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Scared nurse
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Scared nurse

I am a healthcare provider who had a needlestick in march of this year. Pt was HCV +. I had a hcv antibody come back reactive yesterday and my world has been upside down since. It was 15 weeks since the needlestick.  My s/c ratio is 1.29. I am going back to employer today to have PCR drawn. any advice?? Encouragement?? Feeling very overwhelmed and consumed by this.
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Hi Peachy  - I am so sorry for your angst. I too found out about this time last year that I had acute HCV and presumably contracted it through the medical profession.

I was terrified since I had no idea what to expect- or do - or even the first steps to take.  The wonderful people on this forum guided me though and now I am almost done with the treatments.

Presumably you are acute and so I urge you to find a good GI or Hepatologist and being a nurse I assume you have a network.  Treating Acute HCV is a bit different.  You may clear on your own. I waited to see if I would do so - almost did, but in the end, I could not eek out that last little bit of the virus.  My GI recommended an intense but short (24 weeks) course.  

As you get more information. pass it on here and we will help you.  I understand how you feel and know there is another side to it - a beginning, middle AND AN END.
Keep you chin up and be in touch here

Anne
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Fortuntely even if you just got it, hcv is a very slowly progressing disease.  In fact most with die with it and not from it.  So, even in a worse case scenario you are not in any rush to treat it or worry about end stage liver disease.

I believe the odds for getting it via a needlelstick are very very low.  It could be possible you picked it up earlier somewhere but if you just got it and are in the acute stage.....it's easier to beat it then but you certainly dont have to.

I hope it turns out well for you and that while you have the antibodies you do not have the virus.  Good luck.
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I just went and had my PCR drawn and of course I am praying for negative but remaining realistic as well. I am not even sure if I could get a negative. Do you remember what your antibody s/c ratio was when you came back reactive?

Thank you sooo much for the post. I have read your reply about 3 times already and I feel like a sponge trying to soak up any info that I can.

How bad are the treatments?? Also, since this was done on the job I am having to go thru the proper channels and follow protocols so based on the PCR results I assume I will be referred to another MD.

I did get to talk to an infectious disease MD on the phone today and he was EXTREMELY positive and said that treatments out today can eradicate the virus. I do know that the source I contracted it from was genotype 1b which I have heard less than favorable things about this type but also have heard that with treatment the chances of life ending liver failure and liver cancer are drastically reduced. Please feel free to correct me! Again, I am desperately seeking info and finding it in abundance on the web while trying to gather info from reputable sources.

Do you  remember how long it took or know how long it takes to get the PCR back? And does the reactive antibody mean that I definitely have hcv? I hear that it does then I hear that it shows exposure?? Also, in your case with your treatment, are you free of the virus?? Will your viral load levels be in the undetectable range or will they be zero. Just a lot of questions? I know that the patient I contracted it from ha a viral load (quant) of 79k. She didn't know she had it and was 84, retired nurse.

Thanks again. Yesterday and today have been a rollercoaster and getting your post made it a lot better.

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Avatar_m_tn
Hi there...sometimes a weakly reactive positive on an antibodies test can be a false positive,however because you had a known exposure to HCV ,that is unlikely.Thats not to say tho,that you have antibodies and could  not have cleared the virus by your own immune system. This happens in about 15 -25% of cases.If that is the case the PRC will come back negative.If the PCR comes back positive then you have active HCV infection.

As far as treatment goes..if you treat during the acute stage the success rate is approx. 90 %,so good news there.

Depending on were you live your PCR results could take a number of days ..,if in the U.S someone else may have a better handle on that as I am in Canada..it takes about 10 days here.

Try not to panic..as you may or may not know,being in health care..HCV  is a very slow mover  that most often takes many years and most often decades to do any liver damage...and treatments are becoming more and more efficient all the time.

Good luck  on the PCR and welcome..

