False-Positive

[scaredwifeinny]

My husband and I are going through infertility treatment.  He went in a few weeks ago to have the blood checklist for IVF and my doctor called on Friday to tell us that he's tested positive for the antibodies to Hepatitis C.  My husband has never used illegal drugs, no tattoos, no blood transfusions and was vigilant about protected sex.  So... since we haven't been in to see another doctor for follow-up tests, what are the rates of false-positive in this sort of population?  We are understandably devastated and just need to know more information.  Thanks!

[jmjm530]

15-40% chance your husband doesn't have Hepatitis C, but probably closer to the 15-20%. He will need a different kind of test called viral load test (PCR) to confirm whether or not he has Hepatitis C. Let's hope he doesn't, but in the event he does have Hepatitis C, you will want to see a liver specialist. They are called "hepatologists" and can be found at your larger teaching hospitals. Treatments are getting better every day, but he may not even need to be treated, depending on a number of factors.

All the best,

-- Jim

[scaredwifeinny]

I asked the doctor if it was possible to be a false-positive and she said it was not a "weak positive" but that she's not a liver specialist.  How long does it take to get the results back from the PCR test?  Thanks, Jim!

[jmjm530]

It's not that the test your husband took has a 15-40% chance of giving a false positive. I'm sure the test is very accurate. That said, a certain per cent of people (15-40%) who have antibodies, don't have the virus. This is because they were exposed sometime in the past and their body naturally rid itself of the virus. A PCR test takes anywhere from 3 days to two weeks to get the results back. In case your doctor isn't up on Hep C tests -- and many non-liver specialists aren't -- a good viral load test is called "Heptimax" by Quest Diagnostic Laboratories. All your doctor has to do is write the word "Heptimax" on a prescription form (along with a diagnosis code) and you can then bring the rx to a Quest Center to have the blood drawn -- or, if the doctor has a Quest Account, he can draw the blood in his office. You can find a local Quest location here:
http://www.questdiagnostics.com/?gclid=CMq43P3BlI4CFQ9lHgodcShPPA

[FlGuy]

Even if hubby is hcv positive, I don't see what impact that would have on an ivf cycle for you.  Before I knew (about 15 years) we went thru ivf - two successful cycles with no bearing on the procedure or the outcome.  So even if hubby is being sperm-aspirated, or other means to match up sperm and a batch 'o eggs I don't see the issue.  whether it's 'routine' procreation us the use of novel approaches there is no reason that hubby's hcv (if he has it) should get in the way.  Time to have a sit down with the reproductive endocrinologist and the medical team leader.

[scaredwifeinny]

thx so much--it's just so overwhelming and I'm so scared for him.  The baby stuff is sooo in the back of my mind now.  How long does one have once diagnosed?  Can you live a normal life (he has no symptoms now)?  What are the treatments?  I'm making an appointment with a gastroenterologist tomorrow, hopefully we'll get in and he can get tested.  Skipping the internist--we don't have a regular doctor right now and I don't want to have to do this whole thing twice if we get referred to a specialist.
Thanks, guys, for all the information

[jmjm530]

I would recommend a "hepatologist", not a gastroenterologist. A hepatologist is a gastro with a speciality in liver disease, and in general know more about both diagnosis and treatment. However, you might want your regular doctor to run the "Heptimax" test first so you can hand over the results to the liver specialist. At least that is how I would proceed.

-- Jim

[FloridaMouse]

Rest assured,  most people die WITH hep C, not from it.  I've had it 20+  years and I'm still alive and kicking.  I just finished the treatment in April and I obviously lived through that too .  I have lived a VERY normal life since contracting it in 1985 via a blood transfusion.  I did not live a normal live while on treatment ... but that is only a temporary thing.

When you make the appointment with the GI, make sure he is well versed in the treatment of Hep C

Good luck to you both and I think it's awsome that you are showing enough support for him to start hitting the boards.  Gotta get him here next.

Mouse
female, genotype 1a, Stage 3, Grad3
Finished tx 4/13/07
Hoping for SVR in Sept. 2007

[scaredwifeinny]

Thanks everyone for this support.  Right now, we're praying desperately for a miracle, that he's positive for the antibodies but not for HCV.  Either way, I'm going to make this my priority.  Any good questions I should ask?  I am lucky to live in NYC, we have a HCV center at Cornell specializing in this disease.  IF or when he's positive, we're going there next--just want to go to an internist/gi specialist to get the initial testing completed.  Hopefully we won't have to worry about the next step.

