test results

[new2this]

was treated a 2 years ago for Hep C genotype 1
pegasys-had usual treatment issues and between treatment and insurance did not complete full course. LFT labs have been WNL HCV load undetectable-last visit a year ago (big change from pre treatment.
Just got new lab results pre-annual gastro visit.
LFT's are still WNL but I don't understand Quantitative results
for NGI HCV quantasure test.
What does this test result mean for both the HCV log10 and IU log10
"unable to calculate results since non numeric result obtained for component test"

Any help is appreciated since I can't find info on web and it's  a month away from gastro visit.

[painterlady13]

it sounds like your doc is using a pretty sensitive quantitive test which tests the copies of the HCV yirus in your system.  If yours are negative at less than 10 copies it appears that you have cleared the virus.  That is great!  Although I would still get those tests done every year for a couple more.  It really does sound like congratulations are in order.

[cuteus]

hang around for a while, we have had the blessing of a researcher visiting recently and he is with NGI, what more can you ask for?  Right from the horse's mouth!  

is that all your labwork says?  does it have a reference range column, a result column? It sounds like they did not find anything to count and that you are negative.

who were you two yrs ago and did you visit mH then, do I know you?  what were your stats; vl, biopsy result, age, length of tx, time when you first became negative on tx, etc.  THere have been some studies where folks who cleared the virus by wk 4 of tx, were able to achieve SVR with a shorter tx, maybe you are one of them.  
there have been a few miracles in the time i have been reading here, where folks that should not have achieved svr according to the stats numbers, did.  

[returntosender]

Since you are around today and things are not that busy, I want to run an idea by you if thats ok. As you know I just relapsed after 48 weeks of combo.  I think we established that my Riba dose was too low given that I did not really have Hgb below 11.8 and no more that a total drop of two points.  Given my weight of 300lbs the amount of Riba I should have been taking was 1800 rather than 1200.  

My question is this - should I wait six more months, as my doc suggested dryly, and lose weight so that I can get better effects of Riba at 1200 or should I go right back in on 1800 at my current weight.  I wonder why should I wait another six months to let the virus get more established. I know what I will think in six months from now - "I could be well on my way rather than just starting!"  

My other thought is that I will do more testing this time, getting PCRs weekly during the first month or until I clear the virus.  If I clear it really quick like I did the first time maybe another 48 will be enough rather than 72.  It seems to me that if I was on the wrong dose of Riba and still got three months post tx undet then maybe 72 is overkill.  Maybe I do a Jim and hold on for as long as I can after 48.

I was thinking about getting Pegasys this time around to maybe reduce some of the sides from Peg as I am still recovering from the old sides.  I dont want to put you on the spot too much but I value your opinion.  Just give me one of those "if I was in your position" ideas.  

I am interested in how many other people got through 48 weeks and 3 months post undet and then relapsed after going RVR at 4 weeks.  I dont think I ever saw anyone that this happened to.  I am interested because I am wondering whether I should retest to make sure this last PCR isnt an error.  I have never been lucky enough or smart enough to make it into the top 2% of anything.  Leave it to me to finally make it in this area. LOL  Thanks to all.

[HCA]

I know you addressed this to cuteus wno is pretty smart however:
Weight is not just a ribavirin issue it a a question of viral kinetics and therefore an interferon issue too.
Weight based dosing of pegintron produces significantly better results than standard dosing.
Patients with healthy body mass index numbers do better.
The best course of action is not to simply ingest potentialy toxic quantities of riba,which it is unlokely that your doctor could condone,but to reach your ideal weight and then re-treat.
Just my opinion of course!

[returntosender]

Thanks for the comment, although my question was directed to cuteus it is open for comment by all.  This body weight dosing thing is hard for me to absorb because I responded so quickly and so well to treatment -and I did get weight based PEG - just not the Riba.  

Is the moral to this story that rapid and continued response is not all there is?  Does undetectable mean something other than undetectable?  If the Riba was working wouldnt the virus have come back sooner rather than later - like immediately?  Does the fact that I was clear at 3 mos post mean that the Riba has an effect at that precise time or that it sets something up ahead of time that works at that time - sort of a preconditioning?  

