Aa
more sensitive pcr
i went to labcorp a few months ago to get the more sensitive test
(down to 2) but i didnt do my homework and did not have the actual test code number
for their computer. they automatically just gave me the quantasure plus which only has a sensitivity down to 10.
what a disappointment. quantasure plus, this is their version of the heptimax except only half as sensitive but same price range. in search of the better test i finally got through to someone at their office and they found the test
listing, its called NGI quantasure, code # 140639. its range is small, 2 million to 2. it is designed for tissue transplant testing. hepatitis patients and their docs dont normally ever request this. it is also twice as expensive a $714. if this exact code is not specified by your doc you will not get this test. maybe ill make it in this week
to get it and if im lucky i can say im more undetectable than you regular blokes!
in the practical world i dont know if this is justified or even meaningful but i know it would make me feel better so thats good enough by itself. it might also be interesting and revealing to see fluctuations between 4, 3, 2 and less then 2. especially towards the end of the shot cycle were the interferon has dissipated from our system. ive never seen anyone on the forum with these test results and they might show us things we can never see from the heptimax down to 5.
(down to 2) but i didnt do my homework and did not have the actual test code number
for their computer. they automatically just gave me the quantasure plus which only has a sensitivity down to 10.
what a disappointment. quantasure plus, this is their version of the heptimax except only half as sensitive but same price range. in search of the better test i finally got through to someone at their office and they found the test
listing, its called NGI quantasure, code # 140639. its range is small, 2 million to 2. it is designed for tissue transplant testing. hepatitis patients and their docs dont normally ever request this. it is also twice as expensive a $714. if this exact code is not specified by your doc you will not get this test. maybe ill make it in this week
to get it and if im lucky i can say im more undetectable than you regular blokes!
in the practical world i dont know if this is justified or even meaningful but i know it would make me feel better so thats good enough by itself. it might also be interesting and revealing to see fluctuations between 4, 3, 2 and less then 2. especially towards the end of the shot cycle were the interferon has dissipated from our system. ive never seen anyone on the forum with these test results and they might show us things we can never see from the heptimax down to 5.
In two years here, with all the folks taking Heptimax, I've never seen a VL reported between 10 IU/ml and 5 IU/ml, nor anything reported between 5 IU/ml and 2 IU/ml, although probably only a small minority here have taken Quantasure. I guess what I'm saying is that if you are UND by Quantasure Plus (<10 IU/ml) then I think you can rest easy that you're UND. That said, maybe I've got things mixed up but I though you were still HCV positive and off treatment? If so, why would you need such a sensitive test?
Also, one problem with Quantasure -- and possibly why it's not ordered as much -- is it's more restricted dynamic range, as opposed to Quantasure Plus and Heptimax. Quatasure Plus no doubt was meant to compete with Heptimax (or perhaps vice versa don't know who came first) in that both tests have a very wide dynamic range combined with a low end sensitivity (10 and 5 IU/ml repectively) which allows them to be a sort of "one for all" test that can be prescribed both before, during and post treatment. If you have a very high viral load pre-treatment, Quantasure may not capture the exact load as its top limit is 2 million IU/ml. However, once you get down below that number, as for example when treating or post treatment, it seems a reasonable test to order.
-- Jim
Also, one problem with Quantasure -- and possibly why it's not ordered as much -- is it's more restricted dynamic range, as opposed to Quantasure Plus and Heptimax. Quatasure Plus no doubt was meant to compete with Heptimax (or perhaps vice versa don't know who came first) in that both tests have a very wide dynamic range combined with a low end sensitivity (10 and 5 IU/ml repectively) which allows them to be a sort of "one for all" test that can be prescribed both before, during and post treatment. If you have a very high viral load pre-treatment, Quantasure may not capture the exact load as its top limit is 2 million IU/ml. However, once you get down below that number, as for example when treating or post treatment, it seems a reasonable test to order.
