Why do you think they call it a LIVEr?
You are gathering information about the world of Hepatitis C (HCV) medicine. Good. We have been waiting for you. When you bring yourself for treatment, you must bring your mind as well as your liver.
Let’s talk about the lingo you will need to speak with your doctor. Why will you need to know these terms? Because these are the words that doctors use. Remember that you are responsible for your own body, so pay attention. I’m not saying the doctor doesn’t care, but nobody needs your liver as much as you do.
- VR: Viral load – Number of viruses per ml of blood. The goal is undetected, which is below the level of quantification (which is different for each assay).
- RVR: Rapid Virologic Response – Hepatitis C undetectable at week 4 of treatment. Until 2014, this result was rare, but not now. When interferon and ribavirin was the treatment, RVR was more meaningful, and patients who had RVR had the best chance of SVR. With the new all oral treatments, RVR is common but no longer meaningful. Earlier time to undetected does not give a better chance of SVR with the newer treatments.
- NR: Null Response – Less than a 2 log drop in viral load at week 12
- PR: Partial Response – 2 log decline at 12 weeks but still detectable at week 24
- SVR: Sustained Virologic Response – undetectable virus 6 months after treatment completed. This was the goal for treatment with interferon and ribavirin, but the surrogate marker for cure with the new oral Direct Acting Anti-Virals (Harvoni, Sovaldi and Viekira Pak) is undetectable viral load at 12 weeks after end of treatment (EOT)
How will you know that the drugs are working? Let’s talk a bit about a term your doctors use to tell you how much virus is in your body. The term is log. Yes, log. Log jam? No, Log cabin? No. Log splitter? No.
You already know that there are a gazillion little viruses swimming around in your liver and blood. That number is what brought you in for treatment. But what does that number mean and how does it tell you if you are getting better and by how much? Now don’t run off screaming. Just stay with me. I promise not to make this a math problem. I am just here to tell you that the log (or exponent) of a number is a way not to write all those zeros down. It is simply multiplying over and over. There. That is all the math, just greatly simplified.
A million copies of a virus (or anything) equals 1,000,000 = 6 logs (6 zeros)
A billion copies of a virus equals 1,000,000,000 = 9 logs (9 zeros)
A trillion copies of a virus equals 1,000,000,000,000 = 12 logs (12 zeros)
You can see quickly that it is impractical to write down all those zeros, so the doctor says that your virus load is 12 logs, down from the 15 logs of last visit. Then you know the virus is dying faster than replicating. You are getting better and the treatment is winning. There. You just learned in two pages what it took me a semester to learn.
Why do we say copies? Because unlike bacteria, a virus does not live on its own. A virus needs a host (your liver) to survive and replicate (viral reproduction). Your liver is the factory that the virus uses to make copies. So think of your liver as an overworked factory. That is one reason that scarring occurs, too much non-stop replication of the viruses.
Just take the time to memorize these terms, or write them down and keep the information close at hand. That way, when you leave the doctor’s office you will recall what he said and know what that means. You are taking care of your LIVEr.