All very interesting...a few doubts and queries answered here for me as well........
Thanks to everyone that contributed their knowledge.
elizabeth
BJ said
Mar 5, 2011
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.
Fnzol said
Mar 5, 2011
I have asked my doctor for a recquisition for all 3 tests (anti-HCV, RIBA and PCR RNA) again.
Don't bother with anti-HCV and the confirmatory (RIBA). If you were exposed, you'll have some antibody reaction, and that will likely be with you for your lifetime. Not everyone, however, has the same end stage antigen/antibody reaction. You may never get a determinate result to the confirmatory. Not everyone produces the same full complement of bands that are read as the RIBA results.
It's also possible that you hadn't fully seroconverted at the time of the first RIBA. It may indeed confirm now. But, the PCR is the test to bank on. If you get another indeterminate confirmatory, well, you might. That's why I'd blow that off.
The PCR is counting the bugs themselves. Go with that one.
James10500 said
Mar 5, 2011
Hmmm, I should have read it again, makes no sense to me either.
PCR negative no active virus is what I meant to say.
Good luck, and let's us know what happened.
James
cdnab said
Mar 5, 2011
I have asked my doctor for a recquisition for all 3 tests (anti-HCV, RIBA and PCR RNA) again. I hope to have some peace of mind after those are done in a week or two. It would be nice to get the results from one time period to compare the three. Assuming the results are the same, i'll have to wait out the 6 month period to retest the PCR RNA and then i think i'll be OK assuming of course the PCR RNA is still negative.
One last question James. In your response what do you mean by "....negative housing have active virus". I don't really understand the context of that line.
James10500 said
Mar 5, 2011
I would come to the same conclusion. I see what you're saying about test timing. But the bottom line is if the PCR was negative housing have active virus. If there is a worry get tested again,it can only help your peace of mind.
James
cdnab said
Mar 4, 2011
I understand that antibodies can last for a lifetime. My point is that i believe i am in this scenario.
I tested positive (assume its correct) for anti-HCV antbodies using the RIBA test in mid December 2010. Based on the typical amounts of time the antibodies start forming i would say that i would be infected at the earliest in November 2010 but of course it could be November 1996. If i was truly positive and took the PCR RNA test AT THE SAME TIME as the RIBA test in December 2010, the result would be positive since the virus gets picked up earlier than any antibody, correct? I'm saying this becasue everywhere i've read it seems like a PCR RNA test will identify the virus faster than any antibodies would even form. I understand they are different tests but what i'd like to confirm is if i was infected on day 1 and got tested on day 28 the PCR RNA test would confirm the virus but ANY antibody test could show negative, indeterminate or positive becasue antibodies might not have formed yet, correct?
So what i'm saying is that if the RIBA was in fact correct but the PCR RNA test was done 2 months after the RIBA test, the only possible conclusion i can find is that i do not have the disease right now but i probably (again assuming RIBA was done correctly) was infected at some point in my life.
James i don't know if i've confused you more by what i wrote above but i do appreciate your time in answering my questions.
James10500 said
Mar 4, 2011
Positive anti-bodie tests don't mean anything untill they are confirmed by PCR. Anti bodies can remain in the body for a loooong time 20-30 years, with no active virus.
The PCR is the test to tell you not the anti bodie.
I hope that helps and is answering your question
James
-- Edited by James10500 on Saturday 5th of March 2011 02:20:09 AM
cdnab said
Mar 4, 2011
James thanks for your responses to date.
I have an additional question. Is it a fair assumption that if i did in fact have the virus, it would show up in the current (February 2011) PCR RNA test becasue the RIBA test was positive 2 months prior in December 2010? If i was truly positve so to speak then i asuume it would actually be detectable prior to any antibody tests. I have read that the RNA test detects the virus faster (3 weeks?) than the anti-HCV detects the antibodies (2 months i think?). Any comments?
James10500 said
Mar 4, 2011
It's extemely accurate. Maybe BJ will see the thread. He has worked with these tests in labs as a professional.
James
cdnab said
Mar 4, 2011
Hi James,
When you mention "the risk of false positive results is practically non-existent" for PCR tests, can you say the same thing about a false negative result? My test result was negative hence the question. Or are you saying that the test is accurate and either a positive or negative result will be correct.
Thanks
James10500 said
Mar 3, 2011
Hi,
Welcome to the forum. The qualitative test you took doesnt offer numerical results; it states detected or not detected.
PCR test results are considered very specific/accurate for infection; the risk of false positive results is practically non-existent.
The upper bound on my ALT tests is 71. When I started treatment my ALT was 184. 47 is not out of the norm imho.
James
cdnab said
Mar 3, 2011
Hi there,
This message board has many helpful people. I was hoping someone could give me some thoughts on some test results i have been given recently. A point to make is that i live in Canada. I'm not sure if the test results show differently in any way.
