Lab results question

[Freahugs]

Hi,

I’m wondering about if anyone knows anything about this:

12/26/19 - hep c ab lab taken as a general weight loss panel
12/30/19 - md calls to let me know I’m reactive
12/31/19 - hep c ab lab taken again
1/2/19 - md calls to let me know it’s equivocal. They didn’t run the viral load or genotype bc the test is equivocal. So the saga continues
1/2/19 - I go to lab to get hep c viral load and genotype
Awaits nervously.

Do you think that I could possibly be negative if the first one was positive but then the 2nd one was equivocal. I’m really dying right now with this.

[Freahugs]

I meant 1/2/20*

[Lynn K]

Did they send you to get the HCV RNA test or did you request that on your own?
But either way you will know for sure in 7 to 10 days what’s going on.

Yes it is entirely possible you don’t have hep c

I did find this about equivocal results

“When test results are neither positive nor negative

Sometimes the hepatitis C antibody test is reported as equivocal. That simply means the result is neither positive nor negative. In this case, the test needs to be done again with a new specimen.”

Edit: by the way you should be able to edit your post although I think there maybe is a time limit for that ability

[Freahugs]

The doctor requested it bc my ab test had been reactive. Even though it’s equivocal she said that she will still test me for the other things (normally they would wait 6-9 weeks). Thank you for your response Lynn! I have to say ever since the day before I found out about the reactive ab test, I started having a low grade fever that has stayed with me. Yesterday, I started having strange gi issues where the food goes up and down, now I’m having abdominal pain. Previous to all of this, on around 12/6/19 I noticed my face was very yellow. I just thought it might be stress but I rmener even texting my good friend to tell her about it and she asked me if I had jaundice to which I replied no way, why would I have that? And I’ve lost about 8 pounds in the last year which is not normal for me because I’m already thin and I’ve been eating a lot.

Ah noted about the edit.

[Lynn K]

The low grade fever and GI distress could be many things including stress over this situation. It highly unlikely that would have anything to do with hep c.

A better indication of jaundice would be yellowing of the white areas of the eyes and also having very dark urine looking like cola. My friend looked jaundiced at one point. Turned out she was on a weird juice diet drinking a lot of carrot juice. But her eyes weren’t yellow.

Assuming you actually were experiencing jaundice (which by the way I’ve never experienced) here is a link to posible causes of jaundice one on the list is anemia

https://symptomchecker.webmd.com/multiple-symptoms?symptoms=pale-skin%7Cyellow-skin&symptomids=174%7C259&locations=66%7C68

[Lynn K]

Here is an article about unexplained weight loss which is losing more that 10 lbs or 5% of body weight within 6 to 12 months without trying.

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

Have they done a test of your liver enzymes ALT AST? They are often slightly elevated with hep c those would be a part of a metabolic panel might be listed as SGOT SGPT

[Freahugs]

All my liver enzyme tests are normal except for t bill at 1.2. I had an elevated t bili last year as well that didn’t alarm my doctor. Will check out those websites.

[Lynn K]

So yeah elevated bilirubin is what causes the symptom of jaundice. Bilirubin can be caused by many things anemia came up again as a possibility how is your CBC?


https://www.webmd.com/a-to-z-guides/bilirubin-test

https://www.mayoclinic.org/tests-procedures/bilirubin/about/pac-20393041

[Freahugs]

CBC, folic acid, vitamin b12, and liver enzyme tests were normal. But all of these can be normal and I can still have hepatitis c. During acute infection, apparently liver enzymes fluctuate. I can be butchering this info. Please correct me if I’m wrong but I think they can be normal then fluctuate.

[Lynn K]

My CBC specifically my platelet count was impacted by my cirrhosis after being infected for 30 years. My platelet count was about 85 before I was cured of hep c but now is around 110 still below normal 150 but much improved. But prior to cirrhosis all my lab results except ALT and AST were normal. My elevated ALT AST were the indicator that caused further testing to learn I had hep c.

Ive never has my folic acid or vitamins b12 evaluated.

Those were elevated after I had probably been infected for about 10 years. The only other landmark I have other than I had some blood testing done probably two years prior when I had probably been infected for 8 years and my liver enzymes were normal.

