Which PCR Test?

[JulioV88]

I just recently tested positive for HCV antibodies. I wanted to take another test to confirm it and after reading online
it seems the PCR test is the one that I would have to take. However, I've found two different tests and I am not sure which is the one I need. Any help is appreciated. Thanks. The difference between the two tests are that one says its quantitative and the other says it is qualitative.

[jdwithhcv]

Hi and welcome to the forum.  Your positive result on the antibody test simply means that at some time you have been exposed to HCV.  The PCR tests you mentioned will tell you if you have a viral load.  If so, you have Hep C.  If not, your body cleared the virus on its own.

The qualatative (qual) PCR will answer a yes/no question - is there detectible HCV in the sample.  That test is usually the first one you get.

The quantative (quant) test tells you your viral load (how many copies of HCV RNA per ml of blood).  The quant is the test you take during tx to determine the efficacy of treatment.

I hope this helps.  Keep on reading and posting your questions here.  We are not doctors, just people with HCV, but there are some very knowledgable members on this forum and its a great place to come with your questions, problems, comments and when you just need to vent.

Good luck.  Be sure to post your results.

jd

[JulioV88]

Thanks for the quick reply and advice. I guess the quantitative one would be the best to take then since it'll give the same info and then some.

This is all very recent as I literally just found out this morning after waiting a few days and have been scrambling online to find out what to do next.

The antibody results were:

Hep C Virus AB  Results - 1.9 s/co ratio

Negative:  0.9
.
In order to reduce the incidence of a false positive
result, the CDC recommends that all s/co ratios
between 1.0 and 10.9 be confirmed with additional
RIBA or PCR testing.

After reading about the RIBA it seemed like another antibody test, so the PCR test would tell me if I do have a viral load or not?

[JulioV88]

My bad the symbol didn't carry over but was to state that it said less than 0.8 was negative and higher than .9 was positive.

[Bill1954]

Yes; exactly. The RIBA will only confirm the initial exposure; there are occasional false positive results with EIA antibody tests.

HCV RNA by PCR will check for the actual virus, as opposed to antibodies, which are produced by our own immune system in response to the *presence* of virus.

In my opinion, any ‘HCV RNA’ test should be sufficient at this juncture, regardless of test sensitivity, etc.

Good luck to you, and let us know the results, if you have time--

Bill

[jdwithhcv]

You are correct, the PCR will tell you if you have a viral load or not.  I don't know much about the RIBA test but others on the forum will probably give you good info.

[jmjm530]

To make it simple, just tell your doctor you want an prescription for the "Heptimax" test from Quest Diagnositics. All he does is write "Heptimax" on the rx along with a diagnosis code.  Then go to a Quest Center and they will take it from there. If your doc has a Quest Account you can skip the part about going to a Quest Center.

Quest Centers look up: http://www.questdiagnostics.com/

[jmjm530]

If you insurance doesn't cover Quest Diagnostics Labs, then same as above but ask for the "Quantasure Plus" test from LabCorp.

[JulioV88]

About how long does it take to get this test's results back? Went to the Lab on Monday morning.

[Bill1954]

Nucleic acid tests generally require 7 to 10 working days to turn around; although it might be a little faster depending on how they’re batched at the lab.

Bill

[JulioV88]

I was so hoping it wouldn't be that long. These last three days have been so slow long, and another possible 7 to go. I need to know.

[jdwithhcv]

The waiting is terribly hard.  Have you tried calling the lab?  Although the PCR can take a while, I have at times received results in 2-3 days.  Good luck.

jd

[JulioV88]

I just got back my results.
It came back HCV RNA not detected <43.
Range is 43-69,000,000

Is it too early to be relieved? If I'm right from what I've read on this site and online it could mean that I either had an initial false positive or that I cleared the virus. I would have to have a RIBA test now though to confirm if it was a false positive?

What can cause a false positive? I'm curious because after first getting back the initial positive, I was seeing every symptom, but that could have just been paranoia.

[Bill1954]

The results from a an HCV RNA test are quite conclusive; you do not have HCV at the time of the test; congratulations!  There is a minuscule chance that you are in the 'acute' phase, and have not fully developed the virus, but this is so slight as to be nearly nil. If you like; another RNA test three to six months from now should remove all doubt.

Yes, a RIBA test would answer the question of initial exposure and if you actually developed antibodies, then cleared spontaneously. Not much clinical utility in that test though; at this point, it appears you are negative for virus.

Good luck, and enjoy--

Bill

[jdwithhcv]

Congratulations, looks like you are one of the lucky ones.

jd

[JulioV88]

Thanks. That's good to hear.
Unfortunately, finding out if I have the antibodies is still of importance to me. I just graduated from college, and I wanted to spend the next few years of my life teaching English overseas. However, the countries that I had wanted to go to all require testing for numerous illnesses prior to being allowed employment residence. This test includes the Hep C antibody test.Testing positive for the antibodies would bar being able to stay in these countries. Because of that, I'm also wondering if even if I don't have the antibodies, will I always test positive for them in the EIA tests and only a RIBA test would show against?

