Deciphering Lab Results

[DD9th]

I have been diagnosed with HCV Genotype 2b, and will be starting treatment in about 2 weeks.  

I've had several lab tests, and I'm trying to decipher these reports.  Can someone tell me what I'm looking for to determine the viral load?  I'm pretty sure the one test they did would have given this info, but it all looks Ferengi to me.

[Lindaz]

DD9th good you talked to your nurse.  I hope it gets sorted soon for you.  I can see how it must of been a bit unnerving for you with regard to the colonscopy!

About Genotype 2b, and no biopsy.....that is what happened to me also. I did however, have a trispharic CT scan of the liver and ultrasounds.   My Hepatologist told me if I wasnt going to treat within five years he would suggest a biopsy.  Seeing I was going to treat within a 2 year time frame, he said not to worry with a biopsy.  It's interesting to see others with Geno's 2 encounter the same.  

[DD9th]

I called and talked to the nurse on my case, who said she was looking for the report and asked me if I had done the test.  If not, she will set it up so that I go tomorrow and get the lab work going.  So that is all good, and I'm glad I asked about it.

I sure hope these doctors know what they are doing.  My first visit (after the primary doctor referred me to a gastroenterology  specialist, had mixed me up with a patient who was there for a colonoscopy.  (Really!)

When the gal came in with a pamphlet of what all I needed to know about prepping for one.  ...

  "Uh... no, I don't think so... I'm here for Hep C"

They quickly set things right, but it was kind of unnerving.
  

[Bill1954]

Oops! Thanks Goofydude. Yup and yup; DD9th is indeed looking for quantitative results, not qualitative. The quantitative test is synonymous with the term ‘viral load’. Shucks, and I was hoping I could examine her spider veins; all is lost now :o).

Bill

[GoofyDad]

If you have a revious qualitative test, then they might be intending to utilize those results, however.

Can you call and specifically request copies of your ‘HCV RNA Qualitative (viral load) results?

To avoid confusion for DD9 - s/he's looking for a Qantitative result, yah?

[R Glass]

  I don’t think I agree with no bx for 2s and 3s. I would want to know the extent of the damage done to my liver. I don’t think I would be comfortable walking around the rest of my life not knowing if I can return to the normal life I know or do I spend the rest of my life protecting an unhealthy liver (that may not even be unhealthy). How would I know for sure without a bx.
Just because 2s &3s are generally easier to treat doesn’t mean they do less damage to the liver.

With the studies that are leaning to shorten the tx time for some people with gen2 and the chatter about new drugs that could shorten the tx time.

Someone please correct me if I am wrong but if my memory serves me correct, with the new drugs SOC for gen2 could be reduced from 24 to 12 weeks.

I would want to know if it is necessary to start tx or could I wait for the new meds.

DD9th- In no way, shape, or form, am I trying to encourage you not to treat. It can be a very controversial subject here, with both sides bring out good points.
I was a 2b stage1 (minimal damage) without a bx I would not know this.

[can-do-man]

Not sure if its just how my lab does it but my viral load always comes on a seperate page then my labs.

Forgot to say........... Wishing you the best

can

[DD9th]

Genotype 2b, and that is the reason the doctor suggested that we didn't need a biopsy, because I had agreed to do the interferon.  At first I wasn't OK with that, but I am hearing that it is fairly common.

Maybe they didn't give me the copy of the test, but I'll definitely find out when I call tomorrow.

[can-do-man]

Being a geno 2 some Docs don't bother with a bx, also it will be interesting to see if these new PI's will tx a type 2 on their first tx being their success is so high.

If they use the lead-in (SOC the first 4 weeks) and it shows UND its my opinion they will only go with SOC for 2's.

[JennyPenny]

I just scanned over this thread but I didn’t see a Biopsy. If there were not one done, I would run like hell (I am not telling you what to do, only what I would do). There are new Meds coming out soon.
.......................................................

Majority of docs aren't requiring biopsies of geno 2 & 3 patients any more since they have such a high SVR rate.

[Bill1954]

I agree it’s worrisome; and for more than the test itself. I’d hate to think the doctor was missing vital info like this; not a good way to start out treatment. Hopefully, they neglected to provide you with that set of results; and again, it might be bundled somehow with the genotype results. Do you recall this test being preformed in the recent past? They might intend to use month-old results. These tests are fairly pricey; a viral load test is roughly USD $400-$600.

