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Post Info TOPIC: I can't explain my lab results
mallani


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RE: I can't explain my lab results
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Hi Wayne,

Thanks for the link.

It's a bit alarming that the IL28B patients with the TT allele had an SVR rate of only 67% when treated for only 12 weeks, and without Ribavirin. The Optimist results may be of interest, but by then I predict Olysio will no longer be used. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Tig


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I believe that was a very wise choice too!

Tig



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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OldenSlow


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This article sums it up fairly well..  EASL 2014 Cosmos Report

The extra 4 weeks was at my request. With cirrhosis posing additional problems, I figured it wouldn't hurt provided I could get it approved. Surprisingly, it was.



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66 y/o male - Geno 1b - F4 cirrhotic dx 2001 - 16 wk treatment w/ Sovaldi/Olysio/Riba - Und @ EOT+24 SVR

 
drexelpbp


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Thanks for the reply Wayne. So you are being traeted for 16 weeks. I have been approved for 12 weeks without riba.

 

Where did you get your information about the replapsers in the COSMOS study? Do you know whats percent of the total they represent/

 

I was treated with in 2005 with 50 weeks of interferon/riba and replasped six months after treatment. I believe at that time they said I was geno 1b 



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OldenSlow


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Hi Drexel and welcome from me, as well. The established predictors of response are clearly undergoing change as we speak. Not enough data yet to say anything for certain. The Cosmos Trials (studying S/O with or without riba) had a limited number of enrollees and never got beyond Phase 2. The upcoming Optimist Trials will shed further light, as well as forthcoming feedback on those of us currently on or just finished with treatment.

The indicators are good, though. 24% of those in cohort 1 in the Cosmos study (absent to moderate fibrosis) did not achieve UND status until after week 4, and all of those went on to SVR 12. In cohort 2 (half of whom had advanced fibrosis/cirrhosis) there were 3 relapses, with 2 of those relapsers being cirrhotic. You can draw your own conclusions from this, but I would feel quite confident about things, were I you. You were about as close as one can get to being UND at 4 weeks and have every reason to be excited about that.

wayne



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66 y/o male - Geno 1b - F4 cirrhotic dx 2001 - 16 wk treatment w/ Sovaldi/Olysio/Riba - Und @ EOT+24 SVR

 
drexelpbp


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Thanks for the reply. Is it a bad sign that I am not completely undetectable at 4 wks?



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mallani


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Hi drexel,

That means Detected but below the level of quantification for the test used by your Lab. So, your VL is between 0 and 14.

That's very low, so good luck next time. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
patiently_waiting


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drexelpbp wrote:

Thought I would add that these are results after 4 weeks on Sovaldi and Olysio

 That looks like your quantitative viral load count and it looks undetected to me, but can you paste the column headings to be sure?



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42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
drexelpbp


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Thought I would add that these are results after 4 weeks on Sovaldi and Olysio



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drexelpbp


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Does anybody know what these results mean:

HCV ,RNA,QN,PCR                  <15                     IU             <15G

*Detected below the limit of Quantitation



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patiently_waiting


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Thanks Tig for the link and thanks Mallani for posting that RAV information...that's exactly what I was looking for.

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42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
Tig


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Hi PW,

Your labs look good. Some are borderline low but still within normal limits. I do notice that even with the enzyme elevation, they are dropping again. As mentioned, they fluctuate all the time and whatever was responsible for the recent spike seems to have calmed down if the direction they're headed is any indication. We had a recent discussion on RAV's and Mallani provided some good insight into the topic.

Tig

 

http://hepcfriends.activeboard.com/t56863437/understanding-ravs-effect-on-treatment-and-re-treatment-sele/



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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patiently_waiting


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So here's my updated hepatic function panel.  Still haven't seen the FibroSure results...hoping that comes soon.