Typically, liver enzymes are elevated in chronic hep c infection but may fluctuate into normal range so I’m not sure when my enzymes started to be out of normal range initially.

Most people have no symptoms of acute or initial infection. This is why hep c is called a silent illness.

[Lynn K]

Found this

http://www.hepctrust.org.uk/information/impact-hepatitis-c-liver/progression-hepatitis-c/acute-phase-hepatitis-c

The term Acute Phase can be confusing. This is because it only refers to the 6 month period of time after the virus has first entered your body. It bears no relation to the acuteness of the symptoms or the severity of the disease.
Antibodies to the virus are produced by your immune system when it reacts to the presence of the virus and are detectable in the blood from between 3 to 12 weeks after initial infection.

Liver function tests (or LFTs) are a set of blood tests measuring certain proteins and enzymes to see if the liver is performing its various functions correctly. With hepatitis C there is an average incubation period of seven to eight weeks before a rise in liver enzymes levels occurs. As liver cells are damaged by the virus, enzymes leak into the bloodstream. This leads to a rise in specific enzyme levels. However, even in this acute phase there is not necessarily a rise in enzyme levels.

During the acute phase most people do not seem to experience any noticeable symptoms. For the 25-35% of people who do, the symptoms are normally vague and non-specific. They can include low-grade fever, fatigue, appetite loss, abdominal pain, nausea and vomiting. About 20% of the people who develop symptoms contract jaundice.

[Freahugs]

I got my hcv virus rna back- undetectable! My doctor didn’t say what that means which I’m confused about. I’m assuming that this means the ab test was either a false positive or that I cleared it. And how often does either situation happen? I thought false positives were very rare...

In any case I’ll take it!

Thank you Lynn for all your responses. I’ll post an update on the ab test that I’ll get in 6 weeks to see if it really was a false positive.

[Lynn K]

Could be a fase positive while not common does happen but anyway doesn’t matter the important thing is you DO NOT! HAVE HEP C!!!! Woo whooo congrats!

The test has a lower limit of how fer virus particles per mL of blood it can see called the LLOQ lower limit of Quantification usually around 15 IU/mL but if your not detected, unless you know you were possibly infected only within the last week or so, the result would be detected with a viral load.

As far as spontaneously clearing the virus that happens in about 15 to 25% of patients are able to clear the hep c virus without any treatment.

Now just to figure out about those elevated bilirubin results and unexplained weight loss.

[Freahugs]

I spoke too soon. Given the positive ab result and the fact it might be acute infection, there can be times when rna levels fluctuate to even undetectable. I will get an ab test in 6 weeks to assess if it was a false positive and if still positive I will get an rna level 12 weeks from now to assess if it had been transiently undetectable.

[Lynn K]

Seems to me really there is little to be gained in repeating the antibody test. To know with certainty given the varying results you’ve had on the antibody testing I would just think to wait a bit like the 12 weeks suggested and repeat the viral load the HCV RNA by PCR. If that’s still not detected your not infected period no matter what any future antibody test might say. But no harm either in having the ab test I just feel like ya not going to clarify things very much as this point.

An recent infection from what I’ve found would be acute which simply means recently acquired within the last 6 months. Have you had a risk that you are aware of that you hada potential risk of hepatitis c infected blood entering your blood stream? If not it would be an older (more than 6 months) possible exposure and you would be in the chronic phase.

Hep c is not easily contracted and while there are a minority of patients who cannot begin to guess their exposure that is a small minority of patients.

Any best of luck hoping it all works out please let us know how it is going with your next set of labs.

