 IU/ml or less. That's 12 viral particles or less. Below that number, these tests will detect the virus, but aren't sensitive enough to count below that. If you started treatment with a viral load (like me) of 5 million, you can see how small a number of <12 really is. Once the virus had been either eliminated (undetected) or reduced to an extremely low count, the body's immune system takes over the fight. If an individual is still detected at EOT, it's important to note the actual viral load. If it's quite low, then it's entirely possible that the body's immune system will continue to mop up the rest of it. That's why we're seeing people test positive at EOT, yet go on to SVR at the EOT +12 test. Hope this helps....
(The incidence of detected viral counts (albeit low) at the end of treatment is increasingly documented and SVR is still achieved at EOT +12. These new drugs have a completely different action and shouldn't be compared to the results of the old Interferon/Riba +\- PI protocols. The good news is it happens, the majority of the time.)
TIG56, Could you expound on this. How does the body handle the virus at EOT?