Quick VL test question for another

[Lady Lauri]

My 'pro' friend isn't online :)......can someone refresh us on this...I forgot!


4 week PCR - 'almost UND'  at <15IU.

Isn't that UND? it wasn't a qualitative PCR she said ? but with no time to archive it.....can someone answer that?

THANKS!

[Deb_c430]

normaly at  <10 is UND, but that is pretty darn close!

[Deb_c430]

Maybe it depends on who does test and the sensitivity of it? Mine is  <10

www.janis7hepc.com/

Going to look on Janis lol!  *[HCV-RNA (qPCR)-negative] is defined as less than 100 copies/ml of hepatitis C viral RNA as measured by the National Genetics Institute assay. Keep in mind, different labs do the PCR test differently. There is no set protocol for this test as of yet so results vary from lab to lab.


hugs

[jdwithhcv]

Heptimax measures down to <5.  And if my EOT Heptimax result doesn't come back soon I'm gonna go crazy!
jd

[mremeet]

It depends on the test, not all tests are created equal. But right off the bat if it says <15 IU/ml, that probably means your undetectable. The various tests have various sensitivities. Some go down to 2 IU/ml, in which case an UND reading would be <2 IU/ml. A 50 IU/ml test would say <50 IU/ml, and a 10 IU/ml test would say <10 IU/ml and so on. However there are some tests that are multi-ranged, part qualitative and part quantitative, with different sensitivities associated with each part (and interpreting their results are a bit more tricky). But these tests are rare from what I've seen, usually they have a simple cutoff sensitivity, and in your case that appears to be 15 IU/ml. They also commonly report your viral load in log form (in addition to a numerically quantified value), and if it's UND it says something like "unable to calculate result since non-numeric result obtained for component test." This is just a fancy way of saying you're UND as well. If you quote the lab result verbatim word for word here, we can be more certain of the whole thing, but offhand sounds like you're just plain 'ole UND! Congrats!

[comeagain]

I`ve got the same result 4weeks pcr >15iuml it was detecteable but they can´t say the exact nr probebly between 5 and 15 something.

Its a so called borderlineresult.

Your friend was probebly tested with taqman test down to >15 iuml the only test they use where I`m from. (Sweden that is)

Its a good result but can indicate that a extended treatment should or could be in the the tx strategi plan if geno 2 or 3.

Hugs to you Lady L

ca

[IAmTheWalrus]

I think that the test is indicating UND results or you would have received a numeric value, not a "<" value. The less-than indicates that it is below the test sensitivity. I believe in this case, the sensitivity is down to 15 IU/ml. There are a few tests more sensitive than that, but many tests have limits of 50, 75, or more IU/ml.

So it sounds like congratulations are in order. Check the limits of the specific test.

Good luck,
Brent

[zazza]

I second Comeagain. I got the same test result, detectable but less than 15 IU/ml, at week 12 and that is why I did 72 weeks instead of 48.

Detectable but <15 is not UND but darn close, so it is up to your friend to decide which side of the border of extending tx or not he or she wants to stand on. (Unless your friend is a geno 1, of course, in which case such a test result is fantastic at week 4.)

[zazza]

Please listen to us who have actually gotten this kind of test result. I know the others mean well, but they have not done the research we have done. The test result shows that virus is present but is unable to say how much because of the low amount detected. My doctor said it meant I had between 5 and 20 IU/ml.

[Lady Lauri]

All.....thanks so much, this is for another person treating. I was UND wk. 4 and  12 wks. post tx and the biggie, 24 wks. is August 25th. Did 23 wks. tx, but reduced twice due to sides, issues.

It's a Geno 2b-er. I'd figured it was dam close so probably UND by week 5, which really doesn't call to extend, exactly, right??? Week 5 is so borderline, ya' know?
They really can't extend either, labs falling, no rescue drugs, etc.

I get soooo peeved by Dr.'s that don't do enough VL testing!!!  If this was me, I'd want another at 5-6 weeks to know. Most don't do it again until week 12, what IS up with that?

Thanks again mucho! Looks like I was wrong in thinking that is UND.

LL

[comeagain]

I weas dizzy before at this tx merry go round, and now you make me even dizzier Dizzy miss Lizzy.

Who is who is it you or your friend thats geno 2  or both probebly both since both  = 2, or was it a it that was 2b

ca

[comeagain]

I wrote > instead of < they censored that odd?!!!

[Kristina538]

Hey team,
Lauri may be talking about my result which I've shared with her and 'comeagain'.

I'm a 3A Baseline VL 262,000 and just got the print out of the test - it is still detectable - the specialist and doctor say 'it's as good as UND' , maybe because I don't have right of extension (well, I'd have to really fight for it privately even).  I do realise it's a good result and I'm responding well to tx.

