How do I read my Lab test results

[duekah]

I have had Hep-C  Geno 1B &2B for 25 years but just recently discovered(4yrs) , after continued good AST and ALT numbers an examination by a Specialist and after a Liver Bio . The Strategy was to watch the numbers and not treat. However the latest lab results showed an AST of 83 and an ALT of 149 these are high according to the ref numbers on the report.If you would be so kind as to answer a few questions 1) is there a place on this site that describes how to interpret lab results? 2) are those numbers really high? (I have been doing hard workouts)2) should I ask my PCP to immediatly refer me to the specialist ? 3) is another Liver Bio the main decider of needed treatment ?
      The origional main goals 4 years ago was to last long enough to avoid grueling interferon torture and be able to use more modern treatments . Thank you all in advance.

[FRESHSTART51]

HELLO, JUST GOT MY FIRST VIRAL LOAD     REPORT READ DETECTED 3.32E+6iIU/ML   COULD ANYONE EXPLAIN THESE RESULTS TO ME. THANK YOU

[chemister]

I had also little to high ALAT and ASAT in 30 years. In the start of the treatment it went little more up, but later the liver enzymes went to normal :)
Good luck

[chemister]

Hello...
I have also geno 1 and 2, and my specialist-doctor tells me that double infection is easier to treat than only geno 1. Maybe geno 2 are 80% of the virus load and your
Geno 1 is 20 %, if you are lucky, you can easier respond to the treatment.
I had start virus load 2 700 000 IU/mL,
Week 1                          6300 IU/mL
Week 3 and 4                  UND

I am a rapid virus responder and will be treated with geno 1 and 2 for 24 weeks :)

[duekah]

Thank you so much for your input and the references to how to read the lab results, I don't have the most competent PCP so as advised I get my OWN copy of the blood work . I have done as you all have suggested and will be refered to the specialist (I hope its the same guy but I am powerless over that ) The BIO doesn't scare me that much, but I have been worrying myself silly thinking about this Hep-C. I will definately lay off the grueling workouts (or any workouts) 2 wks before the next Blood test. My PCP gave me a repeat test authorization he said to use in about a month or so. Leave it to me to get some weird combination, now if I could just get them to kill each other off , or kill the 1B and leave the more killable 2B that would be good. Or maybe I am so rare I would get the attention of the top medical scientists (NAHH!) I will definately try to remember to have the Geno types rechecked.
                 Godspeed to All                 Duekah

[Marcia2202]

no wonder they didn't mention anything about cleavage in my reports....

[nygirl7]

about cleavage on my report.


I never got cleavage till after treatment......maybe we can copyright the idea and sell it to all those still looking for some - you know interferon boosts your bust? I tell you I ALWAYS wanted some but now that I got it it's like blah my clothes fit better BEFORE........

Always want what you don't have and right now I'm looking money $$$$$ cause the cleavage is straight.

hahahaha we're bad but that's ok :)

[jdwithhcv]

Don't you just love modern science!

Florence, sounds like great fun.  Have a blast.

[portann]

I'm going to need some for Florence but I'll have to use those weird things that look like jelly. I used them at the wedding and wow! They're hot and sticky, though, but not that way.

I had no idea that guys of all sorts love cleavage. Live and learn and don't leave for Florence without them.

[jdwithhcv]

I find that when I display cleavage, I get worked up extra ;^)

[portann]

Thanks, NY, for posting that study. The number of false positives took me by surprise.

What is this specialized testing and should we assume that the masses don't get a work-up with enzyme CLEAVAGE?! If so, how many of us think we are co-infected when we're not? I have no idea what I got when I was genotyped but I never noticed anything about cleavage on my report.

From the study posted above:

"Further analysis based on restriction fragment length polymorphism (RFLP) on type-specific PCR products was used to verify genotyping results. Only four coinfections (1a + 1b in 2 patients and 1b + 2 (a/c) in the remaining 2 patients, respectively) were confirmed by enzyme cleavage.")

So out of 213 subjects, two were verified to have one genotype (with two subsets) and two were verified to have 1b and 2 (a/c).

Jim, do I understand the study correctly? (213 minus 54% of 213, minus 27% of 213, minus 5% of 213, minus 3% of 213 equals not many co-infected subjects remaining and then of those, most had tested falsely.) Only two had co-infections of different genotypes and they both had cirrhosis.

("Only four coinfections (1a + 1b in 2 patients and 1b + 2 (a/c) in the remaining 2 patients, respectively) were confirmed by enzyme cleavage. All patients with true coinfection had long-lasting infection and liver cirrhosis." )

It seems to me that most of the patients in this study originally thought to be co-infected were not. What happened to those two people who had two genotypes long-term and what is the significance, if any, that they both had cirrhosis?  

Duekah presumably did not have cirrhosis, given that his specialist recommended waiting. Could he have had a false reading? Or do dual genotypes not co-exist for long? I'm very curious to hear his new results.

If we rule out false readings, of which there were many on this study from Florence (hi, Florence, I'll be seeing you so soon), would genotype (1 and 2) continue long-term or would one knock out the other?

