Boy, you're gonna carry that load...

While my ego is preoccupied with the day to day concerns of caring for my beloved, my inner geek turns her attention to the science and physiology of the infection (while my super ego gives special discounted pricing to any lab working in hepatitis research).  

I am frustrated that the majority of readily available information, although useful, is not very meaty.  It is to be expected considering the level of scientific education among the general population.  At the other end of the spectrum, a customer/friend (such relationships are hard to clearly define) helps me get copies of scientific journals and reviews, which are a little more than I can fully digest.  I am having trouble finding something in between.  I want more than a definition of alanine-transferase being an important liver enzyme, I want to see diagrams of the biochemical pathways drawn out with clear relationships to the etiology of this particular condition.  I want molecular mechanisms in an easy to read format.

Guess, I'll need to write one myself...add that to the 'someday' list.

In the meantime, I will attempt to contribute to the electronic bank of generalizations and overviews, in a personal, an hopefully entertaining, manner.  So first of all, watch this video:

One of the measurements of the severity of the disease - and the effectiveness of the treatment, is the ability to detect the virus in the bloodstream.  There are 2 basic tests, both of them reliant upon PCR (yay for PCR Diagnositcs! Even though these particular tests are performed with products from 'Competitor R').  One test is qualitative - that is, it only gives two answers:  "yes, you have virus in your blood" or "no, we cannot detect any virus, although it bloody well could still be there".

The other test is quantitative and measures the amount of virus present in the blood.  Because the second test assigns a numerical value to the virus, it can indicate the degree of progress of the treatment.  Quantitative tests are performed prior to the commencement of treatment, and again at week 4 and week 24.  A lack of a good response - that is at least a 100 fold change in the viral load - suggests a poor likelihood of responding to treatment.  It is not used to stop treatment, (unless there is no response by week 24) but it is not encouraging.

Prior to the commencement of treatment, Kevin had a viral load of 9,700,000 viral particles (actually, IU, to be precise) per milliliter of blood.  The test tops out at 69,000,000, so his load was huge.  So that lonely looking viral particle floating through the blood vessels in the video - that is not what his blood resembles at all.

Yesterday, I stopped by the clinic to pick up the results of his week 4 test.  The nurse printed out the results for me.  I just stared at the paper, speechless, blind with tears...Kevin hadn't wanted to see the results until Monday, not wanting to spoil his weekend.

When I got home late that afternoon, he had finally made it out of bed and was washing down a handful of pills with a glass of milk and a sandwich.  Somehow, he had acquired a black eye during the night.  His skin was grey, cheeks tired, mouth turned down.  I handed him the paper.  He stared at it.

"I don't understand what I am looking at here."  I pointed to the number next to a date.

As comprehension washed over him, his eyes began to glisten and his voice caught in his throat.  His breath shuddered as he forced an exhalation.

5380 IU/mL

...not a 100 fold reduction in viral load...a 10,000 fold reduction in viral load!!

Now mind you, this is still just an indicator that treatment has a chance at being successful, not that it will be successful.  And no matter what, the course of treatment still runs an entire year, regardless of the detectability of the virus.

But considering the shortage of feel good news we have had lately, I cannot even describe the amazing sensation of elation and vindication that can come from 4 little digits.