It doesnt make sense to me that at 4 months post treatment the Riba suddenly, as it is leaving the body anyway, elicits some magical curative action for only those at ideal body weight.  It would almost be easier for me to believe that I was reinfected than to be on the wrong dose of Riba.  

And the million dollar question, why didnt my doc pick this up?  Why didnt she pay closer attention to the Hgb?  Or is Hgb and anemia the absolute requirement for SVR?  I guess there are just some things we may never understand.  I am kinda grasping for some hope really.  It is so discouraging to work this hard and not be successful and then to hear that a few extra Ribas could have fixed the whole thing.  I have about 180 left, thats 3 a day for two months.  Well I was looking for a good reason to lose the weight - if this isnt it I dont know what is. LOL

[sfbaygirl]

My take from HR on waiting to retreat is that you risk the chance of a viral flare up. Your immune system is weakened now and the virus comes back with a vengence because of it. This is not good. He didn't say to retreat right away, but my take on this issue is that it would be wiser than waiting for the virus to cause a flare up and increase LFT's and VL. Hit it hard again as soon as you can...JMHO

[Kalio1]

Undetectable does not mean there is no virus, it only means "undetectable as far as our testing allows" even the best test has limits and you can have virus there, it only takes ONE.
When we have more body fat and/or more liver damage and scarring, the virus has more places to hide is the way I understand it. Fat and scars are good hiding spots I guess. It seems yours was hiding quite efficiently, and remained "undetectable" for several months after. We have to get past believing an UND test means the virus isn't there. Relapse just means the virus was there but flying under the testing radar. It sounds like yours was in very minute amounts and it took a few months to replicate enough to be detectable again. HR clearly says UND does not mean the virus is gone. I have a hard time with that one, having relapsed myself I know it is quite true. It was obviously hiding out somewhere even though I was UND for a long time. I know it is discouraging, even more so if it reappears months after when you think you are clear.
Maybe if you address your questions directly to HR he can help with some answers. He also has a lot of information on supplemental support that might be beneficial. Im so sorry you are having to go through this!

[HCA]

The effect of ribavirin is still not entirely understood,however it's purpose is to corrupt the mutational properties of the virus, to cause 'mad mutation'.It's role is more important in the early stages of treatment than in the latter stages.
The virus does not 'come back'-when relapse occurrs it has never left,small amounts of residual viremia have rallied and re-started the process. I hope that explains somewhat that riba does not cause a curative action only for those at the right body weight but that it does at the correct dose, disorganise the virus as it seeks to regroup from the interferon onslaught.
The decision is down to you and your doctor,but having continued to to think about  I consider that the weight loss plan is the better option.Good luck,keep us informed!

[Hepatitis Researcher]

You have obtained NGI HCV quantasure LC#140639 results, I assume and received the comment "unable to calculate results because of nunnumeric results obtained from component test" ?  What else was on that result sheet?
Nom generally speaking, this test is about the best combo test that you can currently get. But one needs to understand its structure, if you are unfortunately falling in between the 100 copy cutoff for the quanitative PCR and the 5 copy cutoff for the qualitative PCR test.
Briefly how is this test actually done :First a smaller amount from your serum is used for the "superquant protocol" which measures quantitatively from 100 copies upwards. If it comes back negative THEN YOU REFLEX to the NGI Ultraqual test, which uses PCR on one full ml of serum with ultracentrifugation concentration to find minute traces of the virus. If this also comes back negative then you are below 2 iU or 5 copies/ml and it is so reported.
But what to report if you are neg on the below 100 but pos on the below 5 copies test? In this case the lab tries to make a mathematical calculation from a redo of the ultraqual with several parallel PCRs which yields so many individual found copies/ ml but needs statistical Poisson calculations to extrapolate to the true number/ml. Thats how this is normally handled. Sometimes there is not enough material left to redo this meticulous search for individual copies after the qual test came back pos but the quant came back neg.. In that case the remark " component test not quantitative" would be used to say that the ultraqual ( "component test")does not quantititate.
I would like to see your result sheet to see if there is other info on that before concluding that you were pos on the qual, neg on the quant and the third leg, the Poisson trest could not be performed because of "qns" quantity not suffcient", a situation which can happen in difficult borderline cases.

