PCR RESULTS IN - HELP.

[bobbyullc]

JUST GOT MY 12 WEEK PCR TEST AND MY DR IS ON VACATION FOR 2 1/2 WEEKS. PLEASE HELP ME INTERPRET WHAT I READ.
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HEP C QUANT  <1.9    <1.9 LOG IU

VIRAL LOAD RESULTS FOR HCV RNA IS LESS THAN 75 IU/ML

THE LOG 10 VALUE FOR HCV RNA IS LESS THAN 1.9

A QUALITATIVE PCR ASSAY WITH A DETECTION LIMIT OF 50 HCV RNA IU/ML IS AVAILABLE TO ASSESS LOWER LEVELSOF HCV VIREMIA.
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I TAKE THIS TO MEAN I HAVE A BETTER THAN 2 LOG DROP BUT THE TEST DOESN'T GO ANY LOWER. IF SO DO YOU THINK I SHOULD ASK FOR A MORE SENSITIVE TEST OR JUST BE HAPPY IT IS BETTER THAN 2 LOG AND CONTINUE TREATMENT?
I AM JAZZED!!!!
I AM GENO 1, VL OF 154,000(VERY LOW) AND STAGE 3 AND HAVE HAD IT FOR 35 YEARS. GOOD BLOOD WORK THE LAST 12 WEEKS. SOME HIGH AND SOME LOWS BUT FAIR.
THANKS TO YOU ALL AND TO COMMITMENT TO CARE.
BOBBY

[mikesimon]

I would definitely be happy and continue treatment. If you are crazy like most of us you might want to get a more sensitive test, if not immediately, the next time you test. I always tell people to make sure the test is quite sensitive eg...<5 IU/ML so as to avoid any extra anxiety. But I think you're doing well and can relax a little for now. Good luck to you. Mike

[jmjm530]

Your non-detectible, congratulations ! You really can't do better than that. Regarding the test sensitivity, I think <75 is fine for week 12 but you might ask for something more sensitive for your week 24 test like something <50 IU/ml or even a very sensitive test like Heptimax which goes to <50 IU/ml. Keep in mind many trials that use the word "non-detectible" only test down to 50 IU/ml.

-- Jim

[jmjm530]

Heptimax goes down to <5 IU/ml not "50" as stated.

[fresnoborn]

i'm glad to hear you are taking care of the infection. also i am pleased to hear you are feeling better. that is truly a nice thing to hear.

[strator]

The 12wk pcr I moaned about yesterday until they agreed to do-I believe the bottom of the slip for Quest had Heptimax written on it. Is that always a <5 or do they do different sensitivities per request or need. Actually I(think) I'm just happy getting a PCR but figured I wouldn't bother asking for a real sensitive one unless God willing I get through tx and get low enough that it might be more appropriate.
How you feeling of late?
Don

[DoubleDose]

My read on the results is that you MAY be undetectable already.  The reason I say this is the suggestion on your test form that a Qual. PCR is available to test for RNA viral load below 50 IU/ml.  Which implies that the quantitative test you used probably only went down to a level of 75 IU/ml. in sensitivity.  So, you could be anywhere below 75 IU, from 74 IU all the way down to undetected.  Usually with test results so low (below 75 IU) this may mean that you have already reached undetected status.  The Log number, by the way, 1.9  means 75.  In this case is was stated as <Log 1.9, or less than log 1.9.  

Log 1 equals 10, log 2 equals 100, log 3 equals 1000, and so on.  The log number 1.9 is a mathmatical equivalent to 75.

So, now you really need to know if this result is saying fully undetected.  The best way to do that is to get tested RIGHT AWAY using a super sensitive PCR, either qualitative or quantitative, which has a lower limit or 5 IU or 10 IU at most.  You need this info to determine if you may need extended tx.  If you really are already undetected, by super sensitive PCR, then going the normal length of time should be adequate.  If there is still a low viral load, somewhere under 75 IU, but above 10 IU, then you will most likely benefit from extended therapy, beyond the planned endpoint.

I would put in a call to your doctor by emergency beeper, or through his assistant, to request this PCR immediately.  

Any way you look at the result, you are in great shape, and should be very encouraged!!!!  You are on your way to SVR.
Just make sure to get adequate information to determine your tx needs.  This super sensitive PCR will allow you to make the right moves.  I hope you can arrange it quickly.  Also don't reduce doses!  You are on an effective course of TX now.  Keep it going.

DoubleDose

[jmjm530]

Heptimax is done in two parts. First, a quantitative is run which has a sensitivity of 50 IU/ml, this takes about 3 days. If you're below the detection limit on the quant, then and only then do they run a TMA which has a sensitivity of 5 IU/ml. A few tests go down to 2 IU/ml but 5 IU/ml is sensitive enough for all practical purposes. In fact, 50 IU/ml is the standard for non-detectible most of the European studies use.

As to how I'm feeling, thanks for asking. Taking an antibiotic (Avelox) for some low grade fever/infection but nothing dramatic. I'm getting off the couch more which is good. My doc wants to extend tx to 52-weeks so if I take his advice that leaves another 11 weeks.

Take care.

-- Jim

[NYgirl]

What great results you are on the WAY!!!  Congrats to you, you must feel great!

And isn't it wonderful that we can ask on this forum when we just can't wait for a doctor!  :)

YAY for YOU!  Keep up the great work!!!