[Freahugs]

Yeah not sure: actually now that I think about it- my doctor really didn’t say anything to me except: that I have hep c ab reactive, that my 2nd test was equivocal and then messaged me later saying my rna was undetectable and that I would get an ab test 6 weeks later. Isn’t she supposed to explain what all that means? I realize that I studied and researched on my own what those things meant and had to educate myself, damn. And even retesting an ab test 6 weeks later I’m guessing only checks for false positives otherwise I would just assume I had cleared it. In any case I definitely wanna get the ab test but the RISA which tests for false positives and also wanna get a viral rna load to make sure I’m not in the acute infection phase. And yes, I have a risk factor- I got a tattoo by a novice scam tattoo artist in an unregulated industry in a country where it is illegal and where tattoo artists are not held accountable bc the people who receive tattoos are just as “bad” as the artists. I actually got a tattoo there bc it was illegal. How ironic that that’s the reason I shouldn’t have gotten it. My tattoo faded out 2 weeks after I got it and the Instagram pics look nothing like my faded tattoo: mine looks like a 10 year did it. Anyway I’ll keep people posted on my results bc this is an interesting case I have to say. It’s not uncommon to clear but it’s uncommon enough I think. Interestingly I would have never known otherwise but I was being extra detailed during my physical exam. My family friend who is a doctor also said that he had hep c and got cured with the newer agents

[Lynn K]

Actually that was how I got hep C back in the day. I was in the military in Germany and went to a bar in town where a guy was where you could get tattoos in his apartment over the bar. Just a bunch on military types hanging out in his kitchen getting tattoos in the guys kitchen. Brilliant right? But hey I was 19 so there you go.

Yeah like I said already I was a 4 time treatment failure with liver disease who was infected for probably 37 years making me one of the hardest to treat and I was cured with these new generation meds. So if you should ever in your life learn you have hep c it is now very curable today. But with that “not detected” result it’s looking very probable you do not have hep c

Best of luck

[Mugwump]

I spoke too soon. Given the positive ab result and the fact it might be acute infection, there can be times when rna levels fluctuate to even undetectable. I will get an ab test in 6 weeks to assess if it was a false positive and if still positive I will get an rna level 12 weeks from now to assess if it had been transiently undetectable.

Just to help clarify. It is possible to have a test that is below the lowest level of detection but the result would be detected but without a viral load reading. This result is rare but it does occur in the case of some new infections. In your situation with a result coming back classified as NOT DETECTED; it most likely means exactly what it says, there is no HCV virus in your blood stream to detect and therefore you do not have HCV and most likely were never chronically infected in the first place.


Chronic infection with HCV is not a hit and miss affair with modern RNA by PCR testing these days. If you were exposed to the virus and cleared the virus then it would explain the positive AB test.
THIS IS WHY the AB test was repeated in the past along with being much cheaper than the procedure to test for HCV by PCR there was about a 10% possibility of false positives.


The older style and cheaper AB tests that are still being used in some places are not as reliable and should routinely be repeated before or along with the test for the presence of the virus. It may very well be that the labs your blood is being processed at cannot afford or obtain the newer more accurate HCV antibody test kits yet.


You are certainly not the first person on this forum to have a false positive AB test occur and indeed there is some debate as to how many people are actually clearing the virus spontaneously because a great many people who test positive for HCV antibodies are then too scared to take further testing.


I have spoken to quite a few people over the years who have tested positive for HCV antibodies but are not sure about their status because they have not gone on to take the PCR test to confirm an infection. They do not have any other symptoms of liver damage and know that more than 60 percent of those infected with HCV never go on to become chronically infected to a level where there is liver damage.


So essentially we cannot know for certain how many people actually have active HCV infections or the real percentile that clear the virus spontaneously.


You most likely do not have the disease at all. Like I said take things one step at a time and don't jump to conclusions until you are absolutely certain that you have verified quantifiable levels of a detectable HCV genotype that requires treatment.


Happy New Year
Eric

[Freahugs]

Update:

2/21/20 -Hep c ab positive, rna indeterminate 

The saga continues...my pcp referred me to a specialist in gastroenterology.

[Freahugs]

Any advice?

[Lynn K]

Don’t do any more antibody testing the results are of no value they will be the same as prior results either positive or indeterminate. I’ve never seen the HCV RNA by PCR test reported as indeterminate. Results are either detected with a viral load or not detected. If your not detected on the HCV RNA by PCR test you don’t have hep C. If you were ever exposed in the past or for some other reason are testing as positive on the antibody test that will never change. The only test you need is the HCV RNA by PCR test that looks for the actual virus in your blood.

See the gastroenterologist ask if they are experienced in diagnosis of hep c. They should be able to get this sorted out for you.