Aa
How important is Viral Load
My ALT/AST are ten times over normal. Same for Iron. Yet my viral load is below 100. This is significant of?? Thank you in advance for your patience. I am in Canada. I waited three months to see a specialist ( very old school) who did not take well to questions. Bloods etc..two months more to see him again and then probably biopsy. Still don't know genotype as I was informed it takes to months to get results. Suffice it to say I will will be 6 months down road after diagnosis before anything significant begins. A little frustrating. Thanks again
Don , absolutely no need to apologize .. Asking questions and furthering our personal knowledge base is what these forums are for .. like most new subjects , it's learning what questions are important, not always easy and definitely time consuming . It is/can be "overwhelming", especially at the beginning of this journey.
That being said .. never forget this is a public forum & the opinions expressed are not made by trained professionals / medical doctors or nurses.
Quite an interesting PCR report actually .. it would appear your VL is under 50IU/ml , but not 100% sure if that is what "minimal detection" implies. If it is that your VL is that low ..and ALT/AST so high ..... perhaps you do not have a chronic infection , but are in the acute stage ?
Your Gamma GT is high indicative of infection ...
Sorry, for the high Iron & Ferritin issues, no input/experience .. but I'm pretty sure Hector who is very dialed into this .. will respond ...
Have you had your liver condition checked ?
There are several very informative websites that do provide up to date on the subject of HCV, study reports etc which make for informative reading .. if you are so inclined ... and of course Goggle .. just enter HCV + high Ferritin in any search engine and you'll get plenty if not too much ... info/data .
Here are only a few of the data bases I use ..
Clinical Care Options - CCO- free registration needed
http://www.clinicaloptions.com/Hepatitis.aspx
PubMed
http://www.ncbi.nlm.nih.gov/pubmed
MedScape
http://www.medscape.com/index/list_4836_0
As you will see as you delve further into the quest for knowledge on this virus & it's Tx ... This is a very complex subject, with unfortunately still many unanswered questions.
At the end of the day , hopefully you'll end up with an informed doc who can guide you with experienced professionalism. Myself, I don't care about "compassion" or "bedside manner" from the doc .. some very experienced/good doctors just don't have that trait ... What is important to me, is that they are experienced and knowledgeable specific on the subject of this virus and can guide appropriately .
For what it is worth .. it's not recommended when consulting with your doctor to refer to the HCV forums like this one .. these are not medical data bases .. or alternative therapy's ... however, mentioning the data bases of CCO or EASL or PubMed etc. is however probably ok ..
Cheers, Aaron
That being said .. never forget this is a public forum & the opinions expressed are not made by trained professionals / medical doctors or nurses.
Quite an interesting PCR report actually .. it would appear your VL is under 50IU/ml , but not 100% sure if that is what "minimal detection" implies. If it is that your VL is that low ..and ALT/AST so high ..... perhaps you do not have a chronic infection , but are in the acute stage ?
Your Gamma GT is high indicative of infection ...
Sorry, for the high Iron & Ferritin issues, no input/experience .. but I'm pretty sure Hector who is very dialed into this .. will respond ...
Have you had your liver condition checked ?
There are several very informative websites that do provide up to date on the subject of HCV, study reports etc which make for informative reading .. if you are so inclined ... and of course Goggle .. just enter HCV + high Ferritin in any search engine and you'll get plenty if not too much ... info/data .
Here are only a few of the data bases I use ..
Clinical Care Options - CCO- free registration needed
http://www.clinicaloptions.com/Hepatitis.aspx
PubMed
http://www.ncbi.nlm.nih.gov/pubmed
MedScape
http://www.medscape.com/index/list_4836_0
As you will see as you delve further into the quest for knowledge on this virus & it's Tx ... This is a very complex subject, with unfortunately still many unanswered questions.
At the end of the day , hopefully you'll end up with an informed doc who can guide you with experienced professionalism. Myself, I don't care about "compassion" or "bedside manner" from the doc .. some very experienced/good doctors just don't have that trait ... What is important to me, is that they are experienced and knowledgeable specific on the subject of this virus and can guide appropriately .
For what it is worth .. it's not recommended when consulting with your doctor to refer to the HCV forums like this one .. these are not medical data bases .. or alternative therapy's ... however, mentioning the data bases of CCO or EASL or PubMed etc. is however probably ok ..