Debby

[bobbyullc]

THANKS FOR THE FEEDBACK. I REALIZE THIS IS ONLY UNDETECTABLE NOT THE CHERISHED SVR YET BUT IS THE FIRST BIG HURDLE. I THINK I WILL ASK FOR A MORE SENSITIVE PCR FOR MY PIECE OF MIND.

I HOPE ALL OF YOU WAITING FOR THAT 12WEEK  TIME TO COME WILL BE HEARTENED EVERY TIME THERE IS ENCOURAGING NEWS LIKE I HAVE BEEN.

BOBBY

YES I WOULD GO CRAZY WAITING TWO WEEKS FOR AN EXPLANATION.

[friole]

This is great news.  However, I was 40 IU at 12 weeks, so am very aware that a test which only goes down to 75 can be deceptive. We all want the true undetectable by the most sensitive standards available.  I finally had a sensitive test run at 20 weeks, but am still waiting for the results

DD - I have read so much that you have posted about occult Hep C after reaching SVR.  My feelings are that until they quit using these test which only go to 50 IU and especially the one that only goes to 615 IU, what they are calling occult hep c may be just a very low VL, undetectable with the tests that had been run during treatment.  Therefore, the virons may have never left the body.

Jim - I am very glad that you are feeling better in these final few weeks.  I still wish you had gotten on the Neupogen train long long ago - I think it might have helped with the infections - but you are almost through now and that is great.

frijole

[DoubleDose]

I appreciate your feedback regarding the 'occult' virus issue.  I think we need to make a clear distinction regarding several 'fuzzy' issues, that the articles often use interchangably, but that are different.

First, most researchers referring to 'occult' HCV are generally referring to people who have no detectable HCV in their blood after tx, but continue to experience elevated liver function tests.  The finding often goes along with a follow-up biopsy of the liver that in many cases shows positive for HCV replicating virions.  This is an uncommon phenomenon, and is sometimes also found in those who have never treated, and are HCV negative on antibody testing and PCR testing of the blood.  These people usually present with elevated liver enzymes, but do not seem to have HCV.  Biopsy of the liver usually shows HCV in the hepatocytes.  Hence, 'occult HCV' infection.  Again, this is relatively uncommon.

The other issue is 'persistent' HCV infection after SVR, and in some research studies seems to be very common in SVR's, ranging from 85% to almost 100% in various studies.  These are people who have been PCR negative for several years or more, on sensitive blood testing, and are often also PCR negative on biopsy of the liver.  These studies show that the SVR's seem to harbor a very low level infection in the PBMC, lymphocytes, and in some studies within isolated organs or tissues.  All of these viral sites seem to be very low level positive for HCV, and seem to quietly 'persist' even though the red blood cell infection and liver infection appears to be totally eradicated on PCR testing.


So 'occult HCV' and 'persistent HCV, after SVR' are two very different issues.  Also, in the 'persistent' infection, often not only SVR's seem to harbor this low level infection, but also those who had cleared the virus spontaneously, often many years ago.  To add to the controversy, some other researchers have run the same tests on peripheral sites, and they find no evidence of HCV anywhere in the body.  There is just no consensus on this issue at all.  It is a disturbing possibility, because if it is true, then we all are carrying replicating HCV in different areas of our body, with totally unknown long-term ramifications.  This is why this issue is so important to get real answers for.  

The articles need to be clearer about these two separate phenomena, 'occult' and 'persistent' HCV.  The reason the 'sensitive testing' explanation does not answer the 'persistent' HCV question, is just that many have had and continue to have undetected PCR tests, using ultra sensitive testing, for years ongoing...and still seem to show this odd viral persistence in certain cell components.  (by some researchers)

I hope this made sense.  Just trying to clarify.

DoubleDose

[Gladitsnotworse]

Did shot 48/48 last night.
Diagnosed last year as 1a/b, 8,000,000 viral load
44year old female,120lbs,liver ultrasound showed no abnormalities
Doctor(GI)said a liver bx was unnecessary due to ultrasound.
(I wish I had talked him into it anyway)
Viral load at 12 weeks, 24 weeks and 48 weeks show <50IU/ml
Treated with Peg-intron and Ribavirin. Ribavirin at 800mg reduced to 600 a day at 14weeks due to labs.
I requested a qualitative hcv test, dr says this is not needed.
I am not sure I would want a more sensitive test at this time. Anyway, I made it. Being able to turn to this site everynight helped keep me going. I cant imagine having to have done this alone. Thank you and God bless you all.

[strator]

HOOORAAAYY!! Excellent!Excellent!Excellent! Typing that 48/48 must have been a great feeling. Thank You-for bringing it home, and sharing it here!
Bask in this one, you deserve it.
Don

[beamishboy]

i'm so glad,i'm so glad,i'm glad,i'm glad.i'm glad......congrats-Great News!!--you have beat the devil

[NYgirl]

Thank you so much for posting, I am an 1a and b as well and you have showed me that it can be done!

I can't wait until the day that I too can say 48 of 48!

WHAT A GREAT ACCOMPLISMENT!

I'm so glad for you Glad!

PS I sure don't get those doctors that say bx was not necessary due to ultrasound - they really freak me out (I was originally told that as well and am a 2/2 verging on 3).  

I'm so GLAD it worked out for you.  :)

[fresnoborn]

yipeeeeeeee!!!!!!!!!!!!!! i am so happy for you. you must be very proud. you should be!!!!!!!! that is wonderful news. HERE'S TO YOU :) :)))  (:)