antibodies but no genotype...?

[RR1953]

Three years ago, I was tested and told I had Hep C but the viral count was so low that it was very very hard to measure. This was done in Central Asia so upon returning to the USA that year  I was checked again but US doctors said they saw nothing.

I went back overseas but stateside last month and was tested again.The antibodies were there so was tested for genotype and viral count again. Now, I have not yet got the the complete results (I'm back overseas working) yet but nurse told me over the phone that viral count was so low they could not identify the genotype. Now, the doctor told me that the testing is standardize and only use the test that can measure the lowest count...

So, I'm not sure where to go from here and have a few questions that perhaps the community can answer or give opinions:
1. What should I do next? What testing? I need a plan of attack.
2. Can you have the antibodies and NOT have Hep C?
3. Can you have HAD Hep C, recovered on your own (cured), but the antibodies remain?
4. Anyone hear of anything similiar like this?

The doctors are not so good here so I need to get smart fast. Any suggestions would be greatly appreciate because I'm pretty lost right now.

RR

[Bill1954]

You’re quite welcome; don’t mention it. I can’t help but wonder if the lab can’t fax or email results to you… are you in Antarctica, possibly :o)?

In any event, there are usually some helpful folks in here that will be happy to assist in the future. Best to you,

Bill

[RR1953]

Bill,

Thanks a million! I will do as you suggested and pursue getting a RIBA and HCV RNA by PCR Quantitative test as soon as possible. Thanks for cutting the learning curve and getting me smart enough to ask the right questions and understand what I should be concern about and reading about. Big thanks! When I get the letter in the mail (mail is extremely slow here) showing my lab results from the states I will see if the forum here can help me make 'heads or tails' out of it.

Rick

[Bill1954]

“HCV RNA by PCR” tests for presence of actual virus, as opposed to antibodies. The “HCV RNA by PCR Quantitative” will yield results expressed with numerical value. The HCV RNA by PCR Qualitative” will yield results expressed with POS/NEG format; if you want a numerical result, request the ‘quantitative’ test.

Importantly in all of this that I didn’t mention earlier, none of these tests return results down to zero. The most sensitive tests only quantify to <2 IU/mL; we don’t have the technology to test below that sensitivity.

I suspect that you are actually undetectable for virus, and have nothing to be concerned about.

If the result you have states “viral count was so low they could not identify the genotype”, this probably indicates that the test result is below the lower limit of sensitivity, and therefore they cannot run genotyping. If a patient has active virus, in almost every case, they have viral load measured in hundreds of thousands, if not millions of IU/mL.

My feeling is that you do not have HCV; and a victim of test language, and possibly spoken language as well. In the end, you’ll find that we’re making a bigger deal of this than necessary :o).

Good luck—

Bill

[RR1953]

Bill,

OK, a "request a ‘HCV RNA by PCR test" an a RIBA test. I will see if I can get them done over here. Perhaps that was done also when I had the rest of my labs done. I will have the report here soon.

Last question...What does the 'HCV RNA by PCR' tell me?

Rick

[Bill1954]

Hi Rick—

I think the next thing on your list would be to request a ‘HCV RNA by PCR test; either a quantitative or qualitative test will do. If the test is negative, you do not have active virus. Ask for a copy of the results if you can, and someone here will help interpret the results if you like.

Yes, a RIBA test will confirm exposure and prior infection; this test is very specific, and should be considered conclusive. However, if the RIBA is positive, it’s still very possible to have previously spontaneously resolved the virus; then a PCR test would still be needed to see if the active virus is present. To keep things simple a PCR test might be your best move.

There are different schools of thought on early treatment. Yes, statistically those with a low viral load (<400,000 IU/mL) have increased odds of clearing the virus with treatment. Additionally, the odds of clearing the treatment as an ‘acute’ patient are much better. Acute infection is defined as acquired within six months; after this time frame, the disease becomes chronic. Diagnosis of acute HCV is rare; most patients are asymptomatic regardless; so this diagnosis is infrequent. Genotype trumps all other factors as far as the response rate to treatment, however.

Try to obtain copies of a PCR test, and type the results here; someone will help you form there.

Best to you—

Bill

[RR1953]

Bill,

"Yes; absolutely. About 20% of patients that contract Hep C (HCV) will go on to clear the virus with the aid of their own immune response. These patients will always test positive for antibodies...I’m betting you resolved the disease with your own immune system."
RICK: OK, I understand that I had it...maybe only a RIAB can tell me, right. Boy-oh-boy this brings up more questions...

1. But, do I still have it if there is not enough viral count to identify the genotype?

I do not have any intention of returning stateside for quite a while which is why I would like to learn a bit more about this. BTW I had labs done to determine liver function and a ultrasound and all was good.

2. I'm assuming the next step would be a RIAB to determine if I truly had it or not or it's a False-positive, right? But, I assume it's is NOT a false-positive as they stated "viral count too low to measure' so the virus is there but can't measure it, right?

3. Big question, shouldn't I get treatment (if I do have it) since the viral count is so low chances are treatment would be very effective?

Rick

[Bill1954]

Hi RR—

This is interesting. Starting with your questions:

1) What should I do next? What testing? I need a plan of attack.

Usually, Hep C isn’t a rush sort of thing. If it takes a year or two to figure all this out, it’s probably fine. When do you plan to return to the States for an extended period of time?


2. Can you have the antibodies and NOT have Hep C?

Yes; absolutely. About 20% of patients that contract Hep C (HCV) will go on to clear the virus with the aid of their own immune response. These patients will always test positive for antibodies, event though the virus is no longer an issue. This happns with many viral diseases… you probably have antibodies now for flu that you had as a child; they are not harmful in any way.

3. Can you have HAD Hep C, recovered on your own (cured), but the antibodies remain?

Yes; we touched on this above.


4. Anyone hear of anything similar like this?

This happens all the time; in fact, I assume this is the case in your situation. It does require quantifiable virus to determine genotype; even if the viral load is very low, it might not be possible to ID the genotype.

Another scenario is indeterminate genotype; this is very rare, but once in a while, the testing cannot properly sequence the genotype, even with sufficient viral load. I doubt this is the case with you, given your explanation.

Take your time, and consult a qualified physician when the opportunity arises; I’m betting you resolved the disease with your own immune system. If you like, you could request a RIBA (Recombinant ImmunoBlot Assay) test; this can confirm exposure, but does not test for actual virus.

Best of luck to you—


Bill