The form says as follows (so it looks as though still detectable but small):

HCV RNA : < 15 IU/ml
HCV RNA:   <1.18 log IU/ML

'this result was determined using the Roche COBAS Ampliprep/Taqman HCV test which has a linear range of 43 HCV RNA IU/mL to 6.9E+7 HCV RNA IU/mL.  Note: Results are expressed as the number of HCV RNA IU/mL and the logarithm of the number of HCV RNA IU/mL'

I've been waiting to post Dr D but always full;  my specialist said 'virtually almost undetectable'.  I know Zazza and many of you would advise me to try to extend.  Quite frankly, I don't want to think about it right now, and have got a little time to build up my case now with the private gastro.

Thanks all for your assistance, and pushing me to get this PCR done.  Much love and hugs for all the encouragement :-

[Trish77]

Your test doesn't actually use the word "detectable".  It says <15 IU/ml.  If the sensitivity of the test is down to <15 IU/ml, that's considered UND down to that sensitivity.  It doesn't mean you have somewhere from 1-15, it simply means you have less than 15 and could be zero.  That's as good as it gets with that test. That's considered UND.  My PCR's are <15 IU/ml and my result was the same at the 6 week test.  I have and still do consider that to be UND.  I'm approaching Week 24 this Friday and so far the results hold.  

Now.. you might want to request a lower sensitivity quant PCR just to be sure .. I've been okay with my <15 IU/ml sensitivity holding from Week 6 and I'll see how I feel as I go, if I want a lower sensitivity than that.  

However...looks like you're UND at Week 4 to me.


Trish

[jmjm530]

Due to the labanese way they are often writen, test results/interpretations easily get mixed/up even with some doctors and NPs.  That can be be greatly magnified when passed from doc to person to person.

Your friend really has to get his/her own copy of the test results, which would include the name of the test taken. If you then post exactly what the lab report says, it should be easy to figure out whether she is UND or not. As posted, I really wouldn't even venture a guess.

[mremeet]

If that's all it says, then you should be UND. But then zazza appears totally confident that you are using the exact same test she is using and that you are still detectable. But strictly based on the text alone you have posted, it says you are less than 15 IU/ml, and if the limit of detection for that test is 15 IU/ml, then by definition you *are* UNDETECTABLE.

Now with that said, as previously mentioned there are dual range qualitative/quantitative tests. I was in a drug trial that used this type of test. It's quantitative limit of sensitivity was 30 IU/ml. In other words it could only provide a numerical value for your viral load if your viral load was 30 IU/ml or higher. Although it could still qualitatively detect the virus down to 10 IU/ml. But it could not give you an exact number if you were detectable between 10 and 30 IU/ml. For example:

If you were below 10 IU/ml, you were UND and the reported result was "<30 IU/ml NO HCV RNA DETECTED."

If you were detectable between 10 and 29 IU/ml, the result would be "29 IU/ml."

If you had a viral load of 31 IU/ml, it would say "31 IU/ml." if you had a viral load of 81 IU/ml, it would say "81 IU/ml" etc.

Confusing? Ambiguous? Retarded? Yes, but in the infinite wisdom of the lab dork shut ins who come up with these reports, this makes perfect sense. The only way you're gonna know for sure is to confront your doctor and preferably call the lab yourself and get to the bottom of it one way or another.

[jmjm530]

Not sure if Lady L. is referring to you -- but as to your results.

I tried to "Google" the test, but got conflicting results and apparently this is a test more popular in your country than ours.

I'd like to say that your doctor's are confusing you by saying "it's as good as UND" because that's a very confusing way to explain things to a patient. You are either UND to the limit of a test or you are not. That should be clarified by your doctor 100%. If indeed the limit of the test (as I suspect but am not 100% sure of) is indeed 15 IU/ml, then you are UND. Period. For all practical purposes 15 IU/ml is a pretty sensitive test. My advice is to try and get this clarfied byyour doctor, and if you feel your med team isn't up to the task, then show the results to a liver specialist (hepatologist) who is.

[Kristina538]

Wow - thank you so much for all your input; I don't know what I'd do without you and all of your comments, research and information is so very much appreciated.

My PCP today said to treat it as UND - 'it's as good as it gets'.  Even if there is a tiny tiny amount there, my hope is that it should be slammed by now (shot 6 today), and, if I'm really on to it, at least I may get them to taper at the end.  I will certainly discuss it next time I see the Specialist at 10 weeks - he did say he didn't need to do another PCR at Week 12, so I guess he believes my body's got a handle on it thus far (budget budget :-( ..).   I have a road to go yet regardless of PCR's and, at least, got this one done (thanks to you all), and it looks a lot better than I expected!!!

Zazza; Comeagain - I came into tx with the hope that my liver could have a rest at least, given I was told a 50/50 chance of UND;  I did mono 14 years ago, and my body has never tried the peg IFN or riba, so maybe I'm reacting similar to tx naieve.  I would love to have the opportunity of a team dedicated and within budget to do what it takes, and am prepared to look at going private at the end of tx if necessary - I really appreciate what you are saying and the lengths you have both gone to in reaching a sustained outcome;  you have given me a yardstick by which I can demand from my team.

Trish - congrats on reaching week 24!!! - you GO Girl;  thank you for your valuable comments.