Will
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Avatar_f_tn
The thought is to treat aggressively during the acute stage so your success rate is in the 90 percentile and you treat for a shorter period of time. This is what my GI who is a Tufts GI recommended. I was undetectable at 2 weeks and then again at 8 and 16 and without the addition of the new 3rd drug.  I am also  geno 1b.  
If you do  find you are newly infected, it would be good to have the conversation with your doctor about:
a) waiting a little to see if you clear on your own - but have a cut off date so you don't wait too long
b) starting on the just Peginterferon straight away to try to give your immune system a boost and perhaps avoiding future duel treatment with the Ribavirin
c) Treating aggressively if you do find you have to treat

Really, before you find out your final results, it would be a good idea to stay as healthy as possible and do everything possible to give your body a chance to rid itself of the virus.  I am an older chick so my chances were not great from the outset but I was able to start treating from a very healthy position.

Above all, relax and do your homework.  It is not a death sentence.



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Gosh, thanks a lot for all of the great info! The day of the needle stick I tested non reactive so I know this is related to the the needle stick so that would make this acute I guess.  It's been 16 weeks today. And as far as the needle stick, I was told I had a 3% chance of seroconversion which I guess I did since I developed antibodies. The needle was a pediatric butterfly approx 24/25 guage.

Again, thanks for the encouragement and important info. I am grateful that if I do have it,  I know when the exposure occured and can get treatment sooner than later if needed.

What makes someone out of the "acute" phase? I of course would like to get treatment within the time frame/window of the 90% success rate if possible. I know I have a lot of info to receive yet as far as being able to make decisions and this is somewhat hypothetical in some aspects.
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Avatar_m_tn

You would be getting close to the chronic stage now..I believe infection any longer than 6 months is considered chronic. So ...obvoiusly there is nothing to be done until such time you get your PCR results other than staying healthy and complete abstinence from alcohol and if you haven"t spontaneously cleared by indication from the PCR a conversation with a Hepa or a knowledgeable G.I.  about when to tx. would seem warranted.

Good luck...let us know on the PCR.

Will
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ALTHOUGH  - there is thought that the acute stage can last over a year or so.  They just know so little about the acutes.  My GI still considered me acute when I started treating 8 months post probable exposure.  

And yes Peachy, it does seem to be largely hypothetical when it comes to Acute HCV. Because so few of us are caught so early, there isn't a whole lot of data.  What is clear is that the cure rate is significantly higher if the treatments are started early - usually about 4 months after exposure.  I didn't because of a doctor change, but still had great results....so far.
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Avatar_m_tn

+ 1 Beaner...
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+1 back at ya Willbb
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Avatar_n_tn
  Hi, peach.  I'm a retired RN (male) who somehow picked Hep C up in the early '80s.  Still don't remember any needle stick (hated filling out Incident Reports!) so I probably was exposed when one of my pts' bled out from esophageal variscies and blood was everywhere.  No way to tell.  
  Now, like most of the other folks here have responded to you, I'm gonna say the same thing,...calm down.  Go check the CDC info page on Hep C for good info.  I think I remember the self-cure rate for acute infection is something like 55-60%, so there's a good chance it won't go chronic.  If it does, as one of the other folks noted, it's a slow-progressing situation.  I've had mine for about 29 yrs now and have only in the last year progressed to cirrhosis (technically).  There are some knowledgable people on this forum, so you're in good company.  Personally, I'm waiting for my Hepa-guy to call about starting one of the new anti-virals regimens.  
  In response to your question for info on INF/Riba Tx:  I non-responded to the INF regimen twice (!).  If you do get put on it, all I can tell you is my experiences, others have different reactions.  The first 24 hrs I could have sworn I had malaria.  The chills were pretty rough.  But by 36-48 hrs they were gone.  Over the next few months I developed an itching over all the long bones (shins, forearms) but nowhere else.  Had to glove my hands at night to keep from scratching.  My nose ran like a faucet, and I carried paper towels instead of Kleenex.  But other than those things, I actually felt pretty good.  Maybe it was knowing that I was doing something to kill the little critters, but every time my doc asked if I was depressed or suicidal, I'd tell him I actually had more energy and was in a better mood than before!  Unfortunately, both times, after six months my PCR had gone UP.  Oh, well.....  We'll see how the new Tx works for me.
   So calm down and read up on factual data (verify anything you read!) .  BTW, CDC says that they feel that only 3-4% of transmission is sexual and there's a chance that data is too high.  My wife still tests negative after 25 yrs.  There seems to be some good folks on this forum.
Carry on, trooper.        ---Palera
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Got my PCR results back this morning and they were NEGATIVE!  This is a negative results 15 weeks post exposure following a reactive antibody of 1.29. I can't believe it actually. I am going to follow up Sept 5th which will be 6 months since my March 4th exposure from a needlestick! I can't say enough about all of the fellow forum posters and the unbelievable amout of support I have felt and received in the last few days!

