? about Hep C detection

[sheade]

Hi.  I'm new to the site - just came in to find out something, if I can.  I also posted this in the "community", not sure where best to get the answer.

I was diagnosed w/ HCV 1a several years ago, went through tx, and I thought I finished "cured".  That's what the PA had indicated.  I had negative tests for 2-3 years following tx.  Then I was trying to get pg and the ob/gyn wanted to test and the results came back positive for HCV.

I was pretty devastated, because I thought I was cured.  When I went to the PA that treated me she said I'll always have the virus, but it's the viral load that I want to track.  But I really thought that before I went through tx I might come out of it with the virus completely undetectable - like if I was tested for HCV, you would not know I had it.

Am I completely mistaken?  Will I always, no matter what, have HCV detectable with a blood test?  I wonder now what I should ask the doc to test for - what do I want to track to know if it is active again?

Thanks.

[alagirl]

Actually, I think you pretty much answered the question right there for me.  Thanks!

[mikesimon]

I have read articles that some people do not show antibodies but it took 15 or more years. I don't have the articles on hand so I can't site a reference. Maybe if you Google around you'll find some supporting evidence - if you're that interested.

I just found this:
"Antibodies to HCV (anti-HCV) are detectable by commercially available
enzyme-linked immunoassays in 50% to 70% of patients at the onset of symptoms, increasing to more than 90% after three months, and completely disappearing 10
to 20 years after resolution of hepatitis. Spontaneous recovery and apparently complete clearance of HCV RNA occur in 15% to 50% of patients with acute disease."
This came from:
Occult hepatits C virus persistence: identification and characteristics
By Tram N.Q. Pham, PhD, and Tomasz I. Michalak, MD, PhD

Mike

[alagirl]

Is there anyone for whom that's ever different?  In other words, does the antibody level ever go to undetectable (like maybe if you had a low viral load to begin with - she asks hopefully)?  Right. Like I should even worry about that stuff now.  Just kicking it and making through the combo is what I should focus on.  Such a weird antibody thing with hepc anyway, since the virus seems to be so mutable.  Here you have antibodies, but they don't protect you from anything.  Bizarre.

[DoubleDose]

I think your GI needs some quick, and specific education regarding HCV and SVR.  If indeed, your doctor tested you for HCV antibodies, and then told you that you still had HCV...all the while knowing that you previously had treated, and achieved SVR....then they really are totally clueless about how HCV and treatment works.  You would almost certainly have a POSITIVE test result on the HCV antibody test, yet it would have NO MEANING whatsoever regarding whether the virus were still in your system.  As the others have stated, you will always have HCV antibodies, because they were originally provoked by the old HCV infection, and they seem to remain forever.  Kind of a long lasting tire mark from a skid.  The accident is long past, but the marks remain.  

First thing I would find out immediately from your doctor just what sort of test they ran, and determine if it is the typical HCV antibody test, and definitely not a PCR or Viral Load test.
I would assume the test was the former rather than the latter.  If you were indeed SVR and undetected for six months after ending your treatment, then the odds are huge that you are still SVR and will remain SVR permanently.

I would also do a little bit of gentle 'scolding' with your doctor, it it turns out that the antibody test was used, as I am almost sure was done.  They should know better than to think you had redeveloped the HCV infection.  Even with a naive person, who had never treated, if they were tested by their GP for HCV and had a positive result, the protocol is for the doctor to run a sensitive PCR test to determine if there is any virus, or if the person was one of the 15% - 25% that spontaneously clear the virus on their own, without treatment.  They also will always have a positive HCV antibody test result.  It only means the blood still carries markers that show the virus was once present in the past.  The antibodies are not at all viral, or dangerous.  Only markers of prior infection.

DoubleDose

[mikesimon]

I like the Heptimax test by Quest Diagnostics because you get the qualitative and the quantitative but any sensitive PCR would probably be fine. You just want to see if there is any active virus detected in your serum so the quantitative may not be necessary. I just like overkill so I always get a Heptimax. Mike

[sheade]

Thanks Mike.  That makes me feel tons better.  I do believe that I achieved SVR following my treatment.  I think I'll ask the GI for another screen, just to be certain.  What should I ask for - PCR?  Quantitative PCR?  Not sure of the right term to use.

Thanks.

[mikesimon]

You will show hepatitis c antibodies even after you clear the virus and achieve SVR - sustained viral responder - SVR basically means that hepatitis c is not detectable in your serum. The antibodies remain however and my guess is that is what they detected on your recent labs. You could get a PCR to see if any active hepatitis is detected in your serum and if your previous treatment resulted in you becoming an SVR then I would think your labs will not detect any active hepatitis. I am assuming that your treatment was successful and that your PA tested you correctly with a sensitive PCR and that you were truly undetectable. If this wasn't the case then all bets are off. Good luck, Mike