Jmjm - Thanks for coming into the discussion; I was hoping you would :-).  And thank you again Mremeet (I actually said that name out loud in my head last night and 'got it'!!! hehe)

ChildAngel and Brent -  You both have your stresses and I'm humbled by your support.  Thankyou too, Deb.   And Lauri, if it wasn't me you were talking about, sorry for taking over the thread - if it was, thanks for starting it.

I'm off to do some exercise to make my bloods increase!!!  Not in a danger zone yet (apparently), but no more checks now for 3 weeks.   Love & Prayers to all.  Thank you.

Kristina

[Lady Lauri]

Laughing as I type ("taking over the thread"). Yep, it was you, for Kristina. Sorry for the confusion but wasn't mentioning that as she hadn't posted it. I had told her I do believe it's UND and wanted the input here before getting your/her hopes up too much.  I wanted to check my input to you. I also thought the Dr. wasn't being to clear...almost UND wasn't working for my thinking in this either. With jmjm on he should be 100% clear with you.
  As it is started and the input here is so extensive, so many heads thinking together.....
the 'no more VL checks' is an issue also. The Dr. saying that concerns me as well. I have heard of no tx's where once you reach UND (let alone his 'almost UND') where they say "well, we won't need to do any more VL test now" and let you go thru the entire tx. I mean....and not to worry on this as it's not so common....but some actually drop or even reach UND and than the virus reappears, VL actually goes up during tx and that is an urgency in deciding the next step....to extend, stop tx, etc. I realize it's handled in different ways where you are, but tx is tx, no matter what the location and some things I would think would be 'standard practice'. While low chance of that happening for you, IF it did even knowing how early it came back would be important for tx in the future and so on. Sorry if this isn't too clear, 2:30 am and at the falling asleep stage :)

Now aren't you glad we nagged you to get that 4wk. VL test and put all this thinking into the mix :) ? EVERYONE should get that 4 wk VL!

Back in the AM, and thanks to all replies, LL

[Lady Lauri]

So happy to see you here posting :)

[CockSparrow]

The form says as follows (so it looks as though still detectable but small):

HCV RNA : < 15 IU/ml
HCV RNA:   15 but less than 43.

You can get a borderline result like Zazza's which means it is detected at <15 but not quantifiable.

You are RVR which is good thing. Because if you werent then you really would need to consider extending.


Hope this helps
CS

[zazza]

I think the one way to find out for sure is to research if a test result your doctor would say is UND actually reads "UND" or "<15 IU/ml". I was hoping you would get another test at week 12, because then you could compare the two, but since this is not the case you could call the laboratory and ask to talk to a doctor there and have him explain your test result. That's what I did, and the doctor was most genorous with his time and knowledge.

The thing is that if you were detectable but below linear range it might very well be noted as "<15 IU/ml". As I said above, the only way to find out is to find out how they note UND with this particular test.

And, Kristina, I am actually very happy for your result since I remember you to be a non-responder to the old interferon. I think your result is good indeed considering this. I think Lady Lauri is right that you probably were UND by week 5 or 6. It is, of course, up to you to decide whether you want to try to get an extension or not, being you were so close to UND at week 4. Maybe 36 weeks would be something to consider?


Zazza

[comeagain]

The taqmantest start as a qualitative test just determen if there is any virus left and in this case it most probebly was according to the doctors statement.

Then the next fase of the test is quantitative and since there is so little left this test can´t measure the exact nr, but that it is <then 15iuml,( but it can still bee 20 because that exact the test isn´t ) but the qualitaive test has determen that there was virus activ and as jmjm said either there is or their aint.( close dosen´t shot a rabbit ) So they have to quess the nr a good guess is something between 5 and 20.

Its a so cold borderline result.

I´m in a studie for relapsers geno 2 and 3 and when I´ve got that result week 4 borderline my nurse told me theres a reason why i relapsed the first time and this bordeline week 4 result was quite common among relapsers.

Both drofi and smaug got a simular result with a test that was sensitive down to <10iuml.

Take care Kristina your on your way to SVR if you play the cards right that at least what I think.

ca

[comeagain]

part of the text is disappearing when posted.

I also said that this test cant measure the exact nr but that it is <15iuml ( could also be 20 because the test aint that precise ), so a good guess would be something between 5 and 20.
And as jmjm pointed out either you are UND or your not ( close dosn´t shot a rabbit )

and I meant called not cold borderline result

[jmjm530]

I just hope everyone is talking about the exact same test because to the best of my knowledge no one here has seen the actual test report. My lab, for example, has over a dozen different tests for HCV, some of which have almost identical names but not the same sensitivities.

Im still a bit confused if we're talking about one or two different people here who are unsure of their test results -- but if it were me, I'd get hold of the lab results myself, and research it myself. Research would include: (1) call the lab (ask for a supervisor or lab director): (2) Speaking to your doctor direclty: (3) Speaking to another liver specialist if you don't feel your doc is familiar with the test reports which unfortunatly seem to happen from time to time.

Its difficult enough to come to the right decision on whether or not to extend, but if you don't start off with the correct data, it becomes somewhat mute.