TOPIC:

Dear All,

I am a little confused because my HCV RNA viral load test was done in 2 different hospitals 24 hours apart and the results are conflicting.
1) Says UNDETECTED ( Ref range 10-100,000,000 IU/ml)
2) Says HCV RNA DETECTED (Ref range <12 IU/ml) - With comments : Low level of HCV RNA DETECTED, below 12 IU/ml by quantitative real time PCR technique

How is it possible to be UNDETECTED with the test with has <10 IU/ml but show as DETECTED on the test with <12 IU/ml . Really need some advice here as I do not know which to believe now?

Both reports attached below.

PCR stands for polymerase chain reaction. It is an amplification process. When there is not very much to amplify... it may not amplify.

The not detected test was done on a Cephied carteidge based system. They are good but possibly not quite as good as the Abbott Realtime or Roche Taqman systems which are giant machines.

Where are you in your treatment cycle?

The old tests crapped out at <30, <25 and <15 so you would be undetected on all of those.

Thanks for the prompt reply Dr James.
Before I started medication, my Viral Load was 4.8 million (Geno 1a) with no liver cirrosis & treatment naive .. Both these tests were done at 4 weeks after starting medication . Today (20th April 2018) I am completing my 10th week of medication ( I have a 12 week of medication supply). The medication i am taking is MyHep LVIR (Ledispavir + Sofosbuvir).

Do I stand a good chance of being Undetected at 12 weeks (complete meds in 2 weeks time on 6th May 2018) ?

Thanks in advance.

This is a perfectly acceptable result for rhe 4 week test.

Your odds of success are 20:1 in your favour.

I the ynlikely event you are in the 1 not the 20 then retreatment is simple so don’t sweat it.

This is a perfectly acceptable result for rhe 4 week test.

I should probably have added that after the PCR fluorescent probes are added to detect the amplified RNA - these target commonly retained RNA sequences in the virus and assuming equal amplification the Abbot one(s) fit your virus slightly better.

Your odds of success are 20:1 in your favour.

In the unlikely event you are in the 1 not the 20 then retreatment is simple so don’t sweat it.

Many thanks again for the clarification & assurance DR James. I already feel much much more confident and looking forward to the next 13 days when i will finally finish my 12 weeks.

Dear Dr James,

It has taken me a while but i would like to update that i finished my treatment on 6th May 2018 and did a Viral Load test for EOT on 8th of May 2018. The test came out Not Detected

However from the picture attached the , its mentioned that this lab tests crap out at 80 IU/ml. The previous tests done during treatment crapped out much lower at 12 IU/ml & 10 IU/ml...




I am now 9 weeks after EOT & have not done any VL tests after EOT. This Sunday I will be doing one in the UAE for work visa purposes thus a little worried what might show up in the test results. Thus far I have done 2 VL tests on :

1) 4 weeks on treatment - Conflicting results ( 1 showed Detected & Another showed Not Detected) as explained at the beginning of this thread. Thanks for your earlier clarification on the different systems used (Abbott might be more sensitive etc)

2) EOT (after 12 weeks of medication) - Showed Not Detected (image attached)


Is there any possibility of the VL count increasing or re-appearing again after EOT ? I am really hoping that the VL test i am going to do this Sunday (9 weeks after EOT) turns out to be Not Detected as well. Should i be optimistic Dr James ?

Thanks

Hello Yugen88,

Most people start with a viral load of around 1 million and if they relapse, they relapse to a similar viral load.

So while people relapsing would pass through undetected, just detected, very detected, it is extremely unlikely that a < 80 at 9 weeks is not also <30, <25, <15, <12, <10 (which are some of the other test sensitivities).

So, yes you should be optimistic. The vast majority of people that relapse are detectable at 4 weeks post-treatment and you are well past that.

Statistically, it is 99.5% certain you are fine. Yes, the 0.5% is annoying but you should be good.