Hello- and VL question

[hoofinit]

Hello- I am new here.  I took a life insurance exam last Nov. and it showed up positive for Hep C.  
My doctor retested and again it was positive.  She then ordered a PCR- again positive.  
I finally got into see a specialist last month and she wanted to confirm the results again as my viral load was low-176.
I got the results back last week and the viral load counts were 2000 on one test and 6000 for a confirmation test.
Is this normal?  What does the low viral load indicate if anything?
All of my liver function tests are in the normal range.
The doctor now wants me to get a liver biopsy and a test for genotype- but I'm not very excited to do any invasive tests like biopsy.  I have been extremely healthy all my life- haven't missed  day of work since 1993 so I am having trouble accepting that I'm "sick".  I think that I've probably had this since the early 90's.
Thanks for any advice! Karen

[Bill1954]

Hi Karen,

A percutaneous liver biopsy is typically performed in a hospital on an outpatient basis. It takes an hour or so for prep, but only a few seconds to actually retrieve the sample. The risk for complications is pretty low now; they usually use ultrasound to guide the procedure, greatly reducing chances for error. As always, be sure to discuss risk vs. benefit with your doctor in advance.

The techs that do this now often take samples pretty regularly; so they’re good at there job. You can request twilight sedation; they used phentanyl and versed on mine, and while I was awake, it’s almost painless. They want the patient conscious, so they can help with breathing and holding breath, etc. The annoying part is the long wait afterwards; they’ll ask you to stick around for several hours so they can monitor for any complications. Bring music or a book to while away time there.

There’s really good info available with this procedure; if you opt out, it really leaves you guessing as to your current condition. Couple this with new drugs right now in late phase clinical trial that are worth waiting for, and it makes even better sense to get a snapshot of your position in all of this. If you have little to no fibrosis, you could possibly wait for years for more efficacious methods of treatment/management. Not all patients benefit from immediate therapy for this disease.

Most of us in here request copies of all labs and procedures; and start a medical file to keep track of everything. It takes a couple of days for pathology to turn a report around to the ordering doctor; ask him/her for copies if you like.

You can refer to the site Janis and Friends to help understand the biopsy results, or post them here, and someone will help interpret them. There is still room for improvement with liver pathology, but it’s still the best we have right now.

The non-invasive blood surrogate blood tests are known as ‘Fibrosure’ and ‘Fibrospect’; ask your doctor about these, but don’t expect a great endorsement from him.

Good luck; let us know how things proceed—

Bill

[hoofinit]

Thanks for the information Bill and Dee-
The viral load was in IU, I think thats why they kept retesting me, in fact when I went in to the specialist she wanted to redo it, before discussing treatment or biopsy because she thought it was a false positive.

Dee- I'm sorry to hear about the relapse, will you try again with the new drugs coming out?

It sounds like I may have to go ahead with the biopsy- as scarey as that is from the literature I'm reading it looks like its gives the best info.  Do you actually have to have this done at a hospital?  I think that is what scares me more than the thought of a huge needle-phobia of hospital gowns I guess:)

I will check into the Fibrospect though, I'm getting pretty used to having my blood taken now!
Thanks again, Karen

[Dee1956]

Hi, hoofinit, welcome to the forum.  When I was diagnosed I thought the exact same thing, except for some red spots and being tired now and then I felt great.  It was a big shock when I was diagnosed.  I was told I had plenty of time to decide when to treat.  Then I got the bx and found that I was transitioning into cirrhosis.  From what I have seen and heard the earlier you treat the better your chances.  I treated back in 2008, responded quickly however relapsed as soon as I stopped tx.  Your viral load is low however you can also have normal liver enzymes and have damage to the liver.  You probably don't however from what my doctor told me the viral grow exponentially, i.e. I started with a vl of 6M then went to 12M in a matter of months.  You probably have  time however I thought I did too until the bx was done, that really will tell you how things are
I wish you the best
Dee

[Bill1954]

Hi Karen,

And welcome to the discussion group. It’s rather unusual to have a viral load that low with chronic Hep C; it’s commonly measured in the millions. If you have copies of the results, you might want to confirm that the scale used is IU/mL, or international units per milliliter.

In terms of significance, I’m not sure there is much. When HCV is chronic, it’s either present or it’s not; and viral load doesn’t necessarily correlate with disease progression. For instance, I always had rather low viral load; around 100,000 IUI/mL, but had significant fibrosis, or scarring of the liver. Others in here have reported viral loads in excess of 50,000,000 IU/mL, with very little concurrent damage per liver biopsy.

The definition of chronic vs. acute infection, by the way; chronic disease is established infection over six months in duration. Chronic infection will not resolve spontaneously, where acute disease will in roughly 20% of cases.

A biopsy will yield valuable info *if* you intend to postpone therapy for any reason. If not, and you’ll treat your disease soon, a good case could be made to skip biopsy, because infection that is resolved will most likely halt any further scarring/fibrosis. There are other options to explore if you’re interested; blood tests such as Fibrospect offer a glimpse as to liver stage, but none can give the same degree of accuracy as pathology can offer.

If you like, read through Janis and Friends website; I’ll link you to their page for newly diagnosed. Be sure to look at the section titled ‘other HCV information’, located in the right hand margin; it has loads of additional pertinent info:

http://janis7hepc.com/have_you_been_just_diagnosed.htm

Again, good luck; and be sure to take your time and ask more questions,

Bill