ComponentStandard RangeYour Value
Protein Total6.4-8.4 g/dL7.3
ALBUMIN3.6-5.1 g/dL4.6
GLOBULIN2.2-4.0 g/dL (calc)2.7
ALBUMIN/GLOBULIN RATIO0.9-2.3 (calc)1.7
BILIRUBIN, TOTAL0.2-1.2 mg/dL0.7
BILIRUBIN, DIRECT< OR = 0.2 mg/dL0.4
BILIRUBIN, INDIRECT0.2-1.2 mg/dL (calc)0.3
ALK PHOS40-115 U/L38
AST10-40 U/L94
ALT9-46 U/L269

 

ALT and AST still pretty high.  I don't like it being this high for this long.  I feel like I should start treatment now.  Even if my FibroSure comes back with a low fibrosis grade I don't want it to get any worse than it already is.  With my ALT and AST this high it appears to me that's exactly what's happening.  Can anyone point me to any information on what the risks are (mutations, etc.) for treating now with Sovaldi/Olysio vs waiting for the other Gilead drug?



-- Edited by patiently_waiting on Friday 25th of April 2014 02:50:54 PM

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42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
patiently_waiting


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Hi all. Thanks for the replies. I neglected to mention the FibroSure (or FibroScan - not sure which) was added to my lab orders. I should be getting those results along with the rest. They did both an ultrasound and an MRI (because I was having some abdominal pains) and both were clear. This was back in November. I've probably just got myself worried again by reading too much. :) Mallani, that's good to know and that makes me feel a bit more at ease. I also do trust my doc but sometimes I just worry about how busy he is and that I need to be on top of this stuff. These are my other results. Basically everything came back normal I think except for ALT/AST, creatinine...

Component Standard Range Your Value
SODIUM 135-145 mmol/L 140
POTASSIUM, BLD 3.6-5.0 mmol/L 4.2
Potassium level in plasma (green top) sample is 0.2 mmo/L (mean) lower than that
in a serum (red top) sample.
CHLORIDE 98-109 mmol/L 105
CO2 22-31 mmol/L 24
ANION GAP 6-16 mmol/L 11
BUN 6-23 mg/dL 16
CREATININE 0.67-1.17 mg/dL 1.21
GLUCOSE 70-139 mg/dL 95
CALCIUM 8.4-10.2 mg/dL 9.2
ALBUMIN 3.5-5.2 g/dL 4.7
Protein Total 6.6-8.7 g/dL 7.3
BILIRUBIN, TOTAL 0.2-1.3 mg/dL 0.5
ALK PHOS 40-129 U/L 51
AST 10-50 U/L 128
ALT 10-50 U/L 334
GLOBULIN 1.5-3.3 g/dL 2.6
Alb/Globulin Ratio 1.8
BUN/CREAT RATIO 10.0-20.0 mg/mg creat 13.2
eGFR NON-AFRICAN AMERICAN >60 mL/min/1.73 m2 >60

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42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
Isiscat2011


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patiently_waiting wrote:

There's some really scary stuff listed there.  They did do some imaging which came out all ok, so I'm hoping I don't have to worry about the dreaded C word.  I have gained a little weight but they said they didn't see fatty liver either.  I'm still at a loss.  Jimbob, I'll give the iron thing some thought but I can't thing of any significant dietary changes I've made.  I think if they come back high again I will probably start pushing to treat now instead of waiting till October for the Gilead drug (blanking on the name right now).  

You might be putting the cart before the horse here.  I would get a clearer picture of the status of my liver before making the decision to treat now.   Definitely the "C word" is not something you should be worrying about at this point.   