[Jakied]

Find out the number of your husband's 'signal to cut-off ratio.'  It will probably be >1.  A 'weak' positive on the screening test is >1 and 3, the screening test is probably accurate.  But that does NOT mean your husband has Hcv.  It means he has the antibody to Hcv in his bloodstream, which means a prior exposure.  To confirm the presence of the virus, he needs to have the Pcr, qualitative, test.

Don't freak out.  Your husband might be Ok.  take it one step at a time.  ask your doctor for the Riba test.  If she is not helpful with that, call 'request a test.'  1-888-732-2348.

[Jakied]

my comment should read  'a 'weak' positive on the screening test is >1 and <3.'

[jmjm530]

Hopefully your husband will test negative for the virus and you will be done. If he tests positive, then you will have many questions, but many of them will have to be answered by a liver specialist (hepatologist) after further testing. You are lucky to live in NYC as they have some of the best hepatologists in the country. This doctor at Cornell is one of the best http://www.hepccenter.org/jacobson.php  but you would have to see him out of network as he doesn't take insurance directly. Others in his group probably do. I am not familiar with the service listed above with the "888" number, but a quick look shows it's not available in NY, nor do they accept insurance.
But as mentioned, any doctor can order the viral load test (PCR) which will save you time because that's the first thing the liver specialist will do anyway if and when you see him. Good luck and do let us know how things turn out.

-- Jim

[scaredwifeinny]

You guys are so awesome.  Just got his test results and it says the test was the

HB S AG w/REFLEX CONF

then it says his HCV ratio is 1.04.

This patient's sample tests reactive with a low s/co ratio; greater than or equal to 1.0 and <8.  The CDC recommends supplemental testing such as RIBA or nucleic acid amplified testing confirmation.

What does this mean?

[scaredwifeinny]

Sorry, the test above is nonreactive (HB S AG w/ REFLEX CONF)

The test that shows he's positive is the HEPATITIS C AB and he's nonreactive for A and B

Could having the Hepatitis A and B vaccinations cause a higher reading for HCV?  Just wondering.

[jmjm530]

It means he needs further supplemental testing to confirm whether or not he has Hepatitis C. The test I mentioned -- "Heptimax" by Quest Diagnostics - is such a supplemental test.

[scaredwifeinny]

Thanks so much.  So I guess we wait and see.  Even if he does have it, does having a weaker s/co ratio mean it's less progressed and/or serious, or does that mean nothing?

[Jakied]

With such a low ratio, 1.04, there is a very good chance of a 'false pos.'  Ask for the 'riba test.'  I have a feeling that will be neg which would mean a false pos on the screening test and no antibody in his blood stream.  Riba is VERY specific for Hcv and does not react with other antibodies as the screening test does, which results in false pos.  The Cdc says a ratio 85% of the time.

If I were you, I would ask for the riba test, since it is much cheaper than the Pcr qualitative.  Call request a test if you need to schedule the test, 1888-732-2348.

I have a feeling all will be well.

[jmjm530]

Respectuflly disagree with "Jakied".  At this point you want conclusive evidence your husband has (or doesn't have) the virus. And that is by directly testing viral load test, not another antibody test. Spend the few xtra bucks for peace of mind. And again, the number that "Jakied" is posting does not work for NY State Residents nor does it take insurance. I would not worry any more about the ratio or what it means. Either he has the virus or he doesn't.

-- Jim

[Jakied]

My typing is terrible today.  My comment should read 'The Cdc says a signal >1 and 85% of the time.  

Be hopeful about this.  I have a feeling all will be well.

[Jakied]

JmJm makes a valid point.  The 'Riba' test checks for antibody only, not the presence of the virus.  Some people are antibody pos and virus neg, which is not a health problem but you will have trouble buying life insurance and cannot donate blood or organs, etc.

Personally, I would want to know if i were antibody pos as well as virus pos so i would have the riba test and Pcr test done.  

[jmjm530]

Good point about donating blood, but not sure if there would be a problem with life insurance or even organ donation, as I believe some centers will even accept Hep C infected livers. As to re-taking another antibody test (the "Riba") , I see no harm as long as her husband takes the viral load test as well.