-- Jim
along the same lines of more sensitive testing, had an appointment with my hep doc's np today, and she mentioned to me they have done away all together doing the "in House" 615 pcr..They now do one down to 50 in house..of course my taqman in sent off to the Mayo lab....but thought it was interesting.......
to refresh you of my status: im in round one, week 53 of 72 as a type 1 slow
responder. ive been getting the heptimax >5 test all along. ive always wanted this other more sensitive test (> 2) just for peace of mind.
this is a rundown of the tests, from your response you might be confused as
to which one is which.
company: quest diagnostics
test: heptimax (50 million to 5) $375
this is their most sensitive test, they of course have many other less sensitive tests.
company: labcorps
test #1 quantasure plus (100 million to 10) $439
test #2 ngi quantasure (2 million to 2) $714 (designed for tissue transplant screening)
these are their 2 most sensitive tests.
i will be getting the most sensitive test from now on, the one down to 2, do you think we will see any fluctuation between 5 and 2 iu? i have been less than 5 iu for 7 months now.
responder. ive been getting the heptimax >5 test all along. ive always wanted this other more sensitive test (> 2) just for peace of mind.
this is a rundown of the tests, from your response you might be confused as
to which one is which.
company: quest diagnostics
test: heptimax (50 million to 5) $375
this is their most sensitive test, they of course have many other less sensitive tests.
company: labcorps
test #1 quantasure plus (100 million to 10) $439
test #2 ngi quantasure (2 million to 2) $714 (designed for tissue transplant screening)
these are their 2 most sensitive tests.
i will be getting the most sensitive test from now on, the one down to 2, do you think we will see any fluctuation between 5 and 2 iu? i have been less than 5 iu for 7 months now.
Cruel: do you think we will see any fluctuation between 5 and 2 iu?
----------------
No. I'd be very surprised. Never seen a viral load here of let's say 3 IU/ml.
That said, if you're going to go with LabCorp, I see no reason (other than the money) not to order the Quantasure. Other than being sensitive, HR favors this test because of the very strict procedures in place to help eliminate false positives. But regardless, it's a very good idea to test periodically during tx with a very senstive test. Monthly is what my doc and a number of others now recommend.
Curious, what was your pre-treatment and week 12 viral load and when did you get UND.
-- Jim
----------------
No. I'd be very surprised. Never seen a viral load here of let's say 3 IU/ml.
That said, if you're going to go with LabCorp, I see no reason (other than the money) not to order the Quantasure. Other than being sensitive, HR favors this test because of the very strict procedures in place to help eliminate false positives. But regardless, it's a very good idea to test periodically during tx with a very senstive test. Monthly is what my doc and a number of others now recommend.
Curious, what was your pre-treatment and week 12 viral load and when did you get UND.
-- Jim
as you can see from the prices these more sensitive tests can get pricey.
sometimes the 615 is all thats needed for a particular situation but obviously
the more sensitive the better, at least once you are nearing the low rage anyway.
this brings me back to my original question, when does more sensitivity become
meaningless? at 10? at 5? at 2? jim sort of answered this question above
when he said that if you get to 10 or 5 you can be reasonably sure youre und. by virtue of the fact that docs never order this extra sensitive test down to 2 we might assume that it will reveal nothing to help in our treatment. i should have results
in a few weeks.
sometimes the 615 is all thats needed for a particular situation but obviously
the more sensitive the better, at least once you are nearing the low rage anyway.
this brings me back to my original question, when does more sensitivity become
meaningless? at 10? at 5? at 2? jim sort of answered this question above
when he said that if you get to 10 or 5 you can be reasonably sure youre und. by virtue of the fact that docs never order this extra sensitive test down to 2 we might assume that it will reveal nothing to help in our treatment. i should have results
in a few weeks.
As an aside, these prices are often negotiable, especially if you don't have insurance. At one point, I thought a test might not be covered -- it ended up being covered -- but I found Quest very willing to negotiate the price on the phone in that I would be personally paying for it. Not sure how that might work with LabCorp. Also, you should know that doctors have their own "discounted' prices for these tests and in many cases will not mark up the test costs to their patients who have to pay out of pocket. Something you could discuss with your doctor - just offer to reimburse the office for the test discounted test cost up front.