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
mallani


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Hi PW,

You've got 8 years of results there, and over time, the enzymes rise as fibrosis increases. The natural history of chronic HepC is a series of acute flares, where the enzymes can elevate considerably, then drop just as dramatically. Get them repeated in a month, and if still at those levels, consider getting a biopsy or Fibroscan to check your present liver status. cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Tig


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Hey PW,

Have you had a recent biopsy or Fibroscan? If not I think that would be a wise next step. That will tell you so many things and a low fibrotic score can allow you the time to wait for Sovaldi/Ledispavir, as well as ruling out many of your concerns. How about a routine abdominal ultrasound? Do you have any recent blood tests, aside from your enzymes? I'm curious about the rest of the picture. I don't think you've got reason to consider HCC as the cause of your enzyme spike. There are a multitude of things that would have to be present to start ringing those alarm bells. Try and avoid the worry, it I'll have you reading problems where they don't exist. Concentrate first on getting your repeat enzymes back and go from there. Hang in there!

Tig



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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patiently_waiting


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Tig56 wrote:

 

Hi PW,

That was quite a rapid elevation in those levels. I'm glad you had that test repeated and will be curious to see if there was an error made. It's hard to say, but as mentioned these enzymes do fluctuate all the time. But this was an obvious spike, so something specific caused it to jump so quickly. I'm adding a link to some information, be sure to read all 12 pages to get a better understanding of potential reasons and causes. Do let us know what the new results are. Good luck...

Tig

 

http://www.emedicinehealth.com/liver_blood_tests/article_em.htm

 Thanks for the link Tig.  There's some really scary stuff listed there.  They did do some imaging which came out all ok, so I'm hoping I don't have to worry about the dreaded C word.  I have gained a little weight but they said they didn't see fatty liver either.  I'm still at a loss.  Jimbob, I'll give the iron thing some thought but I can't thing of any significant dietary changes I've made.  I think if they come back high again I will probably start pushing to treat now instead of waiting till October for the Gilead drug (blanking on the name right now).  



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42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
Tig


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Hi PW,

That was quite a rapid elevation in those levels. I'm glad you had that test repeated and will be curious to see if there was an error made. It's hard to say, but as mentioned these enzymes do fluctuate all the time. But this was an obvious spike, so something specific caused it to jump so quickly. I'm adding a link to some information, be sure to read all 12 pages to get a better understanding of potential reasons and causes. Do let us know what the new results are. Good luck...

Tig

 

http://www.emedicinehealth.com/liver_blood_tests/article_em.htm



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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jimbob


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I do know those numbers will fluctuate. Do the foods you are eating contain a lot of iron. I do know the virus needs iron to replicate. I think this happened to me once when I discovered I was ingesting too much iron. The mods on here are always better informed than I, but that would be my guess.

jimbob

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jimbob: 64 y/o, GT 1A, F1-F2, diagnosed 1996. Since 1970. SOT 3.5 mil VL on 3/10/14 with Sov/Rib/Peg for 12 weeks. Tx naive. UND @ week 4,8,12. EOT 6/2/14.
patiently_waiting


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So here is my historical lab results for ALT/AST.  I have absolutely no explanation for the extreme jump in November of last year.  I haven't drank alcohol nor am I taking any medication other than Benadryl and the occasional ibuprofen.  I take Benadryl almost nightly for sleep but I've been doing that for years.  I've never heard of diet causing this big a jump.  My diet isn't always great but other than that I'm pure as the driven snow.  What could have caused this?  I'm seriously wondering if they could have mixed up my specimen with someone else's.  I just went in to provide another specimen yesterday so I should get those results back in a few days.

Name
Standard Range
9/14/066/28/079/10/0811/7/082/24/095/21/096/10/115/24/1211/28/1211/22/13 
ALT
10-50 U/L
574333314387433940334
Name
Standard Range
9/14/066/28/079/10/0811/7/082/24/095/21/096/10/115/24/1211/28/1211/22/13 
AST
10-50 U/L
282531253149262327128


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42 yrs old: geno 1b, 23mil VL, ALT/AST 269/94 as of Apr '14.  Got HCV when I was 16.  Relapsed from Peg/Riba twice, last time in '08.  Completed Sol/Oly on 9/2/14, UND as of 10/7/14
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