That's what I'm curious about, specifically regarding Duekah.

Duekah, I hope you get to your specialist soon, for your sake. Please don't bury your head in the sand, which is what I did. My PCP was perfectly happy to do the same but my hepatologist was alarmed that I'd left it so long.

[nygirl7]

Oh look they are considering it coinfection of two separate genotypes.......my 1A and 1B is listed right in the list as coinfection of geno! I thought I had it right but really never think about it anymore so I wasn't absolutely sure.

. In this study we determined the effective prevalence of coinfections by two or more HCV genotypes in 213 subjects

coinfected by types 1a + 1b, while the remaining 19 patients had a b + 2 (a/c) mixed infection. Further analysis based on restriction fragment length polymorphism (RFLP) on type-specific PCR products was used to verify genotyping results. Only four coinfections (1a + 1b in 2 patients

[nygirl7]

I just found this - since I had the two I was curious to see if anybody actually did any sort of study. I guess mine is pretty common but they do consider it "mixed infection"

Prevalence of mixed infection by different hepatitis C virus genotypes in patients with hepatitis C virus-related chronic liver disease.Giannini C, Giannelli F, Monti M, Careccia G, Marrocchi ME, Laffi G, Gentilini P, Zignego AL.
Institute of Internal Medicine, University of Florence School of Medicine, Italy.

Multiple infection by different hepatitis C virus (HCV) genotypes may be of great clinico-pathologic interest. In this study we determined the effective prevalence of coinfections by two or more HCV genotypes in 213 subjects with HCV-positive chronic hepatitis by using genotype-specific polymerase chain reaction (PCR), genotype-specific probe hybridization, and direct sequencing. The most prevalent genotype was HCV-1b (54%). HCV-2 (a/c) was also prevalent (27%), and types 1a and 3a were found in 5% and 3% of patients, respectively. A mixed infection was detected in 23 patients (10.8%): 4 out of 23 were coinfected by types 1a + 1b, while the remaining 19 patients had a b + 2 (a/c) mixed infection. Further analysis based on restriction fragment length polymorphism (RFLP) on type-specific PCR products was used to verify genotyping results. Only four coinfections (1a + 1b in 2 patients and 1b + 2 (a/c) in the remaining 2 patients, respectively) were confirmed by enzyme cleavage. All patients with true coinfection had long-lasting infection and liver cirrhosis. Both true and false mixed infections resulting from RFLP analysis were confirmed by direct sequencing of type-specific amplification products. We also determined a recurrent C/T transversion at position 618 in all sequenced samples. In 4 cases another point mutation (G/A at position 626) was found, reducing the number of mismatches between HCV-2 and HCV-1b from 4 to 3 (or 2). Interestingly, all HCV-2 isolates sequenced showed the highest degree of nucleotide homology with HCV-2 subtype c, confirming the relatively high prevalence of this subtype in Italy. In conclusion, we showed the possibility of multiple infection by different HCV types in the general population of chronically infected patients without particular risk factors, even if in a low percentage of cases. Further studies are needed to assess the clinical relevance of chronic HCV infection with multiple genotypes

[portann]

Please keep me posted once you see your specialist again. My guess is he'll want another biopsy soon.

I hope you're re-tested for genotyping. I can't think of anyone except you in this forum who has or had two different genotypes at the same time. Does anyone know?

Susan only had one genotype with two subsets of it, which is not what Wiki referenced.

There is no reason to assume that genotypes are equivalent to subsets, that we can paint them with the same brush or that the Wiki reference doesn't distinguish between the two. (NY: "Still same pricincipal should seem to apply..." )

I can't because I don't know. Can anyone refer me to a source that blurs the distinction between subsets and genotypes and then lumps them together in terms of co-existence?

The Wiki reference stated, "In most of these cases", so it would be neat to know the results of your new genotyping - now that it's been four years since your last one - and
whether you fall into the "most of these cases", if this reference holds water.

The key is to know your current profile and to be in the hands of a very experienced HCV doctor, so please book that appointment with your specialist and not slip through the cracks.

Best of luck and hope to hear from you soon.

[nygirl7]

Most of us have had two different strains not geno's. Susan had 1A 1B and I "believe" was left with only A.  Still same pricincipal should seem to apply (although I would imagine in most settings a 2 would be wiped out by a 1 - while in strains the stronger B would wipe out the A if indeed B is stronger which I have always heard).

I still wouldn't count on it happening - although it could explain why there are not more true dual geno's in the IVDU class where you'd imagine. My understanding though (from  my exhusband) is that he always just believed there was one kind of hepC and if you had it you had it therefore you could shoot up with anybody you felt like it cause you already had it.  GREAT logic huh?  Which might be why I had two if indeed I had caught it from him and not in the 80s as we always assume.

There have been a few real true geno mixes though over the years but none of them hung around for too long (or I just didn't get to know them).  Somebody else might remember better than me who can't remember anybody's stats except Susan because we are friends aside from the forum.