-- Jim

[scaredwifeinny]

We're really lucky to have great insurance, so I'm sure we'll want any and all tests done to give him (and me) peace of mind.  I'm curious to hear what this guy says today.  Keep you posted.

Bridget

[jmjm530]

Good luck, but just be warned, that your average internist isn't nearly as familiar with the correct tests for Hep C as a liver specialist (hepatologist)-- or many here for that matter. If they dont' want to use the test I mentioned -- "Heptimax" -- just make sure you insist that your husband gets some sort of viral load test. It would either be a "PCR" test, a "TMA" test, or perhaps even a "Bdna" test. But it should test viral load, not just antibodies. Good luck!

-- Jim

[scaredwifeinny]

The doctor was okay, I was happy we at least got to see someone.  He really poo poo'ed the idea of a "false-positive", but said that sometimes lab errors, etc. happen and/or he could have an autoimmune disease that's messing w/ the results.  We saw a gastroenterologist, so I guess a little more than internal med/less than hepatology.  Said we'll get the positive/negative results on Wednesday and then the PCR viral load if necessary in two weeks.  Does that sound right?

[nygirl7]

Just make sure you understand there are a LOT of people who don't fall in to the typical "druggie" type picture you get when you think of people who have HepC.  It's possible that anyone who's ever been to a dentist or innoculated with a vaccine could have it (lots of other ways unfortunately).

I'm not saying that he does just that.........you could even get it at the nail salon did you know that?

It's never taken me that long to get a PCR result back - it's usually between 5/7 working days.

As for the internests not really being "up" on hep that is very very very true.  Mine told me my liver was fine and I had no fibrosis.  Imagine my surprise when I switched over to a GI and he told me immediately that I was stage 3 which is not a good result.

You can worry about that all later IF you have to but just know - most of us have lived with this disease for 25 years or more and didn't even know we had it.  We can lead full productife every day regular lives...........it is NOT the end of the world and there IS a cure for it.

Good luck

[scaredwifeinny]

What's been the experience with these weak s/co lab values?  I'm so confused--it looks like on the CDC website, that these values are definitely a cause for a false-positive, but is that true?  Does anyone know?  We'll find out on Wednesday if he's negative for the PCR.  Fingers crossed and prayers being said...

[jmjm530]

Said we'll get the positive/negative results on Wednesday and then the PCR viral load if necessary in two weeks.  Does that sound right?
-----------------------------------------------------------------------
You are going to confuse yourself with too much information. To keep it simple, what you want for your husband a this point is a viral load test, not another antibody test. There are three types of common viral load tests: (1) PCR; (2) TMA; and (3) Bdma
Any of the three should do. I earlier mentioned one that is recommeded by many hepatologists. It's called "Heptimax".

-- Jim

[scaredwifeinny]

PCR test and the positive/negative secondary screening test is what he ordered, along with blood values (ALT, the other one and bilirubin).  He said if the test Wed. is negative (it's apparently the first step in the PCR test?) then not to worry, he's neg.  Although he didn't sound too sure about that.

[scaredwifeinny]

He has a follow up appointment in two weeks to discuss the PCR results.

[jmjm530]

Sound like what was ordered was an antibody test that *reflexes* into a PCR. In other words if the antibody test is negative, they don't run the PCR. But if the antibody test is positive, then they run the PCR. Truthfully, at this point I'd want the PCR test run anyway for peace of mind. I'm sure you will eventually end up with the answer you need, I was just trying to make the process work faster. Let's hope the antibody test comes out negative this time. At that point, assuming a negative, I'd still ask the doctor to run a PCR whether he thinks it's necessary or not.

-- Jim

[scaredwifeinny]

100% agree.  I'm a pharma rep and have been doing all sorts of research this weekend.  The doctor sort of rushed through everything today and I don't know if he even looked at Paul's values on the sheet or just decided to repeat everything to be sure.  Whatever he's doing, it has to at least make us aware of what we're facing!

[Jakied]

the riba' test and the Pcr are two very different tests.  the Riba is a VERY specific test for the antibody to Hcv.  The Pcr (Polymaraise Chain Reaction) check the bloodstream for the virus itself, NOT the antibody.  Your immune sysytem will produce antibodies to any foreign substance (common cold, flu, hiv,hcv etc) and thus, a 'window period' for this to happen exists.  For Hiv, the window period is usually 3 months, for hep b around 2 months and hep c 50 days is average.  this is the length of time necessary for your immune system to produce enough antibodies to be detected by the antibody test.  The pcr test, by checking for the virus itself, is effective within 3 weeks or so after exposure.