Cheers, Aaron
Apparently what I thought was a Viral Load test was a HCV RNA RT PCR test run on a Roche COBAS Amplicor instrument. The result was positive with a comment . "minimal detection; 50iu per ml" A sensitivity detected by the machine not a viral load result. A rookie mistake on my part. I apologize and thank you for your input which initiated my further investigation. Frankly I am impressed and somewhat overwhelmed with the depth of knowledge being demonstrated.
These are results from 13th July The ferritin level June 13th. Thank you for your input.
Test component Value Flag Units Normal range Test Date Time
Albumin
ALB 39 g/L 35-52 ALB 20110713 1451
Creatinine Kinase (CK)
CK 97 U/L 24-195 CK 20110713 1451
Iron Profile (Fe,ISAT,UI
Iron 29.0 H umol/L 6.0-25.0 IRON 20110713 1451
Iron Sat 0.43 Ratio 0.20-0.55
TIBC 67 umol/L 45-72
UIBC 38 umol/L 23-67
Liver Profile (LFT) (MGH
Bili Total 13.4 umol/L 1.7-18.9 LIVP 20110713 1451
Bili Direct 2.4 umol/L 1.7-8.6
ALT 403 H U/L 10-40
AST 205 H U/L 10-37
ALP 86 U/L 53-128
GGT 92 H U/L 7-50
Ferritin 1063.7 H ug/L 23.9-366.0 SFER 20110613 0725
Test component Value Flag Units Normal range Test Date Time
Albumin
ALB 39 g/L 35-52 ALB 20110713 1451
Creatinine Kinase (CK)
CK 97 U/L 24-195 CK 20110713 1451
Iron Profile (Fe,ISAT,UI
Iron 29.0 H umol/L 6.0-25.0 IRON 20110713 1451
Iron Sat 0.43 Ratio 0.20-0.55
TIBC 67 umol/L 45-72
UIBC 38 umol/L 23-67
Liver Profile (LFT) (MGH
Bili Total 13.4 umol/L 1.7-18.9 LIVP 20110713 1451
Bili Direct 2.4 umol/L 1.7-8.6
ALT 403 H U/L 10-40
AST 205 H U/L 10-37
ALP 86 U/L 53-128
GGT 92 H U/L 7-50
Ferritin 1063.7 H ug/L 23.9-366.0 SFER 20110613 0725
Please post your lab reports as written so we can confirm the results.
In order to diagnose iron problems all tests related to iron must to evaluated. Serum Iron alone doesn't tell the full story.
Iron: ?
TIBC/Transferrin: ?
UIBC: ?
% Transferrin saturation: ?
Ferritin" ?
High levels of iron can be caused by blood transfusions, iron injections, lead poisoning, kidney disease, liver disease and hemochromatosis. There is a gene test (HFE) for hemochromatosis if it is suspected.
Again posting number would be helpful.
http://labtestsonline.org/understanding/analytes/ast/tab/test
"Very high levels of ALT/AST (more than 10 times the highest normal level) are usually due to acute hepatitis, often due to a virus infection. In acute hepatitis, ALT/AST levels usually stay high for about 1–2 months but can take as long as 3–6 months to return to normal. Levels of ALT may also be markedly elevated as a result of exposure to drugs or other substances that are toxic to the liver as well as in conditions that cause decreased blood flow (ischemia) to the liver.
ALT/AST levels are usually not as high in chronic hepatitis, often less than 4 times the highest normal level. In this case, ALT levels often vary between normal and slightly increased, so doctors typically will order the test frequently to see if there is a pattern. Other causes of moderate increases in ALT/AST include obstruction of bile ducts, cirrhosis (usually the result of chronic hepatitis or bile duct obstruction), and with tumors in the liver.
In most types of liver disease, the ALT level is higher than AST, and the AST/ALT ratio will be low. There are a few exceptions. The AST/ALT ratio is usually increased in alcoholic hepatitis, cirrhosis, and in the first day or two of acute hepatitis or injury from bile duct obstruction."
Good luck.
Hector
In order to diagnose iron problems all tests related to iron must to evaluated. Serum Iron alone doesn't tell the full story.
Iron: ?
TIBC/Transferrin: ?
UIBC: ?
% Transferrin saturation: ?
Ferritin" ?
High levels of iron can be caused by blood transfusions, iron injections, lead poisoning, kidney disease, liver disease and hemochromatosis. There is a gene test (HFE) for hemochromatosis if it is suspected.