Thus before you get totally nervous, it would be good to see your result sheet. EVen if it actually nominally means, that one virion was found by the ultraqual in your serum, it might have been the case of " a rare catch". Please do not forget, that UND normally only means that the one particular ml of serum examined did not contain any measurable virus. If say your blood contains a total of 1000 circulating viruses, and you look at individual mls of it, you would normally NOT find it, but sometimes, if you look and look again, you will find one pos ml. It is likley, that if we examine the blood of the SVRs over and over again, that we can find virus from time to time. I have already told the story of HBV before, where all the UNDs in fact contain tiny amounts of virus which I typically find when using an ultra ultra sensitive test ( like 0.1 copies/ml).

The simplest thing to do is to redo the test, just with NGI ultraqual LC#140609. This has to be neg. If it is pos it likely means that the virus is slowly coming back.

[APKhaos]

Just want to thank you for you contribution here. Your post above is the clearest description of the current PCR assay that I've seen anywhere. Very much appreciated.

[goldyn]

I just finished 48 weeks on nov3 my last pcr from Labcorp HCV Quantasure Plus Serial said < 10 iu/ml, then there was an HCV log 10 that stated unable to calculate result since non-numeric result obtained for component test.

[Hepatitis Researcher]

That is not an NGI test, but similar principles should guide the reporting.
This result sounds scary, at first sight. Because technically it would mean that the qual component of the test was pos, the quant was neg, so you are under 10Iu but above 5 iU, which means
1. Unable to calculate quant results because of nonumeric but still "pos" result obtained from component test.
2. Still there was a POSITIVE found on the qual test, otherwise it should say  below 5 IU, according to the Labcorp test description.

Maybe it is just a sloppy way of reporting. If you want further clarification you could fax the sheet to me. Kalio has my fax number.

In the future to check SVR it is best to use HCV NGI Ultraqual LC# 140609. You have to be NEG there.

[goldyn]

Thank you for your response, im thinking that this test woulndt give me a number, because it only goes to 10.. here is a little note, it says please note...This test measures hcv rna international units (IU) per ml using real time polymerase chain reaction (RT-PCR) technology, it quantitates hcv rna from10 to 100,000,000 iu/ml...
In this test Hcv quantasure plus serial, what does serial mean, all my G.P. told me was that I was still undetectable....
So this is what Im thinking is that if the quantitive test showed no numbers  above 10, then they dont have anything to report, but if it did show more then 10 then would have given me a number, what do you think?...Im also putting a call out to kalio for your fax, so I can get that to you...
               Thank you

[Kalio1]

Feel free to email me at this name, just add cox dot net.

[goldyn]

Thank you Kalio.....

[Hepatitis Researcher]

I need to make a correction to my previous post: The Labcorp HCV Quantasure has a limit of 10 iU, not 5 iU as I mistakingly wrote.
That means you are simply neg by this test, below 50 copies/ml, which is pretty good and nothing to worry at this time.

But the remark "Cannot quantitate because of component test..." is still simply inappropriate and misleading in this context. There was nothing to quantitate, because there was nothing found.

This note should only apply if the quant is neg but the qual is pos.  Otherwise it should simply say "neg below 10IU"

Thats also why I wanted to see the full result sheet, same for the original thread post, but in your case the issue seems resolved....

[goldyn]

Thank you so much I know your time is  very limited, if there ever is a time when you want any test results or anything from me just ask...

[entrepeneur]

My son came home from Iraq. He now has hepatitis C. He never had signs of this disease before. He has been told that he cannot drink any alcohol for six months and then will be given treatment. This treatment will cause changes in him psychological and physical which will not be pleasant. Any info anyone can give me on this diagnosis and treatment would be great. Isn't it odd that after each war we have had some disease that the "heads of state" do not want to recognize or address until our veterans all become very ill or die. My husband just died from lung cancer due to agent orange exposure. How long did he and all the vets wait for the "big guys" to address that problem???

[sfbaygirl]

Sorry to hear about your husband and son. Hep C tx is doable and it is hard to know what tx will be like until you start. Some have very few side effects, others a lot. Posting here is the best support you can get for you and your son. Try asking a question on top, so that more people will see your post. Threads get buried after a day or two. If you could give the stats, like biopsy, stage , VL, genotype, age etc. we could have a better idea what he is looking at. Good luck.