The net result of missing this information is the inability to custom tailor treatment; you won’t have the luxury of increasing either dose or duration based on initial response. This has been found to be very instrumental in long-term response.

Out of curiosity, what is your genotype? And how elevated were your liver enzymes?

Bill

[R Glass]

I just scanned over this thread but I didn’t see a Biopsy. If there were not one done, I would run like hell (I am not telling you what to do, only what I would do). There are new Meds coming out soon.

[DD9th]

I will do that, because it is worrisome.

I had a similar situation with (minor) back surgery where I was being wheeled in for a fluoroscopic shot of to ease nerve pain due to degenerative discs, and the doctor seemed amazed by the lack of a MRI test (that was never ordered).  Kind of freaked me out.  

This is tenfold.  I'll call them tomorrow.

(By the way, the shot worked, but only for 2.5 weeks, maybe if he had the MRI he could have targeted it better....)

[Bill1954]

Sometimes viral load work is reported on a separate sheet; the viral load and HCV genotype tests are typically performed in a different facility than the rest of your labs—

Bill

[Bill1954]

I see nothing on that list that would suggest a viral load test has been taken. Unless it’s somehow bundled with the ‘HCV GENOTYPE, LIPA’ test; this is the only one on the list that is a nucleic acid test.

I would definitely raise a fuss over this before I began treatment; good catch. Even if it means postponing treatment; it will give you a baseline to work off of. If you have a previous qualitative test, then they might be intending to utilize those results, however.

Keywords to look for are:

Qualitative
PCR
TMA
LOG value

Etc.

Can you call and specifically request copies of your ‘HCV RNA Qualitative (viral load) results?

Best,

Bill

[DD9th]

Thanks to all.

I haven't seen anything on all of these reports that looks anything like that.  I wonder if it is possible that pre-treatment they have not taken a viral load test?  

I have only seen the Gastro specialist once, and the next time I see them will be to get the first shot.  I'm feeling kind of in the dark with the info they have given me.  I had to request a copy of all the lab tests myself.  It was the AST and ALT levels that are so high and the reason I decided to go forward with the treatment.  

Here are the names of various tests that I see:
TSH,
HEPATITIS A TOTAL & IGM
HCV GENOTYPE, LIPA
ANA SCREEN
INR
Transferrin
HEP B Core IgM
HIV1/HIV2
HB S AB, EIA
HEP B CORE AB, TOTAL
HEP C Ab
FERRITIN
HEP B Surf Ag
CHOLESTEROL
HDL
TRIGLYCERIDES
DIRECT LDL
BASOPHIL
DIFF TYPE
EOSINOPHIL
HEMATOCRIT
HEMOGLOBIN
LYMPHOCYTE
MCH
MCHC
MCV
MONOCYTE
NEUTROPHIL
PLATELET MORPHOLOGY
PLATELET COUNT
RBC COUNT
RBC MORPHOLOGY
RDW
WBC COUNT
WBC MORPHOLOGY
BAND NEUTROPHIL
ATYP.LYMPH
Albumim
ALKALINE PHOSTPHATASE
ALT
AST
BILIRUBIN, DIRECT
BILIRUBIN, TOTAL
TOTAL PROTEIN
EOSINOPHIL
BASOPHIL

[JennyPenny]

It should look something like this:

HCV/RNA Quantitative or Qualitative. The results are usually listed as international units (IU) or sometimes, copies per ml.

[Bill1954]

Viral load results are usually camouflaged under the heading ‘HCV PCR QUANT”, or something along those lines. It might use the term ‘quantitative’, but this might head you in the right direction.

Often it is expressed exponentially or even logarithmically; the figures that are batted around are usually rather large. As Newleaf mentioned, a good site to help understand this is “Janis and Friends”; if you haven’t seen this yet, it’s a good time to bookmark the homepage for review:

http://janis7hepc.com/

And here’s the page for help with viral loads:

http://janis7hepc.com/Viral_Loads.htm

Let us know what you see, and someone here will help with further interpretation.

Good luck—

Bill

[newleaf09]

If you go to Janis & freinds site and click on viral load they can help you make sense of translating international units (which many PCR [polymerase chain reaction] test results are reported in) into copies of virus, also making log numbers make sense.  It is a very useful site for understanding a lot of the tests and what they mean.