Again posting number would be helpful.
http://labtestsonline.org/understanding/analytes/ast/tab/test
"Very high levels of ALT/AST (more than 10 times the highest normal level) are usually due to acute hepatitis, often due to a virus infection. In acute hepatitis, ALT/AST levels usually stay high for about 1–2 months but can take as long as 3–6 months to return to normal. Levels of ALT may also be markedly elevated as a result of exposure to drugs or other substances that are toxic to the liver as well as in conditions that cause decreased blood flow (ischemia) to the liver.
ALT/AST levels are usually not as high in chronic hepatitis, often less than 4 times the highest normal level. In this case, ALT levels often vary between normal and slightly increased, so doctors typically will order the test frequently to see if there is a pattern. Other causes of moderate increases in ALT/AST include obstruction of bile ducts, cirrhosis (usually the result of chronic hepatitis or bile duct obstruction), and with tumors in the liver.
In most types of liver disease, the ALT level is higher than AST, and the AST/ALT ratio will be low. There are a few exceptions. The AST/ALT ratio is usually increased in alcoholic hepatitis, cirrhosis, and in the first day or two of acute hepatitis or injury from bile duct obstruction."
Good luck.
Hector
Another problem that could cause a high ALT and AST and a high iron number is hemochromotosis, a genetic disorder of iron metabolism. This is treated with phlebotomy and can be diagnosed with additional testing via blood work alone. I only mention it because your viral load is so low it worries me that the hepatitis c could have caused this much of a reaction yet to me. The liver is inflamed, so something is definitely going on. It may all be the hepatitis c. I think i would be wanting a second test to validate that 100 number. It could be accurate and you just have a very low viral load. That will be very good for treatment. But , something else could be going on too.
Is it possible you are mis-reading your lab report ? Usually the sensitivity will be as you describe .. ie: <50IU/ml , a sensitivity of 50IU/ml is common .. for PCR tests .. there are many sensitivity of tests depending on which one was used .. <50IU/ml , <43IU/ml , <15IU/ml, <5IU/ml, <2IU/ml ...
It's possible your VL is detected but not measurable by the sensitivity of the test.
A PCR report may look something like ... 50,000 < 50IU/ml or 5^4<50IU/ml , something like that , there are several ways the labs use numbers to describe VL ... 50,000 or 5^4 log being the amount of virons per ml of blood ...
At the end of the day .. with elevated liver functions as high as you describe .. it would seem prudent to get further evaluation ... with a "modern" up to date doctor .
VL only starts to become important at the start of Tx. Starting Tx with a low VL increases odds of success ..
More importantly VL reduction and the time frame to achieve the reduction during Tx is the most important factor in deciding Tx duration, and potential for a successful Tx, or not.
Cheers & Good luck !
It's possible your VL is detected but not measurable by the sensitivity of the test.
A PCR report may look something like ... 50,000 < 50IU/ml or 5^4<50IU/ml , something like that , there are several ways the labs use numbers to describe VL ... 50,000 or 5^4 log being the amount of virons per ml of blood ...
At the end of the day .. with elevated liver functions as high as you describe .. it would seem prudent to get further evaluation ... with a "modern" up to date doctor .
VL only starts to become important at the start of Tx. Starting Tx with a low VL increases odds of success ..
More importantly VL reduction and the time frame to achieve the reduction during Tx is the most important factor in deciding Tx duration, and potential for a successful Tx, or not.
Cheers & Good luck !
Is this a potential acute or recent infection? 50 IU/ml is an unusual viral load. In contrast, mine averaged 2million IU/ml.
You appear to have some signficant connections that should help you with locating a knowledgeable and experienced Hepatologist. Good luck with that.
Trish
You appear to have some signficant connections that should help you with locating a knowledgeable and experienced Hepatologist. Good luck with that.
Trish
What is the log10 on your PCR results? 50 IU/mL may be the sensitivity of the test, not the actual viral load. A viral load of 50 IU/mL with chronic hepatitis is not possible.
Thank you all for such a prompt response. My VL iis 50 iu per ML. Statement attached is VL minimal. Trish my wife help designed the MUHC ( McGill super hospital ) software and works at The Montreal General.. I get test results quickly. That said I am perusing other avenues for care. A hospital in the French system here in Montreal is renowned for Liver and I have pulled some strings. Welcome to socialized medicine. I guess VLO is neither here nor there re significance until further along the road. Thank you again.
