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Author Topic: I'm confused by latest genotyping. Could I be infected with two strains?  (Read 7219 times)

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Offline Aussie

  • Member
  • Posts: 11
1986 - non-specific AB

1998 - genotype was 1b.

2010 - genotype 4e

2013 - genotype 4e

2017 - genotype 1b/E&E/4

My treating GP is perplexed by this latest result, he's not seen a genotype(s) reported like this and is awaiting a verbal response from the pathology company. The tests performed in the last three genotypings were using the  "VERSANT HCV Genotyping 2.0 assay (LiPA)".

The local liver clinic (2010 & 2013) felt the initial genotyping of 1b could have been as a result of unsophisticated testing procedures back in 1998.

Can anyone make sense of genotype 1b/E&E/4?

« Last Edit: March 08, 2017, 01:09:22 am by Aussie »
G1b & G4e (multiple infection)
Infected after blood transfusion as an infant and IV drug use in 1980s
Diagnosed 1986
Currently on Zapatier (started 16-1-17)
No Cirrhosis
VL 46000
ALT 43
AST 48
GGT 51
4 weeks into treatment LFTs are within normal range
ALT 26
AST 29
GGT 24
HCV & VL not tested

8 weeks into treatment
ALT 21
AST 20
GGT 19

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,544
  • Get tested, get treated, get cured, fight Hep c!
Well the old result 1986 was before there was a hep c genotype test so at the time hep c was called non a non b.

As far as your most recent test result it looks like you may be infected with both genotype 1B and 4E that doesn't happen every day but it does happen. If I am correct you would need a treatment that works for both genotypes.

If your doctor cannot understand your test results I would look for a doctor who has experience treating hep c. Can you see an infectious disease specialist or gastroenterologist?
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Gaj

  • Member
  • Posts: 172
  • Optimist
Multiple genotype infection is not commonly diagnosed but is thought to occur more often than reported. This may be due to one of the genotypes being more dominant at the time of testing and/or once the lab gets a confirmed result for one they may stop looking. Both these factors plus improvements in the accuracy of testing over the years could easily explain your varying results over time. Fortunately Zepatier is very effective and recommended for both your genotypes.
Male - 61 years
Genotype 3a (since 1978?)
Diagnosed 2012
Treated 2013 PEG/Riba/Dac (Relapsed)
F4 - HCC#1 Resected 06/15 - #2 RFAblated 11/15
11/18/15 Commenced Generic Tx - Sof/Dac/Riba (24wks)
Pre Tx = ALT: 270  AST: 209  ALB: 31
05/05/16 = ALT: 34  AST: 32  ALB: 40  VL: Undetected (EOT)
06/16/16 = Relapsed
06/23/16 = ALT: 92  AST: 59  ALB: 40  VL: 290,770
01/12/17 3rd Tx - Zepatier + Sofosbuvir (16wks)
05/03/17 EOT und
06/22/17 SVR7 und
07/27/17 SVR12 UND!
10/26/17 SVR24 UND & Cured!!!

Offline Mugwump

  • Member
  • Posts: 778
  • My number of posts means nothing, piscor ergo sum!
The genotype 4e seems to be more prevalent in the Egypt and Saudi Arabia for some strange reason. The demographics of genotypes are fascinating indeed. I fully understand that this means nothing if you have the disease though!

The genotypes of the 4 group including 4e seem to be less aggressive and consequently less well studied except where they are more common. I can fully understand if your doctor is puzzled by the lab report but an experienced specialist should be up to speed on what your best options are for treatment if the lab report is correct and you have a dual genotype infection. I would not be surprised if another genotype test is called for just to confirm that you indeed have a dual genotype infection. Either way your circumstance is quite rare and a specialist should be consulted for sure.

If you did travel to the Middle East and had any type of medical procedure there, stitches, a tooth pulled, tattoo or whatever, then this could very well explain the situation. 

Caution shameless self promotion below :-)
https://www.hepmag.com/article/eric-reesor-27742-782589663
DING DONG MY DRAGON (HCV) IS FINALLY DEAD!

Offline Aussie

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  • Posts: 11
It is thought the 4e genotype possibly resulted from a blood transfusion in the early 1960s, while travelling in Tahiti with my family at the age of 2. Genotype 1b could have resulted from IV drug use in the 1980s.

My treating doctor has failed to get back to me about the most recent genotyping, but as you have said, Zepatier treats both genotypes 1 and 4. I had my week 8 blood test done yesterday and I will make an appointment to see the treating doctor to follow-up on those results and that of the genotyping.
G1b & G4e (multiple infection)
Infected after blood transfusion as an infant and IV drug use in 1980s
Diagnosed 1986
Currently on Zapatier (started 16-1-17)
No Cirrhosis
VL 46000
ALT 43
AST 48
GGT 51
4 weeks into treatment LFTs are within normal range
ALT 26
AST 29
GGT 24
HCV & VL not tested

8 weeks into treatment
ALT 21
AST 20
GGT 19

Offline Aussie

  • Member
  • Posts: 11
I had an appointment with my treating doctor last week, it has been confirmed that I do indeed have both genotype 1b and genotype 4e.

He has spoken with the drug company that distributes Zepatier, they say there is no need to have anymore than 12 weeks of treatment. Yipeee :)

Blood tests so far are proving to be promising. Only 9 days left of treatment!
G1b & G4e (multiple infection)
Infected after blood transfusion as an infant and IV drug use in 1980s
Diagnosed 1986
Currently on Zapatier (started 16-1-17)
No Cirrhosis
VL 46000
ALT 43
AST 48
GGT 51
4 weeks into treatment LFTs are within normal range
ALT 26
AST 29
GGT 24
HCV & VL not tested

8 weeks into treatment
ALT 21
AST 20
GGT 19

Offline gnatcatcher

  • Member
  • Posts: 1,372
. . . Blood tests so far are proving to be promising. Only 9 days left of treatment!

Yes, indeed. Your liver is improving nicely.
9/29/71 transfusions
HCV genotype 1a
7/09/15-9/30/15 Harvoni

Before treatment:
Viral Load 9,490,582
FibroScan 19.5 kPa [F4]
ALT 262
AST 217
ALP 183

Most recent:
VL still UNDETECTED (SVR 102)
FibroScan 7.6 kPa [F1-2]
ALT 15
AST 20
ALP 85

 


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