-- Jim
-- Jim
started at 1.6 mil
week 9 1280
week 18 89
week 19 >5
interim weeks >5
week 51 >5
if no one on the board has ever taken this super sensitive test (ive never seen it)
then none of us have ever seen a vl of 3. have you ever seen this test at all? if so what was the result?
the argument can be made that if tissue transplant samples are required to be less than 2, then logically we would want that reading at the eot. is a viral load of 3 enough to cause relapse? an interesting question to say the least.
week 9 1280
week 18 89
week 19 >5
interim weeks >5
week 51 >5
if no one on the board has ever taken this super sensitive test (ive never seen it)
then none of us have ever seen a vl of 3. have you ever seen this test at all? if so what was the result?
the argument can be made that if tissue transplant samples are required to be less than 2, then logically we would want that reading at the eot. is a viral load of 3 enough to cause relapse? an interesting question to say the least.
I tend to agree with you on the sensitivity issue. I can see using the 615 or 50 for pretreatment vl...But IMO, let's say you are clear to 30 @ 4 weeks, what possible adjustments could be made to tx if say your actual vl was 29? Seems like there are dimishing returns at some point...Of course if insurance will cover it, I'd say get the best you can...But, I felt 10 was fine for me..
Well, you appear to have had an EVR (> two logs by week 12) and were UND by week 19 via sensitive TMA, so 72 weeks sound about right. And you're smart to keep testing during treatment using a sensitive test.
As far as "Quantasure" is concerned, no, we've had people use it here, quite a few in fact, but maybe not as many as Heptimax. And again, I've never seen a "3" although I'm sure it could happen. For you, it would be an excellent test to continue on with. But at the end of the day -- either Quantasure, or Heptimax or one of the Qual's should be fine at this point.
-- Jim
-- Jim
-- Jim
As far as "Quantasure" is concerned, no, we've had people use it here, quite a few in fact, but maybe not as many as Heptimax. And again, I've never seen a "3" although I'm sure it could happen. For you, it would be an excellent test to continue on with. But at the end of the day -- either Quantasure, or Heptimax or one of the Qual's should be fine at this point.
-- Jim
-- Jim
-- Jim
MEDICAL PROFESSIONAL
The test to use if extreme sensitive UND status is desired, is the Labcorp test called HCV NGI ultraqual LC#140609. It has the same >2 iU cutoff, but is only a qual test. pos or neg. But that is really all you need at this point.It is of course cheaper than the NGI quantasure. This test is identical with the NGI ultraqual, it is just started with a NGI HCV Superquant and continued with Ultraqual, if below 40 IU, the limit of the NGI Superquant. You can trust me on these issues, since i am actually the inventor of all these NGI tests. But to be clear there is absolutely NFI of mine in these tests.
And Jim, if you are close to or at EOT, and you hand an even more sensitive test (than this above), and it would show you that you are not really UND with this, but UND with the less sensitive tests,
THEN
you could start thinking of killing the remaining virions by extending UNTIL you finally are much more UND.
Remember your stance GONE, NONE, NADA, DEAD, NISCHTA ,KAPUTT implies that if you still have some real virus circulating, that your chance to become a relapser are actually HIGH.
All this sensitivity issues were nicely detailed in the Berg abstract that you recently posted, I was actually there and heard him.
So a very big decison (to extend SOC, maybe to add Alinia, Vertex, etc) could be made at a critical time, when it might matter most ( the virus is already very very low, but just not DEAD YET) and paid the most dividends to do so - to push a real UND.
And Jim, if you are close to or at EOT, and you hand an even more sensitive test (than this above), and it would show you that you are not really UND with this, but UND with the less sensitive tests,
THEN
you could start thinking of killing the remaining virions by extending UNTIL you finally are much more UND.
