going to doctor tomorrow

[pierrot]

Hi, I posted before that I had reactive HCV EIA test (2.94 signal to cut-off), then <1.70 U/ml RNA test, and then negative HCV EIA test (with another hospital/lab). Last week, I found out the result the latest EIA test (same hospital/lab with first EIA test), and it's reactive. So it does seem that I do have HCV. :(

I have an appointment with a gastroentric/liver specialist tomorrow. What should I ask him? I think I must ask for Riba, but that's all I know. Do I need to get another RNA test? How prevalent is false negative in RNA test?


-----
In case anybody is interested, these are the lab result I got so far:

4/18/07 result reads like this:
                                     In Range        Out of Range          Reference Range
*Hepatits C Antibody                             Reactive                  Non-Reactive
                                                          Verified by Repeat Analysis
*Signal to Cut-Off                                  2.94       H          
       or = 1.0 AND <8.0. The CDC recommends supplemental testing such as RIBA or NAAT(nucleic acid amplified testing) for confirmation.

Hepatitis B Surface                              Borderline
Antibody QL                                    

5/7
HCV RNL, quantitative    <50                                               <50 IU/ml                    
real time PCR
HCV RNA, qunatitative    <1.70                                             <1.70 Log IU/ml  
real time PCR

6/22
HEP C AB, EIA SERUM   negative                                     negative
HEP B SURFACE AB       negative                                     negative

8/3 (same test as 4/18)
HEP C  Reactive (didn't get actual lab result faxed to me)

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In case it's relevant, here are other out of range results from blood test I had:
4/18  
Hepatitis B Surface Antigen w/Confirmation:
Hepatitis B Surface Antigen - non-reactive
Hepatitis B Surface Antibody QL - borderline
Hepatitis B Core IGM Antibody - non-reactive

Absolute monocytes - 179 L (reference range 200-950 cells/uL)
Bilirubin, total - 1.6 H (0.2-1.2 mg/dL)
Cholesterol, total - 210 H (125-200 mg/dL)
LDL-cholesterol  - 133 H (<130 md/dL (calc))

5/7
Bun/Creatine Ratio - 23 H (6-22 (calc))
alpha-fetoprotein, tumor marker - 2.6 ng/ml (reference range: <6.1; but for some reason, it was circled)  

[Bill1954]

Your doctor needs to verify all this; however, my interpretation of the results you posted are:

You do not have active HCV. Yes, you test positive for antibodies. This tells us that at one time, you were exposed to and contracted HCV. However, a significant percentage (15 to 20%?) of patients will clear the virus with their own immune system within the first six months of exposure.

This appears to be the case with you; this has been demonstrated by the HCV RNA Qualitative test, which indicates that you have no active virus as measured by serum sample.

The results you show from 5/7 tell us that you are below the limit of detection listed for that test. In other words, that test only measures down to 50 IU/mL; more sensitive tests that measure down to 5 and even 2 IU/mL are available, but would be considered unnecessary at this time.

You will carry the antibodies for life, most likely. While presents no known clinical disadvantage, it might create obstacles when trying to purchase life insurance, etc.

Good luck with your doctor appointment tomorrow, and let us know how things turn out.

Take care,

Bill

[jmjm530]

I can only speak to your Hep C tests, but it appears you DO NOT have hepatitis C. So congratulations! Many people carry the antibody (reactive) but it does not mean they have Hepatitis C. Of course this means you do not have to take riba, or anything else for that matter. Your doctor should explain more in detail at your appointment.

-_ Jim

[jmjm530]

I remember your posts from before. I questioned then -- and I'll do it again -- why your doctor would order another antibody test after you've tested negative for the virus via a PCR. You might ask, but if you get the medical version of "duh", maybe a second opinion would be helpful if only to have someone explain things to you who actually understands the process. On face value, it certainly appears you do not have the virus but we only get snapshots here and none of us are doctors.


-- Jim

[Bill1954]

Thanks, Jim—
I started questioning myself immediately after hitting the post button. I guess I thought I was missing part of the picture or something… it’s nice to know that even if I’m wrong, I’m in good company ;o).

