Hep c Returned using Eplclusa 12/18

[MommaT]

Please what does <11. mean POSITIVE? 0.-.9 What do you do after Epclusa?

[Lynn K]

Was that a viral load test the HCV RNA by PCR test? If it was why did you have a viral load test 2 years post did you have elevated liver enzymes?

Was this possibly a hepatitis C antibody test? The scale you posted 0.0 to 0.9 looks like what you would see for an antibody test. If it was an antibody test that only means you were previously exposed to hepatitis c. Those of us who were ever infected with hepatitis C will test positive for hepatitis C antibodies for the rest of our lives. Antibodies are made by our bodies when it tries to fight a virus. Our immune system will continue to make these antibodies even when the virus is gone.

Did you have a possible risk of exposure for an entirely new infection? Did you have a genotype test yet and is the genotype the same as your previous infection?


What does you infectious disease specialist or gastroenterologist or any doctor experienced on treating hep c say?

[MommaT]

Yes-I had elevated ALT and AST
Hep A Negative 
Hep B Negative
Hep C <11.         >11.0 Reference Range: 0.0-0.9 . Negative: < 0.8 Indeterminate: 0.8 - 0.9 Positive: > 0.9 . The CDC recommends that a positive HCV antibody result be followed up with a HCV Nucleic Acid Amplification test (550713). - Google Search

[Lynn K]

You will always test positive for hep c antibodies there is no reason to take a hepatitis c antibody test you know the result will be positive just like everyone else who was ever infected with hepatitis c virus.

There are other causes of elevated liver enzymes than hepatitis c so this does not necessarily mean you have relapsed or been reinfected. Of course that is a possibility worth investigating with the HCV RNA by PCR test to determine if you have been reinfected somehow or relapsed.

You should work with your doctor to determine the cause of your elevated liver enzymes. How far above normal range were they?

[Lynn K]

https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/causes/sym-20050830

“Many diseases and conditions can contribute to elevated liver enzymes. Your doctor determines the specific cause of your elevated liver enzymes by reviewing your medications, your signs and symptoms and, in some cases, other tests and procedures.

More common causes of elevated liver enzymes include:

Over-the-counter pain medications, particularly acetaminophen (Tylenol, others)
Certain prescription medications, including statin drugs used to control cholesterol
Drinking alcohol
Heart failure
Hepatitis A
Hepatitis B
Hepatitis C
Nonalcoholic fatty liver disease
Obesity
Other causes of elevated liver enzymes may include:

Alcoholic hepatitis (severe liver inflammation caused by excessive alcohol consumption)
Autoimmune hepatitis (liver inflammation caused by an autoimmune disorder)
Celiac disease (small intestine damage caused by gluten)
Cytomegalovirus (CMV) infection
Epstein-Barr virus
Hemochromatosis (too much iron stored in your body)
Liver cancer
Mononucleosis
Polymyositis (inflammatory disease that causes muscle weakness)
Sepsis (an overwhelming bloodstream infection that uses up neutrophils faster than they can be produced)
Thyroid disorders
Toxic hepatitis (liver inflammation caused by drugs or toxins)
Wilson's disease (too much copper stored in your body)”

[MommaT]

Lynn-I called Gastro and she said I will always test positive on Viral Load-so what is the test a PCR to show not returned?

 On a HCV Fibrosure all Bloodwork was normal but
Alpha 2-Macroglobulins QN was 462 high and
Fibrosis Score .42 high
Says Fibrosis Stage F1-F2

My concern is the rate of weight and muscle mass-138 lbs down to 115 and being 5'6 look like I am starved. I have lost all appetite and I am scared.

What standard test should I get when cannot figure how to gain weight?

[Lynn K]

The test to know if you have a hepatitis c infection is called the HCV RNA by PCR test or similar name. It is looking for the actual virus in your blood not simply antibodies which are now a part of your immune system the same as if you had measles or were immunized against the measles you will have measles antibodies.

I found something from Quest Labs and Wikipedia article about elevated Alpha 2-Macroglobulins which seems like it maybe be possibly a kidney related issue or diabetes. I did also see 350 is max normal for women so not extremely above normal range.

https://www.questdiagnostics.com/testcenter/BUOrderInfo.action?tc=18358P&labCode=SJC

“Clinical Significance
Alpha-2- Macroglobulin is produced in the liver. Increased concentrations are associated with patients with some chronic liver diseases, nephrotic syndrome, and diabetes. Decreased concentrations are associated with patients with pancreatitis, rheumatoid arthritis, and multiple myeloma.”

https://en.m.wikipedia.org/wiki/Alpha-2-Macroglobulin

The fibrosure blood test is less accurate in mid range liver scarring you could only have F1 but either way F1 or F2 with cure of hepatitis c the AALSD says you would not require follow on visits for liver and should be able to return to a normal life as if never infected with hep c.

Just for reference I was diagnosed with F2 fibrosis with liver biopsy probably in 1998 and F4 liver cirrhosis in 2008 so 11 years ago this month. In other words I wouldn’t worry a lot about your fibrosis score your liver will very likely improve with time.

As far as your unexplained weight loss here is an article from the Cleveland Clinic

https://my.clevelandclinic.org/health/diseases/17770-unexplained-weight-loss

The causes listed from the article are:

“What are the causes of unexplained weight loss?

Unexplained weight loss can be caused by conditions that range from mild to very serious. The causes can be physical or psychological, and include:

An overactive or underactive thyroid gland. The thyroid gland helps regulate your body temperature and control your heart rate and metabolism (the process that turns the food you eat into energy).
Cancer
Crohn’s disease (an inflammation of the bowels)
Heart failure
Addison’s disease, a condition in which the adrenal glands, which sit on top of the kidneys, do not produce enough of the hormones cortisol and aldosterone
Parkinson’s disease
AIDS
Gastrointestinal problems, such as peptic ulcer or ulcerative colitis
Dental problems
Depression or anxiety
Side effects of prescription medications
Celiac disease (allergy to gluten)
Diabetes
A parasitic infection
Drug abuse
Undiagnosed eating disorders
Swelling of the pancreas
Alcohol or drug abuse
Dysphagia (swallowing problems)
Dementia”

However at 115 and 5’6” per the NIH you are still considered to have a normal BMI although on the very low end at 18.6 BMI with 18.5 the low end of normal range.

https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

You will want to work with your primary care provider to find the cause of your evevated Alpha 2-Macroglobulins and weight loss concerns.

If you wish to confirm you are still free of the hep c virus you would want most of us call a viral load test the HCV RNA by PCR test. This was also referenced on your antibody test result as an instruction to take the “HCV Nucleic Acid Amplification” test. These are all the same thing. HCV means hepatitis C virus and RNA means Ribonucleic Acid. Basically they are looking for the genetic structure of the hepatitis c virus.

Please don’t ever take a hep C antibody test again you know what the result will be. You will always test positive for hepatitis c antibodies.

Best of luck to you and please let us know what you find out.