Remember your stance GONE, NONE, NADA, DEAD, NISCHTA ,KAPUTT implies that if you still have some real virus circulating, that your chance to become a relapser are actually HIGH.
All this sensitivity issues were nicely detailed in the Berg abstract that you recently posted, I was actually there and heard him.
So a very big decison (to extend SOC, maybe to add Alinia, Vertex, etc) could be made at a critical time, when it might matter most ( the virus is already very very low, but just not DEAD YET) and paid the most dividends to do so - to push a real UND.
I'm confused. (so what else is new?)
Like Cruelworld, I have also been getting the Labcorp <10 test for the past 13 1/2 months.
Do you think I should request the HCV NGI ultraqual LC #14069 for the last few tests? Like CW, I've been UND since week 17.
wyntre
Like Cruelworld, I have also been getting the Labcorp <10 test for the past 13 1/2 months.
Do you think I should request the HCV NGI ultraqual LC #14069 for the last few tests? Like CW, I've been UND since week 17.
wyntre
"You can trust me on these issues, since i am actually the inventor of all these NGI tests."
HA! I love it, do we have street cred here at medhelp or not??? We have the actual inventor of the NGI test on hand, how can that be beaten?? LOL
And HR you mention above "...if you are close to or at EOT, and you hand an even more sensitive test (than this above), and it would show you that you are not really UND with this..."
Just out of curiosity are you suggesting using a test even MORE sensitive to 2 IU/ml EOT, or just make sure you get the 2 IU/ml EOT?? I didn't know anything below 2 IU/ml is commercially available to anyone outside of a research environment...unless you mean sending a sample to castillo in spain etc??
And thanks again for inventing the technology that helps prevent us from failing treatment (for the reasons you specified). Considering what tx puts you through, my god that's manna from heaven!
HA! I love it, do we have street cred here at medhelp or not??? We have the actual inventor of the NGI test on hand, how can that be beaten?? LOL
And HR you mention above "...if you are close to or at EOT, and you hand an even more sensitive test (than this above), and it would show you that you are not really UND with this..."
Just out of curiosity are you suggesting using a test even MORE sensitive to 2 IU/ml EOT, or just make sure you get the 2 IU/ml EOT?? I didn't know anything below 2 IU/ml is commercially available to anyone outside of a research environment...unless you mean sending a sample to castillo in spain etc??
And thanks again for inventing the technology that helps prevent us from failing treatment (for the reasons you specified). Considering what tx puts you through, my god that's manna from heaven!
hp's answer is yes. the more sensitive the test, the better chance you have try to and do something to prevent a relapse. the implication is that once you determine that you still have virus left (with the extreme test), you can extend even further or increase dosage or add alinia to kill the last virons. he is clearly recommending this extreme test towards the end of treatment.
hr
Thank you for your inventions.
cw
As far as I can remember, all my PCR quants, except one, were the <2 Quantasure (good insurance). Oh yeah, and one PCR qual at 3.5 yrs post-tx.
Thank you for your inventions.
cw
As far as I can remember, all my PCR quants, except one, were the <2 Quantasure (good insurance). Oh yeah, and one PCR qual at 3.5 yrs post-tx.
Thanks. I absolutely don't trust my eyes anymore, not to mention the ole brain.
I'm going to bring this to the attention of my gastro next month.
Only thing is, I remember he did write a script for the <5 test, after Jim mentioned it on forum and I requested it, and when i got that month's results it was with the original <10 parameters.
The Dr. said labcorp had said they didn't DO the more sensitive test. Maybe it depends on the location of the Labcorp? I dunno. But I will try.
Can you request and get that test where you are?
wyn
I'm going to bring this to the attention of my gastro next month.
Only thing is, I remember he did write a script for the <5 test, after Jim mentioned it on forum and I requested it, and when i got that month's results it was with the original <10 parameters.
The Dr. said labcorp had said they didn't DO the more sensitive test. Maybe it depends on the location of the Labcorp? I dunno. But I will try.
