Hep C Discussion Forum

Gidday cdnab,

I see you are concerned about various degrees of accuracy and to some degree the fidelity of tests at different times, and I must say well done and thanks to James here, who has been pretty well on the mark and correct, when he tells you that the over-riding highly accurate PCR test, is the one that determines whether or not you have an active virus.

Now I am a trained professional pathobiologist and have worked in the area of testing, using and analysing samples with the same equipment that was used in your tests.  I see you seem to refuse to accept the results you have at this stage, and given your lack of training and understanding of these tests and procedures, I'm not exactly sure how else I can satisfy you here except to answer your questions as I would any other client who put a sample into my lab for testing.  Having said that, my position is/was to advise doctors and specialists, not the patients themselves.  The doctor's job is to explain the results to you, but my experience of doctors understanding of complexities in laboratory testing isn't always, shall we say air-tight and not confusing:)

Answers to questions.

1/.  You should be concerned about any ALT level in your blood because the count should be zero.  ALT's are enzymes found in the cells in our livers and they only appear in blood tests when there has been damage to the cells in your liver.  Now there are other reasons that enzymes are in your blood apart from having a virus, but they all say something is wrong.  Do you drink alcohol.?

2/.  Band intensity when discussing antibodies does not relate to strength or anything likethat, and is more or les and antiquity of scientific terminology.  Essentially the antibodies tested for are those known to be found on the outside of the HepC virus 'coat' and is therefore those that are sought when trying to determine the presence of a virus by looking for immune products that would be otherwise not there.  The positive antibody results in your sample indicates that either (a) you had the virus and it's now gone, (b) you have become infected but the virus isn't active in your body, or (c) you have the virus and it is active.

3/.  The Anti HCV measure is one to determine that the antibody is present, but cannot determine activity.  High numbers confirm the virus has been in you and low numbers possibly remnants of a virus that has been long ago deactivated or could be another antigen that is similar but not a match.  These last two reasons are why anything under the tests accepted minimum for accuracy say 1.0, is deemed what they call weakly positive, and this is where a false positive could arise but only if someone didn't know what they were doing.  And this would get picked up when someone else repeated the test.

4/.  Could I give you a false negative by mistake, NO!  Tests are always confirmed by repeating the process to get the same result, it is a standard scientific protocol in appropriately qualified laboratories.  Often once a result is confirmed the result is then tested by applying another test, for viruses usually here an immunoblot test.  You recieved a negative PCR because of the reasons a and b in question 2.

5/.  The PCR could miss the virus if it was either not activated, where the virus is "buried" harmlessly and waits for conditions to become more suitable, or the virus could just be a deactivated shell, good enough to set of the RIBA test, but as you now know, only limited to telling you a small amount of information.

6/.  Cross reaction is highly unlikely and I say that because you would have already been fully knowledgable about anything that would set off the antibody test to HepC, that wasn't HepC.  The only conditions that could set off the antibody test that wasn't HepC would be a serious auto-immune disease or  one or two other serious, genetic blood disorders, and all 3 of these would have been causing problems for you from a very early age.  HepC can lie dormant for 30 or 40 years, these other conditions would get picked at birth or before a child was a year old.  Untreated the child wouldn't make double digits in years alive.

Now I have deliberately repeated similaritys to your testing a couple of times here in these 6 answers, i.e.; the false results and similar antigens/cross react. scenarios so perhaps theha   will clear up the lack of faith you appear to have in your results so far.

Now understanding what had occurred and I always gathered all known factors known about the patient and their medical history and life to date, that were pertinent in my arriving at the right conclusion.  Knowing what I know and what I've determined from histological investigation I would advise the specialist and attending medical officers on the case the following:-   Mr. cdnab  would appear to have cofirmed antibodies with no further outcome from the PCR at this stage.  It is recommended that the quantitative PCR itself is repeated at 3 month intervals in isolation here. Testing here would indicate that the patient is at the moment in the process of sero-converting and we can expect that current PCR situation to revert to becoming positive shortly. At this stage it is further recommended that patient undergo complete liver function tests at monthly intervals and attend monthly clinics, so Mr cdnab can be monitored while receiving your full diagnostic teams support.

This is of course only what I am suggesting, however given that all you intend to do at this stage is repeat the AB tests as well as the PCR, my suggestion is not a great deal different, except of course I have included an explanation as to why you have positive Abs and a negative PCR, for the moment, or perhaps more correctly, when you last had blood taken for that most recent PCR.

I wish you the very best in continuing to follow up on what's happening in your liver at present, and hope you can get an answer a soon as practible.  Good luck.

Cheers,

Brendan.