Hep C Discussion Forum

Dear Brad, I cannot find the reference about Heptimax TMA picking up 12.5% of undetecteds. We do not have Heptimax in Australia. My lab. does the ?latest Roche Quantitative PCR, and goes down to 15 copies. However, we can only get 4 tests a year on Medicare. My doc. says the Qualitative PCR ( measuring down to 50) is good enough. I am not convinced as the difference between 5 and 50 copies seems significant. How many people in the States have access to Heptimax? Cheers.

My dr and the nurses have not been on the same page.  Because of that, I've gotten VLs done at Weeks 4, 8, 9, 10, 11.  So yesterday my dr said all Labs every 3 weeks only.  Nurse said weekly labs for CBC only and big labs every 4 weeks.  But everything was getting done weekly.  So now new schedule is everything gets checked every 3 weeks.  Dr told me I will become more anemic with labs weekly, lol.

Thanks, Brad.  I am going to think that way, because I don't see how anything can stay alive when it's being fought with Victrelis (lol).  It's my "firepower".  Never lets me forget it's there, fighting with that ferocious, firey aftertaste.  I'll never get used to it, and I hope the virus won't, either.

I'm still betting on UND.

Brad

You guys are awesome; I am constantly learning so much from you all. 

Jeremy, thank you.  I SO appreciate seeing others' results on paper because they are all a bit different, showing extra info.  Helpful!!  Mine reads about the same with the quantitation range, but none of mine say "Range of Detection" like yours, and show that 7 - 69 mil range.  I have never seen that. 

You're right, not much difference between 5 or 7 copies.  I wish I could see that detectection range on my lab result.

Today is my dr appt and I'm not leaving without the actual lab report for that May 9 lab which showed 43.  So far, I've just been told this over the phone.  Not <43, but 43 is what she said.  I'd like to see exactly how it is reported on paper.  Thank you so much for the vital info!!   : )

My UND are all from Heptimax .... 

Correction.  My level was 43 (not 46) on May 9.  UND again on May 16.

The test they use only measures  the virus from 43, up to 69 million.  So my 43 was right there, just where the test starts detecting. 

I put in a message to my dr to ask if the Hepti-max test is avail, being that it measures down to 5.

It's exactly what Sunrise just said.  We're only UND if the tests avail at the time don't find the virus.  In my case, it won't find less than 43.

Here might be a good reason to get the 2-part Heptimax, or other TMA test.  Although it doesn't change the outcome, it sure seems to improve the predictive value (actually, it COULD change outcome, since you'd know to possibly extend TX).   Quest Diagnostics uses this test.

From:   http://questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TH_HEPTIMAX.htm

"Although Labcorp and Quest claim comparable sensitivity for their HCV RNA tests, several studies showed that significant percentage of PCR negative patients turn out to be TMA positive. One recent study found that 12.5%(!) of patients who showed clear by PCR at end of treatment had detectible virus when measured by TMA. Naturally, nearly every one of those with detectible virus by TMA relapsed when treatment was withdrawn."

That 12.5% number is pretty big, and may help to explain some of the "relapses", which were really a failure to go UND. in the first place.

This was taken directly off my test result sheet:

"HEPTIMAX (R) HCV RNA (PCR) -- 
HEPTIMAX (R) HCV RNA (TMA) <5

Because the HCV RNA level was below 
43 IU/mL using the Real-Time PCR method,
the sample was assayed using the 
Transcription-Mediated Amplification(TMA)
method."

Good luck, Judy and everyone on this journey,

Brad

Thanks you guys.  My best guess is that they still can't truly eradicate a virus, any virus, with 100% certainty.  They mutate.  I believe that's why we're not considered SVR until 6 months after tx is finished.  They must figure that if it hasn't replicated to a detectable level by then, they must have gotten it all.  Even after that, 1% relapse.

was just talkin bout this very thing with someone today

curious too how if its und, how can it reverse.? and well, yeh its a bit confusing...

CAN IT COME BACK.. like after SVR....?

Thank you, Dave!  I'm so confused, now, sheesh.

Brad, I saw that Steven became Detected at <12 after so much time with UND status.  Then went UND again.  And then it happened to me.  So what do you think?  That it was a false read?  I mean, there's no little strand of virus that stays with us, that can't be detected by testing, is there??  These tests can drive a person nuts.

Thank you for the info on the types of tests.  Mine says PCR.  I didn't know about the Hepti-max at all, but now I will ask my Dr about it.  Mine always says:  Hep C Virus RNA Viral Load PCR.  That gives my number.  Under that, it states:  HCV RNA, SER/PLAS, PCR and that gives a much smaller number.  I know it's serum plasma and that showed UND as well. 

It states the linear range for this assay is 43 - 69 million.  So does that mean if I'm under 43 I will always test UND?  That means that some virus can remain, to replicate, no?

I've been keeping all of my labs and radiology and any surgery records for past 20 years.  I'm pretty anal about it, lol.  I keep hard copies in a labeled folder in my file cabinet and always scan them into my computer so they're electronic, too.  Then I back them up on disk every few months.

I know what every single lab result is and fully understand it and been following all labs for couple of decades.  I've even charted All of my numbers for everything in Excel for years, lol.  THAT is why I was So upset that they didn't even tell me they did more Viral Load counts! 

I have Kaiser and they're avail online within a couple of hours after CBC, then the rest come in next few days with email notifications.  Some labs are not released (Kaiser's system) so I'm Constantly calling in to ask nurse to ask Dr to release my labs, so I can get them online.  Sometimes I drive out there for hard copies if they're slow.  They Know how I am and they know I'm a CMA so can read everything easily and they don't need to "hide" abnormal results from me; I know what I have.  Ugh, it's so upsetting; they know I stay very on top of All of my numbers.

Well, I am currently UND again.  Last Wed labs showed UND again.  The Wed before that was 46.  The Wed before that was UND.  Tomorrow I go for labs again; every Wed.  Now I'm all nervous!

What is going on?  I went to UND somewhere between Weeks 4 and 8.  I happened to call my dr office today and found out they did Quantitative tests both on May 9th and 16th, along with the CBC, enzymes, etc.  I didn't know they did that; thought I was just getting Viral Load testing every 4 weeks.

Well......she told me that after my UND at Week 8 (May 2 labs), I went Back to Detected at 46 on May 9th!!  Then UND again on May 16th.

I asked why they didn't tell me this and she said because it's under borderline so not considered news.

Sooo......does anybody get Viral Loads done weekly?  Do our numbers jump around?  What exactly IS UND?  A few parts that may or may not register??  Is testing often faulty?  How many parts can the test detect?  Why do we relapse if we continuously test UND?  Where does it come from?  I'm so confused, now.