Bill

[jmjm530]

Bill,

I really haven't spent much time studying the antibody tests, so maybe a "postive, negative, then positive" is quite normal, but it does seem a bit confusing, especially why the third antibody test was ordered after a negative PCR. Unless of course, Pierrot is an acute stage where viremia can be intermittent, that's why it's important that a good liver specialist review all this in the context of his entire history.

Pierrot,

Were all three antibody tests the same, or just the first and third? Maybe someone else knows the difference between those tests and his second antibody test (negative).

Also, do you know or did your doctor say anything about being in an "acute" stage -- meaning you might have just picked up the virus in the last few months?

Again, it appears you have nothing to worry about, unless perhaps you are acute where the virus sometimes appears and then disappears. A good liver specialist should be able to sort all this out and give you some answers. Meanwhile, you should feel good but understandably frustrated until things are better explained.

-- Jim

[pierrot]

Thank you for encouraging words, but my understanding from internet is that one negative RNA test does not mean that one is virus free (mine was quantitative test at that), so I wonder at this point just how likely false negative RNA vs. repetitively false positive ELA. I guess that's one of the things I'll have to ask the doctor. I am also scheduled for liver ultrasound for day after tomorrow.

jmjm530. The second ELA test was done independent of the first and third test. It was done by hospital where I was going to volunteer. At that time I mistakenly thought that the first test was false positive, so I did not mention previous HVC test to the hospital. And I did not mention 2nd test to my PCP because I was not exactly told of the test result though I assumed it to be negative. PCP's explanation at the time (which I found quitely accidently after thinking that I was totally HCV free) is that I have HCV (even though RNA quantitative test is <1.70) though not at serious level. The PCP had authorized ultrasound, but canceled it after RNA test, which is another reason why I thought I had no HCV. At any rate, even after talking with PCP, I have no idea what all the test results mean. I hope the doctor I'm meeting tomorrow can help me understand better. But I know this doctor as gastroentologist. Is hepatoloy a part of gastroentology or a separate specialty? How can I tell if my doctor knows what he's talking about? My PCP told me that RIBA and RNA was the same thing, so I asked for liver specialist.

[Bill1954]

To keep this brief, I think you’ll be pleased with your doctors conclusion. Let us know how things turn out,

Bill

[jmjm530]

Pierrot: but my understanding from internet is that one negative RNA test does not mean that one is virus free..
---------------------------------------------------------------------
Of course, these tests aren't 100% reliable, but my understanding is that a false negative is much less common than a false positive. Therefore, unless you're in an acute stage, your negative RNA viral load test should mean you are virus free. That said, testing viral load again under your circumstances is understandable, but probably not necessary.

As to hepatologists verus gastro's, the short version is that if after your next meeting you still feel confused  or unsure of your doctor,  collect all your records asnd make an appointment with a liver specialist (hepatologist). A hepatologist is a gastroenterologist that specializes in the liver.

All the best,

-- Jim

[pierrot]

Thank you all for your concerns and encouragements.
I met the doctor today and I am cautiously optimistic.

The doctor said that I do not have virus although he said that I should get another RNA test in 6 months. This fits with what I read on CDC info that said that single RNA but persistently negative RNA rule out infection. So until 6 months later, I guess I am in a kind of limbo.

However, what he said about RIBA confuses me. I wanted to get RIBA because it would definitely confirm noninfection if it's negative, but he said that RIBA is an old test and that RNA is the best.

He also said that low level of ALT (16 where normal is 6-40 U/L) indicates that it's unlikely I have HCV whereas if it were 20, even though it's within normal, he would have been more concerned. This is the first time I hear anything about ALT regarding HCV, so I don't know what to think of this.

He said that I don't need to get liver ultrasound, which I scheduled for tomorrow. So I'm not sure if I should do it or not.

Since I first got positive EIA test back in May, this would been really harrowing experience if I did not know this forum. So thank you very much again.

[Bill1954]

The following web page: http://www.labtestsonline.org.au/understanding/analytes/hepatitis_c/test.html
will explain this thoroughly.