[Bill1954]

Hi Julio,

I would imagine that a new EIA test would show non-reactive results, assuming a RIBA is negative as well. I would request a RIBA from my doctor, if I were you, considering the circumstances. Th RIBA results should be conclusive; I'm not aware of false positives with this methodology. This should provide a conclusive answer to your questions.

Sincere best wishes to you,

Bill

[JulioV88]

Hi again.
I just got my RIBA results back and I'm a bit confused.
Any help would be appreciated.
It had 2 readouts and I'm not sure why there were 2.
The first said:
HCV Ab w/Rflx to RIBA
HCV Ab Results: 1.8  units: s/co ratio ref. interval: 0.0-0.9 01
This had no interpretation with it but it was highlighted on the report. The last time something was highlighted was when the first Hep C AN test came back positive.
Below that however was:
Hepatitis C Virus Ab, Riba 3.0
RIBA Result Negative Ref. Interval: Negative

I'm just confused as to why the first one came back at 1.8 and was highlighted yet the second one says negative. If someone can help me understand the results, thank you very much. Does this mean I never had it? Or did have it in the past?

[JulioV88]

Sorry for bumping my own post but coming down to a deadline and any help interpreting those last test results in my last post would really be helpful. Why does the RIBA test first show a result that's outside the reference interval, yet the second portion comes back as negative?

Thank you.

[Bill1954]

Hi Julio,

No problem bumping your own post; I’m glad you did.

No one has responded, probably because they don’t have answers for you. None of us are experts; but I’ll take a stab at answering.

The wording ‘HCV Ab w/Rflx to RIBA’ means that an antibody test was to be performed; and if positive (and only positive) then the sample is “reflexed” or sent forward for more expensive, but more specific test methodology. In other words, if the antibody test results were positive, then the sample would be sent forward for further testing.

The key to this is the negative RIBA results. If the RIBA is negative, then I believe the antibody test was a false positive.

Antibody tests are not very specific; they do occasionally have false reporting, but they are inexpensive, and good for screening large groups of people; blood banks use them because they are cost effective.

My understanding is that the RIBA test is very specific for disease, and the results should trump any EIA antibody results.

Again, we are just patients that have dealt with HCV; not techs or health care professionals. Your doctor or laboratory should interpret your test results before you act on any information you receive in here.

Best of luck to you; it appears you were never exposed to the HCV virus!

Bill

[JulioV88]

Thanks for the reply and for all the help.
I guess that does mean I had 2 false positives through EIA tests then.
Havn't gone to the doctor yet (Have been doing the tests through a website confidentially.), but seeing as that seems to be the case, I'll have to go and bring it up since it seems odd. There has to be something causing the tests to show antibodies while the PCR and RIBA were negative.

[JulioV88]

To add, I just found this on the medical side.
http://www.medhelp.org/posts/Hepatitis-C/positive-x-2-for-hep-c-antibody/show/562612
Hopefully, that's all it is, but will have to ask to be sure.

[Bill1954]

You’re quite welcome, and I hope everything works out for you in the future. Just out of curiosity, are you living in the U.S.?

Please let us know how this turns out; I’ll be interested to see how this resolves,

Bill

[Bill1954]

I just now read the link you provided; this looks very hopeful, and Dr. Dietrich is eminently qualified. I wish you nothing but the best,

Bill

[JulioV88]

Right now I am living in the US. I just graduated, and if everything goes to plan I should be in Korea by the end of the year. However, since I'm going there for employment, I need a work visa. To get one of these you must have a medical exam when you arrive in the country which includes a Hep C test. I'm just scared that this will show positive for the antibodies even though according to all these tests I do not and was never even exposed. It would result in having my work contract cancelled and all travel expenses for return falling on me because those that test positive can not receive a residency or work visa in Korea.

[Jakied]

A false pos on the screening test is because that test is VERY sensitive

for antibodies of any kind.  The screening test can sometimes 'cross

react.'   A 'low pos' on the screening test (such as your result) is usually

a 'false pos.'  This is the value of the Riba confirmatory test.  It is VERY

specific for Hcv antibody, and only Hcv antibody, ( no cross reaction

with other antibodies).   A neg Riba means you are neg for antibody

and the neg Pcr means you are neg for Virus.  Bottom Line:  you were

never infected with Hcv and you don't have antibody or virus now.

[Jakied]

Btw,

      Did you know Hcv is not a STD?  It is transmitted by blood to blood contact so

Blood Transfusion, before 1992 or so, and Intravenous drug use are the two most

common methods of transmission  Sexual transmission is possible, but not likely.

Sexual transmission, when it happens, is usually male to female, not female to male.

Fyi.

May i ask why you were worried?

[JulioV88]

A few weeks ago, I did a wide range test which included Hepatitis C in preparation of applying for the program I mentioned above. I did not expect to have any results, but the results in my first post surprised me. I then looked it up online to find our how it might have been caused or what to do next. I remembered that two years ago a doctor had told me that my liver enzymes were elevated, but I never went back for a followup - I assumed it was just from me being overweight at the time. The first results though made me think perhaps it was related and that I had somehow been exposed to Hepatitis C. However, as you and Bill have pointed out, the other two tests I had show that this does not seem to have been the case.

[Jakied]

You are definitely good to go.