Your comments and encouragement are priceless and made a  significant impact on my life and will continue to do so.

Thanks again or te encouragement and knowledge base!
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  Good news, Peach-ster!  I'd neglected to put in some info in my posting that might have also helped to keep you calm.  There are various forms of our bod's reaction to exposure.  There's antibody (Ab) formation to the surface of the viral coat and is, I believe, abbreviated as AbS.  It means the immune system has "seen" a virus particle in the bloodstream.  Then there's AbC, or antibody to the Core of the virus.  There, the viral DNA goodie inside has been detected by our immune system; that's more worrisome.  It's possible to have AbS and never develop AbC.  I think I found this information (for a friend in your position) on the CDC website.  
   Anyway, good news, but keep us all posted on developments.

   --- Patrick
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Congrats!!!  Always love hear good news!!!
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Avatar_m_tn
Negative PCR"s are always a good read  :)  Enjoy !

Will
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Heard I may need a PCR ultraquant. Measures lower level than PCR would. Any info??
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Avatar_m_tn

    your signal of 1.29 is considered a 'weak pos.'  With a reading that low,  there is a good

  chance it is a 'false pos.'  Ask your doctor for a 'RIBA' confirmatory test.  Riba is very

   SPECIFIC for Hcv antibody.  the screening tests are very SENSITIVE for antibodies

   and may cross react with antibodies other than Hcv to give a 'false pos reading.'

   If the Riba is neg, that means you never had Hcv antibody and the screening test

    was a false pos.  the pcr looks for the actual virus.  With that being neg, you do

not have the virus.  Hopefully, your riba will be neg and that would mean no prior

   exposure.  Patients who clear the virus retain the antibodies for a LONG time,

  usually the rest of their life.

   Anyway, if you need a place to go for the Riba test, call 'request a test.'
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      The number for request a test is 1-888-732-2348.  ask for the Riba confirmatory

test.
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Thanks. I am not sure why the md wanted an ultra quantitative. Thus would be a workers comp situation and I guarantee you my hospital won't pat for another teat since Thr qualitative PCR was negative. The md wants to treat as soon as possible since I am at 17 weeks so I guess that's why he wants the ultraquant PCR??? I agree with him just trying to figure out what to do and if I can pay out of pocket because i bet my health insurance wont pay for it with it being a workers comp situation. My go to my priimary care md tomorrow and see what he says.
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Avatar_f_tn
So just to back track, anibody positive, qualitative PCR negative and currently nothing scheduled until sept 5 when I will have another PCR maybe.

Nurse practitioner friend just said that GI doctor she works for would recommend a ultra quantitative pcr.  