[portann]

Can you tell me who else other than Duekah has or had two different genotypes, not subsets of one? Does or did Susan have two different genotypes and do you know for how long?

Susan, are you there?

[nygirl7]

In most of these cases, one of the strains removes the other from the host in a short time[7]."

It might be true but there have been enough of us on here with two strains to show that they can coexist together.

And in another case Susan400 treated diligently and erradicated one but not the other.

You can't take it for granted because my reinfection chances were pretty non-existent as far as I can tell anyway.

Get the biopsy to be sure.

[portann]

Hi Duekah,

Regardless of your ALT levels, I recommend you return to the specialist you saw four years ago for follow-up.

The reason I say this is that my hepatologist (liver specialist) had the same viewpoint as yours when I saw him in 1995, 2001 and 2008, that I should watch the numbers and wait.

He's very experienced and conservative about treating but at a minimum, he expected me to see him every five years and was dismayed when I showed up to the party seven years later. Somehow my file had slipped through the cracks and the truth is a lot can go wrong quickly for some people.

In my case, nothing did, despite my negligence. He still held the same opinion about my treating, that I should wait. (I didn't.)

My ALT's fluctuated over time and they were at their highest during a couple of years of a lot of biking. I don't know if the extra exercise contributed to that.

Unless you're determined to treat now, the best available tool for making an informed decision to wait is to have a liver biopsy, as you did four years ago. Your specialist will likely recommend another one if he favors waiting for the newer drugs, which will provide  not only better chance of success for genotype 1 but shorter treatment time.

I'm curious if it turns out that you still have two genotypes when you're re-tested by your specialist. I read on Wiki that one genotype can eradicate another, so I wonder if your second one was a latecomer to the scene and you contracted it shortly before your testing four years ago. It would be fascinating to know. If so, wow, if you now only have genotype 2!!!!!!!!!!!!!!!!!!!! I don't know anyone else who has or has had two genotypes, only one genotype with two subsets.

From http://en.wikipedia.org/wiki/Hepatitis_C_virus :

"Infection with one genotype does not confer immunity against others, and concurrent infection with two strains is possible. In most of these cases, one of the strains removes the other from the host in a short time[7]. This finding opens the door to replace strains non-responsive to medication with others easier to treat."

For more info about elevated ALT's, check the archives on this site, such as:

http://www.medhelp.org/posts/Liver-Disorders/Elevated-Liver-Enzymes-Read-This/show/712904

or go to:

http://www.janis7hepc.com/

http://hcvadvocate.org/

http://www.phac-aspc.gc.ca/hepc/rl-cd-eng.php#3

[Bill1954]

My limited understanding of multiple genotypes is that one genotype will become dominant; the other will not be much of an issue. I’d imagine you’ll be managed as a genotype 1 patient, and will treat accordingly.

The only way to get a good view of fibrosis is by biopsy. It remains the gold standard for assessing fibrosis/cirrhosis, and yes, it is “the main decider of needed treatment”. It’s important to remember that about thirty percent of Chronic Hepatitis C patients will have normal enzymes regardless of hepatic histology; I’ve talked to patients that have progressed to significant levels of fibrosis with normalized enzymes. I’m not trying to unnerve you, but it shows how important it is to be seen by a specialist.

I would personally request a referral to a GI or hepatologist from my PCP. They are generally well intentioned, but it’s *amazing* how little they typically know about managing this disease. Just getting a referral to a hepatologist doesn’t mean you are committing yourself to IFN treatment; in fact a good liver specialist will probably be more conservative in moving forward in treatment.

Interferon can be a challenging therapy, but most of us manage, one way or another. If you have little or no damage, it might be in your best interest to wait a bit, and see what happens with the Protease Inhibitor drugs as they become available. Understand that these new drugs *will* be used in conjunction with interferon and ribavirin; they are a ways off until they will be used as monotherepy. See a liver doc, get his assessment, and go from there—

Bill

[nygirl7]

(I have been doing hard workouts)

While exercising CAN increase your enzymes the fact that you do have hep alludes to something different altogether. I had geno 1A and 1B - there have been a few of us dual geno's but it is rare to see a 1 & 2 dual.

I want you to know though it's not really anything different....you will just treat the geno1 virus as the stronger version and follow all the geno 1 rules and the geno 2 will get wiped out with it too.

I had thought I had to take more meds and treat harder and it was all at my own expense......I had just made it harder on  myself cause in the long run they both were gone for good.

Anyway you didn't say what grade and stage your other bio showed?  But yes depending on the enzyme levels staying up I would think another biopsy wouldn't be a bad idea at all.

[fretboard]

Here's a link to help you read and understand your results but you seem to know what you're doing.  As far as the working out hard, that in and of itself can raise your ALT and your AST.  Why don't you tone it down a week or so prior to your next blood test, that way you can get a better reading.  There's no reason to think that you must tx immediately just b/c your labs came up a little bit above normal or even twice normal.  Especially since you said that you've been working out hard.  Relax a minute, see a heptologist to get totally informed of your condition and take it from there.  good luck

http://www.labtestsonline.org/