HCV by PCR positive recently after a HCV by PCR negative post six months treatment. Very urgent

[Paki517]

Hi. I was detected HCV positive by PCR last year. I had a six months treatment with peginterferon and ribavirin dosages. Before the completion of the treatment, I received a HCV negative in PCR. Irrespective of it, I continued the six months course. The doctors then advised me to get PCR again after six months to confirm complete eradication of HCV. However now as I got the PCR done again, it came positive. Does this mean the Hepatitits C virus has reactivated and functional? What do you propose?
Thanking you in advance.

[Bill1954]

Both the Pegintron and ribavirin are prescribed as weight appropriate; hopefully your doctor took your weight into consideration. The dose you describe sounds appropriate for an average woman.

Genotype 3 patients are often grouped into the same treatment protocol as genotype 2 patients; however, GT-3 patients tend to relapse more often.

Your doctor may want to increase the duration of your next treatment to 48 weeks to provide the best chance of success.

While normal liver enzymes are always encouraging, approximately 25-30% of chronic Hepatitis C patients will eventually develop significant scarring/fibrosis while maintaining normal AST/ALT values.

At your young age, advanced disease is unusual; this typically occurs over many years. If you decide to defer/delay your next treatment attempt, you might want to discuss the possibility of a  liver biopsy to determine if any damage if present. Not necessarily now, but at some point in the future.

Relapse happens to many patients; this isn’t your fault or any thing you did incorrectly. Try not to become depressed about this situation; you didn’t fail treatment, it failed you. Discuss your options with your doctor soon, and see what he/she has for you.

Best of luck—

Bill

[Paki517]

Thanks again Bill. I took peginteron injection 100mcg, one per week. Along with it, I'd capsule ribazole 400 mg 1+1 in the morning and evening. The treatment continued for six months as prescibed by the doctor without any delay. The ALT as I mentioned above was in the normal range (30 IU/L) that made the docs conclude that my liver is completely healthy.  

[Bill1954]

Unfortunately, if virus is present in any quantifiable amount, then yes, the virus has returned as relapse.

Genotype 3 is relatively easy to manage; relative to genotype 1 anyway. Can you describe your treatment in detail, including the type and dose of interferon, the dose of ribavirin, and the length of treatment? Were you fully compliant with the medication; did you take all the doses as prescribed? Perhaps someone in here can help detect problems with the last treatment, and recommend suggestions for better results nest time.

It is encouraging the doctors have told you the liver is not affected. Do you know how they arrived at this conclusion? For instance, was a biopsy performed to assess damage?

You have my sympathy; this occurred to me as well; I had to undergo additional treatment to resolve the issue.

Best of luck to you—

Bill

[Paki517]

I had HCV genotype 3. The doctors kept telling me it is minor (resulting from a blood transfusion) and the liver is not even slightly affected. The ALT test was in the normal range. However, the PCR I just had was qualitative. In the result it is mentioned, "HCV RNA detected." Does this even mean the virus has returned?

[Bill1954]

“Id he can't gve you a number then you never had a PCR”

Although quite often, viral assays will be qualitative, rather than quantitative.

If this is the case, it is quite possible to have a positive result without a quantitative number attached. It sounds as though you have suffered relapse. Depending on genotype, this occurs in 10 to 55% of patients, and is an unfortunate risk with the current treatments.

This happens relatively frequently; you might wish to do the treatment again, using a different drug. If you are genotype 1, you might opt to wait and see if the new drugs in clinical trial right now will be appropriate for you in the future.

Sorry to hear of your misfortune—

Bill

[uniqueflower]

I understand the system in Pakistan is somewhat different then here.  Others reporting from that country have mentioned that the quality of care is not always the best.

If you actually did have a PCR then you should have a number associated with it - a viral count.  If the viral count is above zero (or above the minimum sensitivity of the test) then that does mean the virus has returned and is active.  You will always have a positive ANTIBODY test (antibodies are good things) but only a positive PCR  means the virus has returned.

Try to make sure there is not some miscommunication between the doctor and you regarding which test is beig talked about.  Try to get the actual PCR number from the doctor to make sure the he is not confusing the OCR with another antibody test.  Id he can't gve you a number then you never had a PCR