Hi Don....welcome to a fellow Canadian. :) "doncheery" eh? Catchy. :)
Viral load of below 100...that doesn't sound right. How is your viral load written, exactly? Is it possible that's an antibody test? Seems odd that they wouldn't have genotype along with viral load and that's a very low number.
Viral load on the whole doesn't make much difference. So far, there hasn't been any direct corelation between viral load and liver damage. Viral load becomes significant with regards to treatment, as the reduction in viral load in response to treatment drugs at specific intervals gives important indication how you're responding to the drugs.
I would ask for copies of all your test results. If your doctor is old school and doesn't like questions, he probably won't like you asking for copies of your test results but I'd do it anyway. I would also strongly consider investigating your options for a doctor you can communicate with. You're either in or near Montreal, with the benefit of McGill so perhaps there will be other options to pursue. A second opinion might be worthwhile. I stayed with my first GI until the biopsy results but had concerns about how up to date he was, went for a second opinion thanks to the referral of another Canadian who was here at the time to a liver and research centre in a Toronto hospital and the result was that I was under excellent and knowledgeable care there, before during and after treatment. There was someone else on this forum who was from Montreal who went through treatment and I'll try to remember who that was.
It's frustrating the delay between each step in the beginning for sure. It took me ages to get through each step...10 months to see the GI! Then two more months to get the viral load and genotype. Biopsy was three weeks which was lightning speed comparatively. There is a lot of hurry up and wait with this process so hang in there.
Welcome to the forum.
Trish
Viral load of below 100...that doesn't sound right. How is your viral load written, exactly? Is it possible that's an antibody test? Seems odd that they wouldn't have genotype along with viral load and that's a very low number.
Viral load on the whole doesn't make much difference. So far, there hasn't been any direct corelation between viral load and liver damage. Viral load becomes significant with regards to treatment, as the reduction in viral load in response to treatment drugs at specific intervals gives important indication how you're responding to the drugs.
I would ask for copies of all your test results. If your doctor is old school and doesn't like questions, he probably won't like you asking for copies of your test results but I'd do it anyway. I would also strongly consider investigating your options for a doctor you can communicate with. You're either in or near Montreal, with the benefit of McGill so perhaps there will be other options to pursue. A second opinion might be worthwhile. I stayed with my first GI until the biopsy results but had concerns about how up to date he was, went for a second opinion thanks to the referral of another Canadian who was here at the time to a liver and research centre in a Toronto hospital and the result was that I was under excellent and knowledgeable care there, before during and after treatment. There was someone else on this forum who was from Montreal who went through treatment and I'll try to remember who that was.
It's frustrating the delay between each step in the beginning for sure. It took me ages to get through each step...10 months to see the GI! Then two more months to get the viral load and genotype. Biopsy was three weeks which was lightning speed comparatively. There is a lot of hurry up and wait with this process so hang in there.
Welcome to the forum.
Trish
The viral load does not mean anything until treating then it is significant to see how well the treatment is working.
Next step is a biopsy then to treat ASAP.
You ALT & AST indicate there is damage being done to your liver and should treat now rather then later.
Personally I would find a different doctor even if it meant traveling a far distance. I would not want a "very old school" doctor. There are so many new things happening with HCV that you should have an up to date doctor. And most importantly I would want to be able to ask questions!
Best of luck
Next step is a biopsy then to treat ASAP.
You ALT & AST indicate there is damage being done to your liver and should treat now rather then later.
Personally I would find a different doctor even if it meant traveling a far distance. I would not want a "very old school" doctor. There are so many new things happening with HCV that you should have an up to date doctor. And most importantly I would want to be able to ask questions!
Best of luck
*Probably have had Hep C for 30-35 years*
A viral load below 100 IU/mL is unheard of in those with chronic hepc. Are you sure that number is corrrect? In the acute phase, enzymes can be high and viral load low while the immune system is working to eradicate the virus. If you're taking a supplement to lower the viral load it's obviously effective but it's not enhancing liver function with enzymes 10 x normal.
The significance of a viral load below 100 IU/mL is if you were to treat now you would just about be guaranteed viral clearance and a shorter treatment duration.
A viral load below 100 IU/mL is unheard of in those with chronic hepc. Are you sure that number is corrrect? In the acute phase, enzymes can be high and viral load low while the immune system is working to eradicate the virus. If you're taking a supplement to lower the viral load it's obviously effective but it's not enhancing liver function with enzymes 10 x normal.
The significance of a viral load below 100 IU/mL is if you were to treat now you would just about be guaranteed viral clearance and a shorter treatment duration.
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