That is where i stand now.
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Avatar_m_tn

         Do your self a favor and ask for the Riba confirmatory antibody test.  Since your

  screening test was a 'weak pos' thre is a good chance your Riba will be neg and then

  ALL your worries are over.
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The md wants to treat as soon as possible since I am at 17 weeks so I guess that's why he wants the ultraquant PCR??? "

If you had a PCR come back negative I can't see why he would want to treat you, it means you do not have the virus.  I mean the test they used couldn't have been that old.....
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Hey nygirl7, He was wanting a more specific test I think to detect lower levels of the virus if there were any present so that tx could start sooner than the 6 month time frame.

I understood him to mean that the ultraquant could detect sometimes what the qualitative PCR couldn't. Who knows though? Could have been just an md test preference. I have no worries was just kinda wanting all the forum experts to weigh in!!

Thanks and I am going to enjoy my neg PCR results as some of you  suggested!
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Avatar_m_tn


      Something is not adding up here.  You have a neg Pcr, correct?  That means you

  do NOT have Hcv.  there is NO reason to begin treatment.  a qualitative Pcr is very

  sensitive and your post says it was neg.  for sure, you do not have Hcv.

   IMO, there is a good chance you do not have the antibody to Hcv.  that is why I

   suggested you ask for the Riba test.  Is your doctor confusing hep C antibody

   and hep C virus?  Something is not adding up here.
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I think the common test would be <50 and if it came up less but detectible wouldn't it say detected <50 meaning it was lower but not counted at that sensitivity?  I mean please dont tell me they used the old old old <615 test that wouldn't make any sense.

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He is NOT wanting to consider tx at this point. No way!

He is simply making a statement thru his nurse practitioner (who is a friend of mine) that I may want to ask for a different test. A ultra quantitative. That is all there is to it at this point.

I was just wondering if y'all knew the difference in qualitative PCR (which I had) and ultra quantitative which is what he mentioned in casual conversation.

At this pout I have NO doctor and am being seen by my hospitals employee health dept. They have policy's in place for this kind of thing and have doctors that are over the dept and medical directors. So at this point I am by scheduled for any form of anything until sept 5.
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Your fine the tests now are so sensitive they would pick it up if you were positive.  The ultra ultra tests are mostly used to confirm when you get a detected <50 or something.

You got great news I dont know why they dont just say hallelujah you are ok, I wish more than anything that they had said that to me and all my friends (and even people I dont know on here).

I think you should concentrate on the good news and enjoy the summer!
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Yeah, nygirl7 I have no clue. I don't they used an old version. I am just gonna forget about the test the GI md mentioned I think. It was 16 weeks after exposure so I hope it would have shown up if it was going to. I have seen some things out there abt how it didn't need to be the only confirmatory test. But I have no clue about any of this and was gonna ask the forum!

My world was turned upside down a week ago with the antibody reactive results.

Thanks.
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OH Peaches by the way the cost of treatment is roughly $150,000 - 300,000 so please pray you dont have to try and pay it  out of your pocket!

My attorney friend just sent me this to tell you - just in case:

Her medical insurance carrier can go after the hospital's worker's comp carrier but meanwhile their contract with her is to cover her medical expenses.  If they decline coverage then that's a breach of the contract.  The insurance companies can settle the "who pays" question between themselves but one or the other of them has to pay for her tx NOW if she needs it.
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Thank you nygirl7.

Good luck on your endevours. I have seen the beautify on forums and how supportive others can be in times of confusion and uncertainty.

Best wishes.
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And there is NO WAY I could begin or would begin to pay for treatment. I feel like the hospital would definitely step up because of their obligation. I was just meaning if others said I needed that other blood test I might could have swung that. Then again it could have been on up there in cost.
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Avatar_m_tn

    A qualitative Pcr looks only for the presence of the Hep c virus.  Does not measure

  amount of the virus, if the virus is detected.  the quantitative pcr is used to measure

   the amount of hep C virus. usually the qualitative is first and then, if pos, the quantitative

   is used to determine the virsal load.

   The qualitative is more sensitive beacuse it looks only for the presence of hep c virus.

    Does not measure the amount.

  fyi
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