My own experience is this.  In sept 05, I had a one night stand with a woman (pros).  Not proud of that but we all make mistakes.  In december 05, I had a reactive screening test, 1.0 score, very weak but i had to take the Riba test.  waiting for that was the longest 4 days of my life.  I was frantic but, thankfully, the Riba and Pcr qualitative were both neg.  I learned my lesson.
That is why I recommended your husband take the Riba test and Pcr.

I am sure your husband would want to know his antibody status as wells as his virus status.

[jmjm530]

Scared: The doctor sort of rushed through everything today and I don't know if he even looked at Paul's values on the sheet or just decided to repeat everything to be sure.
---------------------
As a pharm rep, you unfortunately know that this is the way medicine is practiced all too often these days. Because of your obvious intelligence and involvement, you will eventually get the answers you want, but not necessarily as fast as you could.

All the best,

-- Jim

[scaredwifeinny]

I do--could tell that he had about 4 lanes going at once, didn't really take a detailed history and threw out some statistics that were a little off what I'd read (33% of patients don't know where/how they got HCV, treatment works 40% of the time).  Based on my experience in the field, I think he was just placating us by sitting down and really just wanted to get the bloodwork so he would have something to work with.  The good news is, that's really all we needed right now and if he is positive, we'll be at Cornell asap.

[jmjm530]

Actually his stats are pretty on the money -- alot of us don't know how we got Hep C and  the "40%" cure rate being for the most common type of Hep C in this country -- genotype 1.

Do let us know when you get the test results back. My guess is that the PCR (viral load) test is not going to be run unless the antibody test comes out positive again. That's how some of these "reflex" tests work.

If it were me, at this point I'd insist on a PCR (viral load test) being run even with a negative antibody, but probably best now to wait until you see what the results of the current tests are. Just make sure you ask for your own copies of all tests done.

All the best,

-- Jim

[scaredwifeinny]

We will definitely make sure he runs that test--I know my husband just feels better having gone and started the process.  It's been the worst weekend ever--the not knowing is the worst part.

[scaredwifeinny]

Sorry to bump, but does anyone know if the antibody screening test is more sensitive now than it was a few years ago, or are they using the same tests?

[jmjm530]

Let me try and give this a shot although I'm certainly not as knowledgeable about antibody testing as some others.

The antibody test your husband took is a preliminary antibody test. He scored very low meaning the test is somewhat inconclusive. For this reason the laboratory suggested he confirm the first test with a more sensitive antibody test called "Riba", or an RNA (viral load test). As to how inconclusive, I really dont' know.

While it's unclear from your posts, it appears your doctor ordered a Riba test (or he should of) that will reflex (automatically trigger) an RNA Viral load test (PCR) in the event the Riba test is positive. That's because you can have still have a positive RIBA but not have Hepatitis C. Chances of that happening are around 15-20%. However, if your viral load test is positive, then the chance you have Hepatitis C are 100%, barring lab error.

On the other hand, if the Riba test is negative, then it will not trigger a viral load test and the assumption will be that your husband does not have Hep C. That said, I suggested earlier that at this point you might want to ask for a viral load test regardless of the Riba result.

Aside from calling your doctor -- requesting copies of all tests taken and all tests ordered -- and then making some waves giving the office instructions (my speciality with my docs. LOL.) my suggestion is to sit back and wait for the results of the tests ordered.

Then make sure you get your own copies of the results. If at that point, you still feel your husband doesn't have a conclusive diagnosis -- then by all means see the liver specialist at Cornell and/or have another doctor order up a viral load test like "Heptimax" which will answer the question once and for all.

All the best,

-- Jim

[scaredwifeinny]

Thanks, Jim, we were just confused.  It looks in some articles that the lower the s/co, the lower the risk of actually testing positive with RNA.  I guess we just wait and see!  If he is positive, what are your thoughts on treating immediately?  Given than our insurance would charge a total of 100 dollars for the total thing, I didn't know what to ask when we see the doctor.

