Hepatitus C Liver Function and Viral Load Test Results

[computerguy]

Hello,

I am a 42 year old white male who was diagnosed 3 weeks ago with positive Hep C anti-bodies. I went to a board certified infectious disease specialist to have by blood tested. I was wondering if you could give me your opinion as to my prognosis and what my next steps should be. Here are the results from my tests.

Liver Panel (all reported as within normal range):

Total Protein: 7.0
Albumin: 4.4
Bilirubin Total: 0.3
Bilirubin Direct: 0.0
Alkaline Phosphate: 51
SGOT (AST): 14
SGPT: 27

Viral Load Test Results (all reported as within normal range):

CBC/PLT
WBC: 6.5 th/mm3
RBC: 4.53 mil/mm3
Hgb: 14.3 g/dL
Hct: 42.6 %
MCV: 94 fL
MCH: 31.5 pg
RDW: 12.9 %
Platelet Count: 292 bil/L

Diff(Abs)
Polys-auto: 4.30 th/mm3
Lymphs: 1.59 th/mm3
Monos: 0.59 th/mm3
Eosinophils: 0.05 th/mm3
Basophils: 0.01 th/mm3
ALT(GPT): 24 U/L
AST(GOT): 14 U/L
AFP, Tumor Marker: 4

HCV RNA, PCR Qnt: <600 IU/mL

Comments: Done on AxSym (Abbott), new reportable range of 600-500,000 IU/mL effective 7/18/02.

Additional comments: HCVGENO is cancelled, unable to amplify.

My doctor told me my actual viral load is 400 copies per ml. He explained this is less than the low end of the low range. He also explained they could not genotype be due to not enough blood sample and/or too low of a viral load. He said basically I was "off the scale" at the low end.

Due to these results, myt doctor recommended against treatment with Interferon due to the potential side effects and the cost. He also recommended against a Liver Biopsy due to the potential risk of bleeding and said if they took a sample and the bleeding didn't stop, they would have to operate because they cannot compress the wound in the liver.

Instead, my doctor recommended I come back in six months to run these tests all over again, and if my levels start to elevate, we can talk about a biopsy and treatment at that time.

As I mentioned I am a 42 year old white male, I have had a history of heavy alcoholic consumption but that was between the ages of 16-29. In the past 14 years I have not consumed any alcohol of any type. I have maintained a healthy lifestyle and take plenty of high potency vitamins and anti-oxidants.

I estimate I contracted Hepatitus C approximately 14-16 years ago, my number one question is how can my viral load only be 400 after all these years? And second, does it sound like my immune system has this virus held at bay? That is what my doctor suggested. And last, based on everything I have provided here, what is your opinion on my prognosis, and what steps should I take next?

Oh and one more, what does genotype cancelled unable to amplify mean?

Thank You.

[GI.PA]

You have an exposure to HEP C (therefor a positive antibody saying you have had it or have it right now).

Your futher testing, a Hep C RNA by PCR was undetectable (<600, termed "less than 600").  This means one of two things:
1.  You dont have any Hep C, you cleared it on your own (happens 15% of the time)
OR
2.  You have hep C right now but at an extreamly low level, in fact too low to detect with this lab test which tests from 600-500,000 IU/ml.

Either way, you have either no virus or an extreamly little ammount.  With normal liver enzymes (ALT and AST) and an undetectable PCR, you have little (less likely) to nothing (most likely) going on in your liver.  I would agree with your doctor that liver biopsy and/or treatment would not be indicated.

I would agree that retest in 6 months, with perhaps an even more sensitive PCR (they can go down to 10 IU/ml), is the right way to do this.

They were testing for your subtype or genotype of Hep C.  This requires a PCR of at least 300 IU/ml to do.  So because they couldnt fing enough of the virus, they were unable to amplify (or type) it.  

Hopes this helps..

Join us on the Hepatits boards sometims.

GI.PA

[Kevin Pho, MD]

Erin, PA has kindly answered your question in her comments below and I agree with her assessment.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[computerguy]

Outstanding news. Thank you for your very straight forward answer. While this may not mean I am totally clear of the virus, it is encouraging news indeed. I will follow up for further tests in 6 months.

Thanks again!