PCR testing

[traveler65]

I keep going round and round with my doc as to the sensitivity of the PCR's he is having run on me. The 4 week one was <50. I asked for him to run a more sensitive test (down to <5) and even mentioned the heptimax test. He still claims that the <50 test is fine and as long as my results are <50 I am UND.
Are there any articles on the web stating that a more sensitive test should be run that I can bring to the doc? I will be having my 12 week Pcr shortly.
Thanks:

[jmjm530]

Mike: I really don't know for sure how my transplant status translates into viral load so it could be that we are more apt to sustain low levels of virus than non-transplants.
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Mike, I really think that your transplant status is not of distinctive value here, and the points you made are valid for those treating, or finished treating, who have not had transplants.

As I mentioned earlier-on, I tested below 50 IU/ml early-on in treatment as well as NYGirl, just for two examples of folks we know. Both of us would have tested negative with a PCR of sensitivity 50 IU/ml, but not with a more sensitive TMA.

This study http://tinyurl.com/3dqutf suggests that 22% of PCR negatives at week 20 of treatment were actually TMA positive and therefore using a more sensitive TMA would have given the treatment doctors a better predictive value to base treatment on.  http://tinyurl.com/3dqutf

And this study suggests that a percentage of EOT negative PCRs are actually TMA positive and 100% of that sub-group will relapse. Something someone would definitely want to know before stopping the treatment drugs, especially if the plan was to re-treat right away. www.hivandhepatitis.com/2006roberts/hcv/081106_c.html

And then there are members here who have reported being given either "Heptimax" or similar sensitvive tests by literally the 'Who's Who' of HCV treatment incluidng Dr. J and Dr. D. of NYC, Dr. S of Miami and Dr. G. of San Francisco. I doubt very much these esteemed doctors would admister more sensitive TMA tests unless they felt they offered useful data to improve treatment.

As to whether the vast majority of doctors use these more sensitive tests or not, I personally have no idea, but don't see that as the point. What we should be striving for is the best possible treatment scenario, not the most common scenario. Of course, insurance plays a role, but at least from my own experience, as well as many others here, getting a test like "Heptimax" through the insurance process has not been a problem, as long as the doctor writes an rx for the test. At the very least, the paitent owes it to themselves to contact the insurance company and confirm for themselves which test(s) are and are not covered.

I'll conclude by quoting Mike (hope that's OK, Mike)  because, as stated, the value of these more sensitive tests is valuable to all of us, not just transplant patients. -- "There are more sensitive tests available and I can see no reason not to use them. I am not saying that traveler should be worried about the PCR but that's not the same as saying that <50 IU/ml is absolutely undetectable."

-- Jim

[madbrad]

I'm just upset my fighter Georges St Pierre lost his title the other night..lol

[Forseegood]

Be joyful, even though you've considered all the facts....

why not? we only get one trip on this planet, might as well make it as pleasant as possible, though of course that's hard sometimes...Course I've never been to Sambone's planet, maybe I'll try to go sometime:) Sorry for the wayward posting, realize it should be on the other side...

[mikesimon]

Honestly, everything I read nowadays depresses me. The DOJ, Iraq, Iran, Imus, border security, education, the disparity between the RICH and Poor, the cost of education and the lack thereof, flight of corporations and the exportation of jobs. I see it all as dismal Kalio - way too dismal. Mike

[Kalio1]

I certainly didn't intend to come off that way at all, my intent was to ease his fears, if he can get his hands on a <0 test power to him, but my doctor and all the docs  basically don't see the value in spending all that money for a sensitivity difference between <5 and <50. He told me the same thing travelers doc did, "if it's hiding under <50, then it could hide <5 too, you are UND" plus he is on tx, the need for a maximum sensitivity test might be there after tx is over, maybe he can convince him when his tx ends. That is when I would spend the bucks for the most sensitive test, to ensure the virus is gone after tx. On tx he's got that "protective layer" of drugs suppressing the virus, the test is more to indicate tx progress than anything else.
I can see why a transplant patient is a different story and detecting virus popping up (even in very low numbers) would be prudent.

I had the same exact reaction from the doc regarding more sensitive tests as traveler has had, the doc basically didn't see the need on tx.

Are you having a field day reading all about issues with the DOJ? Man, what a MESS. Next week we should see some very interesting developments...

[mikesimon]

I cannot argue with any of your points. I really don't know for sure how my transplant status translates into viral load so it could be that we are more apt to sustain low levels of virus than non-transplants. I will tell you that when I asked my surgeon what percentage of SVRs in the general population did he believe would show HCV on biopsy his response was 75%. That's just one man's opinion of moonlight but he has always seemed very on top of this stuff. I have to assume that you are more familiar with the protocols followed by the majority of practitioners because I have little experience in that area. I did not realize that getting the most sensitive test was such an uphill fight. And, I do believe that <50 IU/ml is highly suggestive of undetectable and I didn't mean to suggest otherwise or cause traveler any undue anxiety in that regard. My Niece is a brilliant attorney - far more intelligent that I - and I remember when she started law school we were discussing an area of law when she asked me what was the rule. I told her that in law there is no rule - it's all on a case by case basis and everything hinges in the particular facts. She was used to certainty and she had a lot of trouble accepting that reality. That may explain why I posted to you. I recoil whenever I see absolutisms because I am leery of them and I try never to state anything as a fact that I am not 100% certain of and there are few instances when I am that sure about something - anything. I am not a good poker player because I find it very hard to bluff - to present something that might not be true. I wish I were better but I don't think I ever will get passed that inability and win a lot of money. I have no hard feelings Kalio - I hope you don't either. Mike