Can you request and get that test where you are?
wyn
Hi all. Long time lurker, first time poster.
I am a geno 2b and had an initial VL of 1.6 million IU/ml before starting TX. I took the NGI Quantasure test LabCorp #140639 and my results were a VL of 2 (yes, only two) IU/ml. This was for my 4 week PCR taken on 7/19/2007. I would like to blow it off as a false positive and think UND, but after seeing HR's post elsewhere on this forum regarding the test's sensitivity (2 iU - 2 million iU), reliability and resistance to false positive issues, I will accept the fact that the results are probably accurate. Sooooo, do I still qualify as RVR with an actual virion count of 5 copies/ml? I am guessing no and will live with the fact that I took the test with the highest sensitivity available. I took the same test at 12 weeks and was UND with less than 2 IU/ml so I am remaining optimistic in achieving SVR. I just received my 24 week results today and I am still UND at < 2 IU/ml. I will be doing another NGI Quantasure test at 8 weeks post TX on 2/1/2008.
I would also be curious to know if HR has seen any other test results of 2,3 or 4 IU/ml at the NGI Los Angeles, CA lab with any regularity.
I am a geno 2b and had an initial VL of 1.6 million IU/ml before starting TX. I took the NGI Quantasure test LabCorp #140639 and my results were a VL of 2 (yes, only two) IU/ml. This was for my 4 week PCR taken on 7/19/2007. I would like to blow it off as a false positive and think UND, but after seeing HR's post elsewhere on this forum regarding the test's sensitivity (2 iU - 2 million iU), reliability and resistance to false positive issues, I will accept the fact that the results are probably accurate. Sooooo, do I still qualify as RVR with an actual virion count of 5 copies/ml? I am guessing no and will live with the fact that I took the test with the highest sensitivity available. I took the same test at 12 weeks and was UND with less than 2 IU/ml so I am remaining optimistic in achieving SVR. I just received my 24 week results today and I am still UND at < 2 IU/ml. I will be doing another NGI Quantasure test at 8 weeks post TX on 2/1/2008.
I would also be curious to know if HR has seen any other test results of 2,3 or 4 IU/ml at the NGI Los Angeles, CA lab with any regularity.
with the obvious simplicity of the concept and your confirming its relevance, why have we never seen this approach by all the so called top hep docs? also, from your
message i assume that we are guaranteed to see readings of 5, 4, 3, 2 iu in some patients at eot. is this assumption correct? i would also guess that a test which only
goes down to 10 should not even be trusted at all at eot. from what i have seen, many patients around here never have a test more sensitive than 10 even at eot. i guess its all a matter of money and practicality and the slowly moving medical community. just a few years ago svr's were declared at a sensitivity of 50!
maybe a few more relapses can be prevented by going this extra mile.
message i assume that we are guaranteed to see readings of 5, 4, 3, 2 iu in some patients at eot. is this assumption correct? i would also guess that a test which only
goes down to 10 should not even be trusted at all at eot. from what i have seen, many patients around here never have a test more sensitive than 10 even at eot. i guess its all a matter of money and practicality and the slowly moving medical community. just a few years ago svr's were declared at a sensitivity of 50!
maybe a few more relapses can be prevented by going this extra mile.
MEDICAL PROFESSIONAL
Labcorp wil only perform the more sensitive test if you do specify it EXACTLY by name and labcorp number, otherwise it will default to their quantasure. The regular "quantasure" is easier to perform and likely has a slightly higher profit margin, so it is the preferred test, from the companys point of view. I guess we have to understand these views as well, but you can get the better test, if you specify EXACTLY. I have given these numbers and explanations several times here, but everything gets diluted and forgotten.
Oh, thank you for clarifying.
I never saw your explanation but someone else had posted everything EXCEPT the #140639 and so I gave the info to my gastro WITHOUT the reference you mentioned.
Now that i know the specific name and number of the test, I will request it once again. My gastro had no problem ordering it but I guess because i hadn't mentioned the code, the results I got for that month had defaulted to the <10. I'd assumed that was the only test i could get from labcorp, which is my insurance company's lab.