Had a physical for Life Insurance in December 2010. The tests were performed on December 20. ALT level was 47 with a normal range of 0-45. Hep B was negative. Hep C Ab (RIBA 3.0) was positive stating that a positive result meant that an "antibody was detected to at least two HCV proteins". There was also a band intensity given to which i have no clue what this means. Hopefully the formatiing works on this forum so this is what the result looked like. The results were a photocopy of a photocpy so i'm not sure if the Band intensity names are spelled correctly. Here are the results:
Band Intensity: 5-1-1B/C100B Band: Abnormal value of 2 CBBC Band: Normal value of 0 C22P Band: Abnormal value of 2 NS5 Band: Normal value of 0 DSOD Band: Normal value of 0
So i went to my doctor with horror and she made me do another bloodtest on about February 20, 2011. I had an anti-HCV test and an HCV PCR RNA test.
Anti-HCV results: Indeterminate. "Serology findings are equivocal for HCV infection. A follow up specimen of TWO SST blood is requested to test for HCV RNA by qualitative RT-PCR to define status of infection" My doctor followed up with a virologist ( i think thats the name). The 1st anti-HCV test was 1.2 which i was told is considered positive and the 2nd anti-HCV test was 0.9 which i was told is considered negative hence the indeterminate result.
HCV PCR-RNA: Negative. "Result was determined by Cobas Amplicor HCV v2.0 Qualitative (Roche Diagnostics System)
I have never done drugs and i don't believe i've ever had a blood transfusion. I was born overseas in Central Europe and my doctor had made a comment that perhaps the anti-bodies could have been passed on from my mother which i doubt. I have had unprotected sex (not much but i know that doesn't matter) but that was far back.
Questions: 1. My ALT level is 47 but my doctor says they don't consider anything abnormal until the level is 50 or higher. My wife's nursing textbook actually gives the normal level up to 55. But should i care about this anyways? I have read that Hep C positive people can have normal ALT levels anyways.
2. I have tried to find the band intensity meanings and can't. Can anyone provide some info on what they mean and what my results mean if there is anything important in terms of band intensity?
3. For the anti-HCV results. What does 0.9 and 1.2 represent? Units of something? Googling numbers is a disaster and all i ever see is positive, negative and indeterminate results for this test. But do the values go from 0-4 which seems like it in the RIBA test? Maybe someone with experience can give me an idea what the numbers mean.
4. I was quite surprised with getting a negative PCR-RNA result as supposedly RIBA is quite accurate but of course this is for antibodies ONLY and the PCR-RNA test tells you if you have the VIRUS ITSELF. There are a few websites (maybe 1 or 2) that i have found that a single negative RNA test doesn't necessarily tell you that you don't have this virus. I know that the test is something like 99.5% accurate and i could fall in the 0.5% but i am surprised about these websites interpretations. Can a lab actually screw up somehow (besides switching my samples) to create a false negative?
5. How quickly would a PCR-RNA test detect the virus? From what i've read it is usually 3 weeks. If i had the positive RIBA test in late December 2010 would the PCR-RNA test pickup the virus 2 months later in my late February test?
6. I have read an answer on here about cross-reaction with other antibidies in your immune system. Is this a distinct possibility in my case?
Any information would be greatly appreciated. It's great sites like this and the responses especially from first hand experience that goes along way in calming me down in this time.
All very interesting...a few doubts and queries answered here for me as well........
Thanks to everyone that contributed their knowledge.
elizabeth
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.
I have asked my doctor for a recquisition for all 3 tests (anti-HCV, RIBA and PCR RNA) again. I hope to have some peace of mind after those are done in a week or two. It would be nice to get the results from one time period to compare the three. Assuming the results are the same, i'll have to wait out the 6 month period to retest the PCR RNA and then i think i'll be OK assuming of course the PCR RNA is still negative.
One last question James. In your response what do you mean by "....negative housing have active virus". I don't really understand the context of that line.
I tested positive (assume its correct) for anti-HCV antbodies using the RIBA test in mid December 2010. Based on the typical amounts of time the antibodies start forming i would say that i would be infected at the earliest in November 2010 but of course it could be November 1996. If i was truly positive and took the PCR RNA test AT THE SAME TIME as the RIBA test in December 2010, the result would be positive since the virus gets picked up earlier than any antibody, correct? I'm saying this becasue everywhere i've read it seems like a PCR RNA test will identify the virus faster than any antibodies would even form. I understand they are different tests but what i'd like to confirm is if i was infected on day 1 and got tested on day 28 the PCR RNA test would confirm the virus but ANY antibody test could show negative, indeterminate or positive becasue antibodies might not have formed yet, correct?
So what i'm saying is that if the RIBA was in fact correct but the PCR RNA test was done 2 months after the RIBA test, the only possible conclusion i can find is that i do not have the disease right now but i probably (again assuming RIBA was done correctly) was infected at some point in my life.