From the page:

•
• Anti-HCV tests detect the presence of antibodies to the virus, indicating exposure to HCV. These tests cannot tell if you still have an active viral infection, only that you were exposed to the virus in the past. Usually, the test is reported as “positive” or “negative.” There is some evidence that, if your test is “weakly positive,” it may not mean that you have been exposed to the HCV virus.
•
• HCV RIBA test is an additional test to detect the presence of antibodies to the virus. It can tell if the positive anti-HCV test was due to exposure to HCV or represents a false signal. "Weakly positive" anti-HCV tests can be re-tested with HCV RIBA to see if they are positive or not. Like the anti-HCV test, the RIBA test cannot tell if you are currently infected, only that you have been exposed to the virus.
•
• HCV-RNA test identifies whether the virus is in your blood, indicating that you have an active infection with HCV. It is usually performed by a test called a qualitative HCV; the result is reported as a “positive” or virus “detected” if any virus is found; otherwise, the report will be “negative” or “not detected” if no virus is found. The test is also used after treatment to see if the virus has been eliminated from the body

The RIBA test is essentially a more specific antibody test; it does not test for active viremia, but only for the body’s reaction to exposure. The HCV RNA test extremely predictive of active infection; as Jim mentioned above, it isn’t faultless. However, most physicians would consider additional RNA testing redundant, especially given your liver enzyme levels.

A second RNA test 6 months from now will sum things up nicely for you, as serial RNA testing should remove all doubt of infection.

Best of luck to you, and enjoy your good health,

Bill

[Jakied]

The Riba test and Pcr test are definitely NOT the same thing.  Riba is a very specific test which checks for antibody only and is used when a low risk patient has a 'reactive' result on the screening test.  Screening test reactive and riba neg is a neg outcome for antibody.  

The Pcr test is either qualitative or quantitative.  The qualitative tests checks for the presence or absence of Hcv.  the quantitative checks for amount of Hcv.  the qualitative pcr is more sensitive than the quantitative pcr.  the quantitative test is used at the start of treatment to measure viral load and during treatment to measure how much drop has occurred in viral load.

Your bilirubin level of 1.6 is high.  When that is above 2 or so, juandice(yellow skin) is possible.

A signal to cutoff ratio of 2.94 is worrisome, to me.   The higher the number above 1, the more likely the reactive outcome is correct.

Pierrot, what was your risk for Hcv?  Blood transfusion/sexual/Drug use?  Sexual transmission of Hcv is possible but not common.  Blood to Blood contact is needed for transmission which is why drug use and blood transfusion are the most efficient methods of transmission.  Hep c is NOT considered to be a Std.

Do you know what your albumin level is?  Normally, when bilirubin is high, albumin is low.  the normal range is 3.5 to 5.5.  High bilirubin and low albumin levels are classic signs of liver problems.

If I were you, i would ask your doctor for a Riba test to confirm or rule out exposure to Hcv.

You can call 'request a test' 1888-732-2348 if necessary.

Good luck with this.  Hope for the best.

[pierrot]

Thank you for your suggestion. For some reason, neither my PCP nor gastroenterologist (he had various HCV brochure in his office, so I guess it is his specialty) wants me to take RIBA. Is it because it's too expensive? PCP said that it is done only in places like universities, and gastroenterologist said that it's an old test that's not as good as RNA. Furthermore, I am not quite relieved because my RNA test was quantitative RNA (with only measuring up to <50 IU/ml (<1.70 log IU/ml) and not qualitative. And various website says that follow-up RNA is needed to rule out infection.

As for bilirubin, gastroenterologist said that bilirubin level goes up when one is fasting (I skipped meal for blood test) and albumin level was 4.7 (3.6-5.1g/dL is reference range). In a later test, bilirubin level was 0.4 (0.2-1.2 mg/dL reference range) and albumin level was 4.2. In any case, he specifically menitoned ALT level (16 and 12 in two tests where reference range is 6-40 U/L) as a reason why he thinks that I do not have HCV.

