Again another TMA pos. after 29 weeks… False positives?

[SkipinCA]

Updating, after being UND TMA<10 from weeks 5 through 18; then TMA pos week 19 and VL 775 and 885 at weeks 22 and 24, we raised my riba dose to 1400 on January 10.  Then I was UND TMA <10 again beginning 1/21. The plan was to start another 24 weeks beginning 1/21 when I first became UND, and now after being UND again through wee 28, now at week 29 I get TMA pos again!  Have today done another HCV RNA TMA test and the results will be back next Wednesday.  My doc wants to see a pattern before we decide to stop tx – says the plan now is to test every two weeks and if it continues positive we will stop treatment but if it is intermittent negative and positive (false positives) to continue for the full 24 weeks.  

My history:  Started 7/23 (pre-tx VL 2,387,610) with Pegasys 180mcg, Riba 1200 daily (Geno 2b; weighing 238, 6’3”); was UND TMA <10 at week 5.  At week 10, lowered riba dose to 1000.  Remained UND until week 19 when I got an HCV RNA <615, TMA pos.  Then at week 22 my VL was 775; at week 24 (1/07/08) my VL was 885.  On 1/10/08, we raised the riba dose to 1400mg/day and at week 26 I was TMA neg again and remained so until week 29 which gave me the last TMA pos.  The tests I did today are during week 31.  

What are the chances that this is a false positive?  I’m afraid my confidence that this is a false positive is waning.  If the previous pattern follows, then the tx isn’t working, even at the weight-based dose of riba.  Wishing it didn’t take so long to get test results… Frustrating!
Skip

[jmjm530]

At this point, given the number of intermittent positive TMA's you've already had -- I think they only way you could confirm this was a false positive would be to re-run the test from the same vial of blood, assuming they still have enough left. As to continuing on with tx with a continued pattern of positives and negatives, I just see that pattern repeating when you stop the drugs,  i.e. no SVR. Wish I could be more optimistic. Maybe get another opinion before committing to much more time.

All the best,

-- Jim

[SkipinCA]

Thanks for lending an ear.  I guess I'm still hopeful that this last was a false pos.  Will know by next week.  From your past responses and others, the thought has been lurking in the back of my mind that in my case I probably wouldn't ultimately reach SVR at any case after the earlier TMA positives.

If I end up stopping treatment, I will be needing to find ways to think of this past year as not being a total waste.  My Dr. says there are new therapies all the time, and that I can take a rest for a couple years or so before I take another stab at it.  Once the VL gets high enough we'll do another genotype testing, and then in a couple months or so I'll do a liver biopsy and I suppose if my liver is still showing zero fibrosis, etc., then I can wait even longer before I jump in again.  

Since I first was diagnosed in 1997, my ALT and AST has always been within normal limits, and the biopsy in 2003 showed a healthy pink liver, no fibrosis... This after years of drinking quite a bit, and use of various other dangerous controlled substances.  I've never had symptoms of Hep C these 10 years, and sometimes I think "why not just live with it - I've done ok so far."  I guess I shouldn't kid myself that my liver could take a nose dive if I don't treat it.

It's just that after investing a whole year to a treatment that didn't work, I need to get my mind in a place to be able to do it again when a good opportunity arises.

I'm not drinking any more, and I've lost a ton of weight I needed to lose.  Can't wait to get back to the gym.  If there isn't much collateral damage from the Interferon and ribavirin I guess I will at least have that to be thankful for.

My trials and disappointments seem trivial compared to what many on this forum have gone through.  I look here for inspiration to keep from getting too down about my situation.
Thanks again.
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[jmjm530]

I'm real sorry about the positive test result.

Lots of discussion back at week 26 in this thread here:
http://www.medhelp.org/posts/show/423357?post_id=post_2455819

My comment then in part:

"I'd think you might want to try another another 24 weeks if you can tolerate, esp if you have significant liver damage. Also, given your mecurial viral response, I'd ask for monthly viral load testing and use one of the most sensitive tests available such as Quest's HCV RNA TMA QUALITIATIVE or LabCorp's ULTRAQUAL. If you for some reason, the virus raises its ugly head gain, I'd consider stopping."

So, if you've recently been on full-dose riba, then it seems that it may not have been the riba issue that caused the earlier TMA positives, but just that the virus was still lurking which it still appears to be and that the treatment is not working, as you suggest.

-- Jim