James i don't know if i've confused you more by what i wrote above but i do appreciate your time in answering my questions.
The PCR is the test to tell you not the anti bodie.
I hope that helps and is answering your question
James
-- Edited by James10500 on Saturday 5th of March 2011 02:20:09 AM
I have an additional question. Is it a fair assumption that if i did in fact have the virus, it would show up in the current (February 2011) PCR RNA test becasue the RIBA test was positive 2 months prior in December 2010? If i was truly positve so to speak then i asuume it would actually be detectable prior to any antibody tests. I have read that the RNA test detects the virus faster (3 weeks?) than the anti-HCV detects the antibodies (2 months i think?). Any comments?
James
Hi James,
When you mention "the risk of false positive results is practically non-existent" for PCR tests, can you say the same thing about a false negative result? My test result was negative hence the question. Or are you saying that the test is accurate and either a positive or negative result will be correct.
Thanks
Welcome to the forum. The qualitative test you took doesnt offer numerical results; it states detected or not detected.
PCR test results are considered very specific/accurate for infection; the risk of false positive results is practically non-existent.
The upper bound on my ALT tests is 71. When I started treatment my ALT was 184. 47 is not out of the norm imho.
James
This message board has many helpful people. I was hoping someone could give me some thoughts on some test results i have been given recently. A point to make is that i live in Canada. I'm not sure if the test results show differently in any way.
Had a physical for Life Insurance in December 2010. The tests were performed on December 20. ALT level was 47 with a normal range of 0-45. Hep B was negative. Hep C Ab (RIBA 3.0) was positive stating that a positive result meant that an "antibody was detected to at least two HCV proteins". There was also a band intensity given to which i have no clue what this means. Hopefully the formatiing works on this forum so this is what the result looked like. The results were a photocopy of a photocpy so i'm not sure if the Band intensity names are spelled correctly. Here are the results:
Band Intensity:
5-1-1B/C100B Band: Abnormal value of 2
CBBC Band: Normal value of 0
C22P Band: Abnormal value of 2
NS5 Band: Normal value of 0
DSOD Band: Normal value of 0
Chiron recombinant immunoblot assay HCV 3.0 Band Intensity (0=non-detected... ...4=strongly detected)
So i went to my doctor with horror and she made me do another bloodtest on about February 20, 2011. I had an anti-HCV test and an HCV PCR RNA test.
Anti-HCV results: Indeterminate. "Serology findings are equivocal for HCV infection. A follow up specimen of TWO SST blood is requested to test for HCV RNA by qualitative RT-PCR to define status of infection" My doctor followed up with a virologist ( i think thats the name). The 1st anti-HCV test was 1.2 which i was told is considered positive and the 2nd anti-HCV test was 0.9 which i was told is considered negative hence the indeterminate result.
HCV PCR-RNA: Negative. "Result was determined by Cobas Amplicor HCV v2.0 Qualitative (Roche Diagnostics System)
I have never done drugs and i don't believe i've ever had a blood transfusion. I was born overseas in Central Europe and my doctor had made a comment that perhaps the anti-bodies could have been passed on from my mother which i doubt. I have had unprotected sex (not much but i know that doesn't matter) but that was far back.
Questions:
1. My ALT level is 47 but my doctor says they don't consider anything abnormal until the level is 50 or higher. My wife's nursing textbook actually gives the normal level up to 55. But should i care about this anyways? I have read that Hep C positive people can have normal ALT levels anyways.
2. I have tried to find the band intensity meanings and can't. Can anyone provide some info on what they mean and what my results mean if there is anything important in terms of band intensity?
3. For the anti-HCV results. What does 0.9 and 1.2 represent? Units of something? Googling numbers is a disaster and all i ever see is positive, negative and indeterminate results for this test. But do the values go from 0-4 which seems like it in the RIBA test? Maybe someone with experience can give me an idea what the numbers mean.
4. I was quite surprised with getting a negative PCR-RNA result as supposedly RIBA is quite accurate but of course this is for antibodies ONLY and the PCR-RNA test tells you if you have the VIRUS ITSELF. There are a few websites (maybe 1 or 2) that i have found that a single negative RNA test doesn't necessarily tell you that you don't have this virus. I know that the test is something like 99.5% accurate and i could fall in the 0.5% but i am surprised about these websites interpretations. Can a lab actually screw up somehow (besides switching my samples) to create a false negative?
5. How quickly would a PCR-RNA test detect the virus? From what i've read it is usually 3 weeks. If i had the positive RIBA test in late December 2010 would the PCR-RNA test pickup the virus 2 months later in my late February test?
6. I have read an answer on here about cross-reaction with other antibidies in your immune system. Is this a distinct possibility in my case?
Any information would be greatly appreciated. It's great sites like this and the responses especially from first hand experience that goes along way in calming me down in this time.
Thanks again for any responses.