PCR testing

[traveler65]

I keep going round and round with my doc as to the sensitivity of the PCR's he is having run on me. The 4 week one was <50. I asked for him to run a more sensitive test (down to <5) and even mentioned the heptimax test. He still claims that the <50 test is fine and as long as my results are <50 I am UND.
Are there any articles on the web stating that a more sensitive test should be run that I can bring to the doc? I will be having my 12 week Pcr shortly.
Thanks:

[Kalio1]

The vast majority of doctors do not use the <5 test, maybe the case is different for transplant patients but most typical patients are using the tests the doctors have available and the difference between a <5 test and an <50 test is not significant.It is a rare patient who has the virus return in such tiny numbers. Testing in the teens is not the usual experience of nontransplant patients, normally if you relapse you will have more virus than <50. Being a transplant patient puts you in a different category than those without a transplant and the availability of tests that sensitive just isn't there for many people who don't have a team of transplant doctors nor is it needed. A <50 test is sensitive enough to satisfy the vast majority of doctors, it is rare for the virus to show up in such tiny numbers. I can see why a transplant doctor would use them and why they would be necessary but the average patient will show virus on a <50 test.

He seems overly worried about being detectable when his <50 test is clear and I think it is due to too much importance being put on the tiny difference between a <5 test and a <50 test. If it is readily available then sure, do the <5 test but if you can't get it, the <50 test is just fine. Im sure his doctor thinks it is a waste of money to test again trying to look for virus. Doctors can't just order tests willy nilly without having a good reason, being a transplant recipient would be a good reason, but just wanting the most sensitive test known to man even though you already are UND by <50 test would be rejected by my insurance company and Im sure most insurance companies. Doctors can't just test because a patient wants it, it has to be warranted by medical evidence and in this case there is none. He is UND <50 so what would suggest he needs a more sensitive test? Nothing, that is why his doc says he doesn't need it.

Being a transplant survivor puts you in a whole different category than the "average" Hep C patient.Most insurance companies won't even pay for <5 sensitivity tests and they aren't available for many patients unless they pay the hundreds of dollars for it out of pocket.

[jmjm530]

Third paragraph refers to viral load tests taken at the end of treatment. Of course, you could be TMA positive during treatment and then later become TMA negative and SVR.

[jmjm530]

Here is the specific study you are looking for, but as you say, your doc can say "that the meds kept it under ___, until you stopped.

Here's the study: http://www.hivandhepatitis.com/2006roberts/hcv/081106_c.html

Basically it says that a certain per cent of PCR negatives (detection limit 100 IU/ml) were indeed TMA positive (detection limit 9.6 IU/ml). ONE HUNDRED PER CENT OF THIS GROUP RELAPSED.

I do understand the predicatment you're in with a doctor who wants to do it his way and wish I could help you more. Maybe you can get a bit more assertive or try and get the more sensitive test through your PCP or another doctor.

-- Jim

[traveler65]

Thanks all.
My doc is good about everything. Rescue drugs, frequent cbc's, PCR's, and visits. He is just real hung up on this PCR sensitivity. I even told him that I would pay for it myself and he told me I was just being foolish.
I looked at the studies for stopping treatment early and even all of those only talked about using <50 rather than <615.
I really would like to find an article showing that by not going to <5 that the virus could be hanging in there at low levels and come roaring back once the drugs are stopped. Basically that is my worry, that the meds are keeping it under 50, but once stopped it would come back. Of course, he could say "so the meds kept it under 5 untill you stop"
I will have another go at him before my next PCR.

[mikesimon]

You said:
"I wouldn't worry about it, if you are UND on the <50 test then you are UND. The virus replicates in the trillions PER DAY so if it was there, it would show up on the <50 test."
I disagree with you on this though traveler may indeed could be clear. You make these kinds of statements as if they have been proven through unassailable studies and that what you say is absolutely true. If you have support for that absolutism I would like to see it. It is not as simple as you try to make it. I have tested in the teens before with blood tests. And, you may recall that my biopsy showed 30 IU/ml in my liver which is the primary site of replication. So the virus can be present in VLs <50 IU/ml and if it were I would want to know it. There are more sensitive tests available and I can see no reason not to use them. I am not saying that traveler should be worried about the PCR but that's not the same as saying that <50 IU/ml is absolutely undetectable. By definition <50 is not necessarily <5.
Mike

[madbrad]

I said that mine came back<50........Thats what I began to show at 12 weeks...I actually don't know what test they used fro that....I'm just looking at what they used recently...I was merely stating it because I noticed it didn't go down that far....It caught my attention.