Elevated AFP

[gelia]

   I am a 62-year old female.  In July-August, 1983, I had a very serious case of (what they now call) hepatitis C ( which they then termed  non-A, non-B hepatitis) for 6 weeks & was in the hospital for a week.  I've never been so sick.  So often websites say  that symptoms for hepatitis  C are  mild to moderate--this wasn't the case for me.  I worked in dentistry & caught it from a sick patient.  After I got well, the dr. did a scan & said my liver looked fine.
   Last October, my primary care  dr. sent me for regular blood tests, including an AFP test.  It came back at  15.3 (with normal being  0-10).  I had  a  CT scan & it was clear.  In Dec. I had another AFP blood test   & it came  back at 16.7.  I had a PET scan &  it came back clear.  In January I had  another AFP test, & it came back at 18.4  So, I had  an Ultrasound  & it came back clear.  Today I  got  the results of the latest  AFP & it is now  16.5.   All of my  doctors  are totally  stumped.  This  merry-go-round has  me  & my husband very upset  because our doctors just don't have any answers.  They say that my AFP shouldn't be elevated from hepatitis C  after all these years.  But, my gastroenterologist thinks I will develop liver  cancer, with time.  He has seen this before  & says  that the liver cancer tumors can take months  to years  to show up.  He had one patient whose AFP went  up slowly like mine, & after 5  yrs., she developed 3  tumors in  her liver  suddenly, all at once.
   Has  anyone had a similar  situation or  know  why  an AFP  would go up & down?     Incidentally, I feel fine & have not been ill, but I  do have pain most of the time in my right side  within  the ribcage area.
   I would really appreciaate hearing from anybody with any thoughts or knowledge about an elevated AFP.


This discussion is related to Alpha Fetoprotein questions....

[Bill1954]

Hi again Gelia—

My Hep C (HCV) was diagnosed in 2004; and yes, while I’ll never know for certain, I had a history of sharing IV drugs so chances are my exposure was from a typical source. There is a percentage of patients that don’t fit into standard risk categories, and might never know where or how they acquired the disease.

The HCV RNA by PCR can be ordered by your doctor to include genotype testing; the most cost efficient way of doing this initially is to order a ‘HCV RNA by PCR with reflex to genotype’; this language will instruct the lab to conduct a PCR test; then, if and onlyh if this test is positive, they will run the same sample for HCV genotype. This eliminates the need to draw blood twice, and saves the draw fee at the lab.

The HCV RNA by PCR test should only be ordered once a patient tests positive/reactive to HCV antibodies; in your comment to Trish above, this has already been ordered… it is the ‘Hep C Ab+’ you already mentioned.

Good luck; yes, a hepatologist is generally better informed as to the disease than a GI doc; however, most GI docs are capable of managing simple cases of HCV. It might require months of waiting time to see a hepatologist; no reason a GI doc can’t get this moving along for you.

Take care—

Bill

[gelia]

    Thanks so much for your response.  By your name, you obviously are speaking from experience.  How  difficult is it for them to determine the genotype once the HCV RNA by PCR comes back positive  for HCV?  Is that another blood test or  something more  extensive?  Thanks so much for your input.

[gelia]

    Hi Bill--you sound very well informed & I really appreciate your input.  Was your Non-A, Non-B hepatitis transmitted blood-to-blood?  Mine definitely wasn't.
    I can get my PCP to requeest a HCV RNA by PCR test & if he has no idea  what  I'm talking about, MAYBE my gastro-guy will...however, what I think I TRULY need is a hepatologist because my gastro-guy primarily understands & deals with colonoscopies & endoscopies & all the problems associated  with negative results from them.  I know he is the one who is supposed to handle all the liver questions,  but if he just isn't knowledgeable enough to deal with that part of his practice.  I think it's time for a  change or at least a 2nd  specialist.
   Oh, & thanks for the heads-up about getting copies of all my test results, etc.  I've been doing  that & it really makes a difference.  Thanks again.

[gelia]

   I will get tested for hepatitis C so I can get this settled once & for all. However, can Hepatitis A  or B cause an elevated AFP many yrs. later???  Toxic hepatitis  sounds more like what I  had--& I did have a new house with a new lawn that I sprayed with all kinds of stuff to keep pests out, & cause everything to grow.  I would think that maybe that was what I'd had, but what about the patient who had come to our office & been worked on & later fund out he had Hepatitis, & my girlfriend's husbaand who  had it?--All coincidence?   And, about 3 weeks after I was diagnosed, a  friend of mine at our  dance school came down with it.   However, her dr.said she got hers from sushi!
   Thanks so much  for the mayo clinic lnk--I will ck. it out.

[jdwithhcv]

The test you need to have them order is HCV RNA by PCR.  This will determine if you have a viral load, and thus that you are infected with HCV.  If you have detectable virus, then you will need to know its genotype.

Good luck.

[gelia]

   Thank you so much for your input.  My doctor ordered a complete liver panel & all of that came back fine.  How extensive is a PCR blood test--in other words, is it only used to detect hepatitis virus & determine it's type, & how active it is or isn't?  I have a lab request sheet from my dr. for my next AFP test, & I see  they do not offer a PCR test.  They offer: 1) lipid profile, 2) liver/hepatic function, 3) AFP, 4) Hep A Ab IGM, 5) Hep A Total Ab, 6) Hep B Core Ab IGM, 7) Hep B surface Ab QNT, 8) Hep B surface Ag w/reflex fonfirmation, 9) Hep C Ab+.  Are any or all  of these part of the PCR test?  You sound knowledgeable about this, so I assume you or someone close to you has had it done. & therefore you'll know the answer.  Agan, thank you so much.