Hep C viral load

[ricks4654]

I was Dx with Hep C about 13 years ago but have never had a detectible viral load on a PCR quant test. All my liver functions are good and I rarely drink. Do I still need to try Peg therapy or this new drug coming out from Vertex?
thanks,
Rick

[Bill1954]

Hi Rick,

I still maintain that the original diagnosis *could* have been erroneous. Years ago, HCV was diagnosed via antibody test and a sideways glance at liver enzyme results; Nucleic Acid testing wasn’t prevalent then.

What science has found since those days is that this yields an inaccurate picture. Occasionally; people *can* resolve the virus during the first six months of infection (acute phase). Additionally, liver enzymes are a notoriously inaccurate method of determining HCV status; many of us have active HCV (and sometimes severe liver damage) and continue to have normal liver enzyme levels. Conversely, a person could have elevated liver enzymes (due to causes other than viral hepatitis), be HCV antibody positive, but HCV RNA negative.

The RIBA test methodology is very specific; I agree that at one time you were probably infected with HCV. However, given the significant percentage of folks that clear the virus via their own immune response in the acute phase, the possibility exists that the original diagnosis was faulty.

The PCR quant is also considered quite specific (accurate?) and tests directly for the presence of active virus in serum. This test (or ones like it) have become the gold standard for determining HCV status; not liver enzymes or antibody status.

Yes, there are more accurate tests available; Quest diagnostics for instance offers “Heptimax”; a serum HCV RNA test using both PCR and TMA methodology with an sensitivity of <5 IU/mL:

http://tinyurl.com/http-cas2-questdiagnostics-c

http://tinyurl.com/5kh39s

however, the lower limit of sensitivity in your case might not be that important. One would expect the patient to have a rather high viral load in the event of relapse or ongoing infection.

Let me ask you this; did your doctor ever assign you a HCV genotype? This is a critical component in managing HCV infection, and determines the length of treatment as well as the theoretical rate of response to antiviral medication. Genotyping requires a detectable viral load in order to process the genotype test.

Bottom line, ask your doctor again if you are serum HCV RNA negative or positive; the answer to this simple question will determine your current HCV status.

Good luck, and let us know what you find out—

Bill

[ricks4654]

Hi Bill,I gave blood about 13 years ago. the Red Cross sent me a letter that said I had tested positive for Hep C antibodies. I then went to my family doctor and he repeated the test and I had another positive. I think it was called RIBA. My doctor also did another test called EIA and it was reactive. Over the years we repeated the tests a few more times and they always came back the same. For a time I also had  elevated ALT and AST liver enzymes. The last 10 years or so my liver enzymes have been within "normal range". The only tests for virus levels in my blood were the quantitative RT-PCR and the virus was undetectable. As I understand it the PCR quantitative only measures down to 500  virus per ml. of blood. about 4 years ago I was also Dx'd with Parkinson's Disease [and I have no thyroid function (hypothyroidism) and anemia]. My biggest worry is that with all this other stuff going on my body gets run down and the Hep C could become a problem. By the way I don't drink or do drugs, never smoked and I'm 54 years old. Are there any newer more accurate tests that could show active virus or virus load. Thanks in advance.

Rick

[Bill1954]

Hi Rick,

I think there might be some confusion regarding your original diagnosis. You say:

“I was Dx with Hep C about 13 years ago but have never had a detectible viral load on a PCR quant test.”

A PCR viral assay tests directly for the presence of active virus. If none is found, you do not have HCV.

The question you want to pose to your doctor is if you are currently “serum HCV RNA positive”. This will determine whether or not you are actively infected.

What makes you believe you have been diagnosed? If the original Dx was based solely on a reactive or positive anti-HCV antibody test, then you probably have contracted the virus at some point in your life, but it has self corrected and resolved via your own immune system.

Again, contact your health care provider; ask the following:

1) “Am I serum HCV RNA positive?”
2) “How did you arrive at the original diagnosis”?

These are critical questions, and need to be answered before much else can be discussed.

Good luck going forward—

Bill