[jmjm530]

Scared: what are your thoughts on treating immediately?
------------------------------------------------------
You are getting waaay ahead of things :)

First, you need to find out if your husband has HCV or not. Then you will need to run a genotype test which tells you which strain of HCV he has. Then, you will need him evaluated by a hepatologist (liver specialist) over at Cornell who will try and determine how much liver damage he may have. Other tests and/or procedures might be needed for this, inlcluding a liver biopsy.

Once you've gotten all that together, listened to what the liver specialist has to say, plus do some independent research if so motivated (I have a feeling you will be), then you can make an intelligent decision on whether to treat now, or hold off on treatment for newer and better drugs in trial. The important thing is to take your time making decisions so the decisions you make will be the right ones.

Just remember, your husband is the same husband you had a few days ago before you found out he had Hep C and in general Hep C is extremely slow moving. Nothing is going to change overnight so no reason to make any decisions overnight. Personally, I think he has a decent shot at not having Hep C. Let's see what the tests say.

All the best,

-- Jim

[scaredwifeinny]

Thanks, I'm hoping so.  I really appreciate all the help, Jim.  It's just that a week ago, the WORST thing in our lives was our difficulty having a baby!!  I can't believe it--now I just want him to be well, so I'm channeling all my energy into that arena.  I think he's a bit calmer than me, so I'm so glad I have this board to unload my high anxiety.  

[Jakied]

According to the Cdc, if the signal on the screening test is <3.8, there is 78% chance of a neg riba.  Your husband's signal was 1.04 which is a VERY low pos.  There is a VERY good chance the Riba test will be neg and, in almost every case the Pcr test has the same result as Riba.

I would definitely ask for the riba test and the pcr, qualitative.  I have a feeling both will be neg and your husband can relax knowing he is antibody neg and virus neg.

I will give you the Cdc web site if you would like to read their report.

[scaredwifeinny]

Thanks, Jakied.  I read it!  I also read a 2005 article from the Journal of Microbiology that spoke to the s/co rate of the antibody tests.  That article said that anything lower than 5.0 on the Ortho Vitros EIA was considered a very weak value.  I am assuming that's the test he got b/c it asked the lab to retest for values below 8.0, which I think is that test.  I guess this is all just conjecture, but it's making me feel better to just read everything I possibly can.  Regardless of what happens, I have so much more knowledge about this disease and I'm so appreciative of everyone's advice.

[Jakied]

believe me, i know how worrisome a 'reactive' screening test can be.  i went through that myself but fortunately the Riba and pcr were neg.

I truly believe your husband's screening test is false pos.  Let us know this turns out.  try to relax.

i have a feeling all will be well.

[scaredwifeinny]

My husband got his PCR results today--NEGATIVE!  Yeah!  The doctor said the additional testing would be a few weeks but he didn't need to come back because this means he doesn't have HCV.  Thanks so much, everyone, for all the help and the information.  You really made this week between the shocking news and this last call bearable for both of us--Bridget and Paul

[jmjm530]

Congrautlations! That must be a real load off both your minds. And good  luck with the fertility treatment.

-- Jim

[debnevada]

My dear, the bullet has been dodged.  I am so happy that this turned out this way.

Have some babies now!

Deb

[scaredwifeinny]

Thanks so much.  Now I have to get over my anger at my fertility doctor, but we really feel fortunate.  Thanks so much, Jim, and I wish you good health and happiness.  I am so glad I learned more about this disease and won't ever judge people without knowing all the facts!

[jmjm530]

Glad we could be of some help here and that it all had a happy ending. All the best with your infertility treatments.

-- Jim

[debnevada]

come back and let us know when you are in "the family way"

[alfeezy]

please note that i have gone through hcv antibodies and the result was cut off one month back then i have checked the pcr and the result was negative, but when i repeat the hcv antibodies after a month from the first test again i got weak positive, my question is this weak positive will remain always when i take this test or may be it may be changed in future

[Jakied]

Your 'weak pos' probably means a signal of <3 on the screening test.  Ask for the 'Riba' confirmatory antibody test.  Riba is 'Recombinant ImmunoBlot Assay.'  this is VERY specific for the hep c antibody.  Your neg pcr means you are virus free.  A neg riba would mean you are antibody free, also.  A pos Riba  means previous infection and clearence, meaning you have Hcv antibody in your bloodstream and will probably have them for the rest of your life.

Having antibody only is NOT terrible but you cannot donate blood and obtaining life ins or health ins may be a problem.

Most 'weak pos' results on the screening test are neg on the Riba test.