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Post Info TOPIC: Lab work—what to look at? Treatment and insurance...
Tig


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RE: Lab work—what to look at? Treatment and insurance...
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It's always encouraging in the acute phase of the infection to see all of those numbers dropping. If I were in your shoes, I would absolutely wait until you have either cleared on your own (20% avg) or your doctor diagnoses you in the chronic phase of the disease. I'm not sure your insurance would approve it anyway at this point. They will also want you to wait for at least 6 months. Truly, if there is a chance that you can clear this on your own, wait to find out. The thought of easy approval is nice, but if you don't have to subject yourself to treatment, don't. It's easier now but it still takes it out of you.

I'll answer your questions best I can:

1. The AST/ALT can elevate again if the disease is active. Often, people don't witness an elevation until years later. It depends on the damage to your liver. Sicker livers tend to show elevations on a regular basis, but depending on your immune system response, things like the viral load and test levels will fluctuate.

2. Yes, I have seen people clear this on their own. 20% historically will do it on their own.

3. The blood test you referred to is called the Fibrosure test. It measures blood markers and they are calculated in a manner that is said to stage fibrosis. It's inaccurate IMO but they may be improving it with practice. It is known to be inaccurate at both the very low and very high ends of the scale. So you understand my skepticism. Google it.

4. There are no recognized alternative treatments outside of those we speak of here. There are always new trials ongoing but they aren't available to consider unless selected into a study. The other medications you mention will have no action or curative value on the Hep C virus.

I hope this answers some questions! Good luck....



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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obsessing


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Hi all,

I got my labs back from last week and things look even better.

Viral load 70,391, dropped from 327,777

ALT 68, dropped from 411

AST 35, dropped from 372 (in normal range!)

I asked my doctor if I could do another set of labs next week and if still reactive, start TX on Harvoni because my insurance company has an agreement with Harvoni and I will be changing insurance companies soon. He wanted to wait until the end of July because with every lab my numbers are dropping and he actually thinks my body could clear this on it's own but I've read the chances are only 15%. And even though my numbers are low, they will continuously fluctuate. I was told that I have some very minor scarring. Questions:

1. When the AST drops to normal range, can it go back up again?

2. Have you ever heard of anyone clearing Hep C on their own?

3. The scarring was detected with a blood test not a Fibroscan. Is that possible?

4. Because my numbers are so low and have only dropped, never fluctuating, should I be asking about alternative anti-viral meds or is Harvoni and the two others my only option? Could something common like Valtrex, Favir or Tamiflu help my body clear the HCV?

 



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46 year old male, DX March 2015, Gen type 1a, Harvoni TX started 3 months July-September 2015. SVR 4 months now.

 
Cinnamon Girl


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HI again Obsessing,

I  think that sounds very likely, that the first set of high numbers were from your first lab tests, when the Hep C infection was still in the acute phase, and now your latest readings indicate it has settled down more.

Your genotype testing isn`t repeated once it`s been established, and I remember you said that you have Gen 1a, is that right? 

Actually it would be very useful to us if you could write that information in your `Signature` line so that it shows beneath all your posts, underneath the short black line.  And you could add your date of diagnosis and the fact that you`re waiting for tx, that sort of information helps us a lot when replying to you.  Go to your `User Details` page and you should see where you can do that, in the box marked `Profile`.

Let us know when you have more information and try not to get too stressed about starting treatment.  If you were infected with Hep C only a few months ago it won`t have had time to do any serious damage at all, and you have plenty of time to wait and consider your options.

Wishing you all the best!  smile

 



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Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 
obsessing


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Thanks. This is helpful. I'm my own patient advocate so need to know what to ask the doctor, what the numbers mean and that I can push for treatment now even if denied by insurance. Why not? Both of my doctors (the first one I didn't like) said that they could treat me now but to wait and see if it clears on its own the first three monthseven though there's only a 15% chance.

As far as the discrepancy in numbers, my doctor must have been comparing my first set of labs to my second. I thought the second set of labs were taken just to determine the genotype because I can't find the ALT and AST numbers on the report. My next set of labs are scheduled for tomorrow and I can see on the lab sheet everything I'll be tested for but a lot of it is coded or abbreviated. Next week, I'll talk to my doctor about the results, get clarification on the numbers, ask what kind of ultrasound I had, the Fibroscan and treatment.

Will give you guys an update next week. Hopefully good news.



__________________

46 year old male, DX March 2015, Gen type 1a, Harvoni TX started 3 months July-September 2015. SVR 4 months now.