Thank you for the phone number. I called them, and they say RIBA test is $199 but do not accept insurance. Now I'll have to decide whether to wait for 6 months, push for RIBA with my doctors, or shell out $199 out of my pocket.

[pierrot]

As for risk for HCV, I used to have gum disease and had oral surgery. I also had a surgery to remove mass from ovaries. I don't think I had blood transfusion. As for other risks, I lived absolutely most boring life - no sex, no drug use, no tattoo, not even ear piercing ever. So the news of HCV infection was a complete shock to me.

[pigeonca]

I really hope you don't have hcv, but it is a fact that a lot of us had no risk factors according to the usual list of risks: sex, drugs, or rock 'n roll.  But there are other factors like surgery, as you mention, or sharing tools in school or at work.  About 10 to 40 percent of us have really no idea how we got the disease.

[Jakied]

With no risk factors, you are 99.99% in the clear for hcv.  If your six month window is almost up, i would wait.  if your 6 month time is still 2 months  away,  $200 for riba is a small price to pay for peace of mind.  Just my opinion.

I have a feeling all is well with you.  

[Jakied]

Pierrot, the reason I believe you should have the riba test, even if you pay for it yourself, is this:  A neg Riba means no antibody in your blood stream which means no prior exposure.  This is important for insurance purposes/employment opportunities etc.  If someone is lucky enough to have a 'Svr' (sustained viral response) after treatment, that means the virus is gone BUT the antibody is still in their blood stream, and may remain for the rest of their life.  If you are antibody +, you cannot donate blood or organs, etc.

Antibody + is MUCH  better than virus + but can still have an impact on your life.

[pierrot]

Jakied,

If I don't have active infection, I am not infectious, right? Does it really affect insurance/job if I had past infection?

BTW I asked the gastroenterologist again for RIBA test, but he insists that I don't need it. He says that maybe 5 years ago, it was useful but since I already had RNA test, it's unncessary. He's mistaken, right?

[Jakied]

With a neg pcr test, you are neg for the virus now, but you don't know if you had an exposure to hcv and cleared it (which explains the presence of antibodies) or if the screening test was a false pos and you never had an exposure.  The riba test will clarify this.  Pcr neg/riba pos = prior exposure with clearence, pcr neg/riba neg = no prior exposure and no antibodies.

If you have hep c antibodies in your blood stream, you will probably have them forever and will always show up on blood tests.

Some insurance companies will reject you for being antibody pos and for sure you can never donate blood or organs at time of death.

Tell your gastro you would like to know if you are antibody pos or neg.  Riba will give you the answer.

Wouldn't you feel better knowing one way or the other?  I sure would.

[Lele3257]

I donated bood about 5 years ago & I got results back saying that the ELISA test done for HCV was reactive and the RIBA was indeterminate. They then did the test again and came back the same.  So they did a 3rd test the PCR test and they said the levels were too low to consider a positive therefore I was negative.  They said I may have been exposed to the virus at some time.  Can you help me understand what this means? Should I have another test done or does it mean it is negative?

[Lele3257]

Hello all,

I donated bood about 5 years ago & I got results back saying that the ELISA test done for HCV was reactive and the RIBA was indeterminate. They then did the test again and came back the same.  So they did a 3rd test the PCR test and they said the levels were too low to consider a positive therefore I was negative.  They said I may have been exposed to the virus at some time.  Can you help me understand what this means? Should I have another test done or does it mean it is negative? Any help is appreciated. Thanks!

[Javi1962]

I went on a website where I can ask a question, I asked the same question I asked on this post and this is what this doctor replied online, does this sound right:

Hi,
Welcome to JustAnswer!
You have chronic hepatitis C infection.
The liver enzymes are within normal limits which indicates that there is no active inflammation going on in the liver.
The S/C ratio is used for confirmation in low positive cases.
If it is less than 3.8 additional confirmatory test should be done to confirm HCV infection.
Since your S/C is more than that you do not need any additional confirmatory test.

[Marcia2202]

It's true that you cannot donate blood, but you are allowed to donate organs, if you only have HCV antibodies.