I really appreciate the clarification.
wyn
I never saw your explanation but someone else had posted everything EXCEPT the #140639 and so I gave the info to my gastro WITHOUT the reference you mentioned.
Now that i know the specific name and number of the test, I will request it once again. My gastro had no problem ordering it but I guess because i hadn't mentioned the code, the results I got for that month had defaulted to the <10. I'd assumed that was the only test i could get from labcorp, which is my insurance company's lab.
I really appreciate the clarification.
wyn
super cool dude, youre on the really paved road to svr. so glad you came out of the woodwork, you lurkers scare me! (just kidding) apparently this extreme test matters most at the end and you got the best possible reading. i had always wondered about increasing dosage at the very end to smash the last virons, after all its your last chance. this would make logical sense. your first test results are interesting and answer many of my questions.
you actually could have had a lower reading of >2 but you didnt ,you scored 2 iu.
your next test did hit the lower limit of less than 2. and then again same result at week 24. did your hep doc get you on this track or did you request this extreme test on your own? its use has to be pretty rare. thanks for the info wily lurker.
you actually could have had a lower reading of >2 but you didnt ,you scored 2 iu.
your next test did hit the lower limit of less than 2. and then again same result at week 24. did your hep doc get you on this track or did you request this extreme test on your own? its use has to be pretty rare. thanks for the info wily lurker.
I recommended LabCorp's Hepatitis C (HCV) QuantaSure because that is the test you recommended if you remember the last time we had this discussion, but I agree that at certain points in the process, you mine as well go to the Qual with equal sensitivity but less cost -- but perhaps there is confusion because that discussion was not EOT which brings me to the next point...
One reason I often recommend "Heptimax" is because it's less confusing than to keep switching tests and as you can see here, even the doctors are making mistakes ordering.
The other way, for example, you might have to order the Quatasure Plus initially (if very high pre-tx viral load) THEN the Quantasure (once viral load gets down some) THEN the Qual (once vl is down to save some money).
Also, wasn't sure of the "GONE, NADA, NUNCA" paraphrase from me previously. Are you saying that 5 IU/ml isn't sensitive enough to monitor during treatment VL? It was pointed out to me during tx otherwise. Lastly, in your post above to Wyntre, don't you mean the "otherwise it will default to their Quantasure PLUS" I thought that is what you had said previously -- that it's the "NGI Quantasure" being the more expensive test that must be specified. But maybe I misunderstood.
-- Jim
One reason I often recommend "Heptimax" is because it's less confusing than to keep switching tests and as you can see here, even the doctors are making mistakes ordering.
The other way, for example, you might have to order the Quatasure Plus initially (if very high pre-tx viral load) THEN the Quantasure (once viral load gets down some) THEN the Qual (once vl is down to save some money).
Also, wasn't sure of the "GONE, NADA, NUNCA" paraphrase from me previously. Are you saying that 5 IU/ml isn't sensitive enough to monitor during treatment VL? It was pointed out to me during tx otherwise. Lastly, in your post above to Wyntre, don't you mean the "otherwise it will default to their Quantasure PLUS" I thought that is what you had said previously -- that it's the "NGI Quantasure" being the more expensive test that must be specified. But maybe I misunderstood.
-- Jim
LabCorp gave me the NGI Quantasure by mistake at 4 weeks. After that I made sure my gastro ordered it by LabCorp's specific reference number.
This is in par what "Cruel" wrote in his opening post"...
"..They automatically just gave me the quantasure plus which only has a sensitivity down to 10.what a disappointment..."
That's why I said it appears that the default is the less sensitive Quantasure Plus, not the more sensitive NGI Quantasure per your last post..
"..They automatically just gave me the quantasure plus which only has a sensitivity down to 10.what a disappointment..."
That's why I said it appears that the default is the less sensitive Quantasure Plus, not the more sensitive NGI Quantasure per your last post..
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