 
Cinnamon Girl


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Hi again Obsessing,

I`m glad you`ve got some lab results back now.   Yes, your viral load is low, although as Tig said, this can fluctuate quite a lot over time. 

The  ALT (SGPT) and AST (SGOT) numbers of 60 and 50 seem more likely, and about what we`d expect to see with an ongoing Hep C infection, and I`m not too sure what the other set of figures relate to.

It`s good to hear that your ultrasound scan was clear, although it will only show liver damage once it`s reached an advanced stage.  For a more accurate reading you would need to have either a liver biopsy or a non-intrusive Fibroscan test. 

About when to start treatment, I guess if you have good insurance now would be a good time to get the ball rolling bearing in mind the approval time could take a while, especially if you`re denied the first time round.  You`ll need to discuss that more with your doctor really, and also if you could ask for more clarification about your lab results that would be useful information to have.

I`m so pleased you`re managing to stay clean from drugs, very well done!  I know it`s not an easy thing to do, for many reasons.  You`re taking back control of your health and your life, which is wonderful! 

Keep in touch and best of luck!  smile



__________________

Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 
Tig


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Hi Obsessing,

Glad to hear you're hanging in there and have made such great progress! You're to be commended for accomplishing a none too easy task like that. Each day is another day to be proud of yourself, so keep it up!

Your viral load is still considered in the low range, but it can and does fluctuate. It doesn't impact your ability to achieve SVR (cure) regardless of number, but if it's above 6 million IU/ml, a person may have to take treatment for a longer period.

The ALT (SGPT) score of 372 is fairly elevated. So is the AST (SGOT) of 411. They do indicate that you have some liver disease and inflammation going on. The higher they climb and longer they stay that way, is an indication the injury is continuing to progress. Did you have them repeated after the first set of tests? The other two figures of 60 and 50 are much improved over the first. I would have to see the lab report to understand it better. You should ask your doctor or his office for clarification.

As far as the liver ultrasound is concerned, was it a basic test or the test known as a Fibroscan? A basic test looks for abnormalities in the liver, such as size, cancers, and anatomy. The Fibroscan measures the liver density and is a specialized test. That is done to measure fibrosis stage, similar to what a biopsy determines. Have they mentioned anything about the possibility of fibrosis/cirrhosis? That's what the latter two tests help determine. Generally all insurance carriers require a current fibrosis staging before approving treatment. If you're not yet at an advanced stage, many won't approve it until you are. We hope to see that foolish requirement go away soon.

In my opinion, it's always good to push for treatment as soon as possible. The sooner you can rid yourself of this disease the better. Why should anyone have to wait until things reach an advanced stage? It makes little sense.

Here are a couple of links that will better explain the blood tests you had done. Be sure to check out our search function above for information on many items discussed here. Let me know if you have any other questions. 

 http://www.hepatitiscentral.com/hcv/hepatitis/loadchart/

http://www.mayoclinic.org/tests-procedures/liver-function-tests/basics/results/prc-20012602

 



__________________

Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

Hep C FAQ   Lab Ref. Ranges  HCV Resistance

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obsessing


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Thank you all for the support! I don't feel too alone knowing that others have transmitted Hep C from needles. I've been clean for 6 weeks now! It's quite a change not waking up on the floor or walking into walls. I told my entire family to hide all of their prescriptions.

I got lab results back. I'm trying to figure out what's most important to look at. My doctor said that I'm barely reactive and that I could have already gone through the acute phase already. Please tell me if this is what's most important to know:

Viral load: 327,777 Doctor said this is very low. 

Alanine aminotransferase (SGPT) 372 U/L on the lab report but my doctor is saying that it's around 60

Aspartate aminotransferase (AST or SGOT) 411 U/L on the lab report but again the doctor is saying it's around 50

My ultrasound showed no liver damage.

So I don't understand the discrepancy but in any case everything has gone down. I'm getting another set of labs done this week.

Once concern...I have very good health insurance now. Aetna has an agreement with Harvoni that cuts the cost of treatment in half. So maybe they are more likely to cover treatment with just a co-pay. When I get a new job, I'm not sure what that insurance will be and whether I'll have such good coverage. My doctor says to wait but I'm worried that the new insurance may not have such an agreement. Should I push for treatment now? I haven't discussed this with the Dr yet. Does insurance only cover treatment if labs show significant liver damage? 



__________________

46 year old male, DX March 2015, Gen type 1a, Harvoni TX started 3 months July-September 2015. SVR 4 months now.

 
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