Link2Labs is a USA based laboratory that allows patients to order discount priced lab tests. Unfortunately they have had to restict their services to patients in Texas. Their packages are listed below, but for patients in the USA but not in Texas you can consider any of these labs:
- https://pals-labs.org/ (need doctors order)
We may wish to do some, or all of these tests. Here are links to them as well as terms used to find them in search:
- CBC - $10 Complete Blood Count (bundled with CMP below) - red cells, white cells and platelets
- CMP - $10 Complete Metabolic Panel (bundled with CBC above) - liver and kidney function
- HCV GENOTYPE LIPA - $135 Hepatitis C Genotype
- HCV RNA by PCR, QT - $80 Hepatitis C Viral Load (quantitative)
- HEP B CORE AB, TOTAL - $15 Hepatitis B Core Antibody (quantitative) - exposure marker
- HEP B SURFACE AB QN (HBV Titer) - $15 Hepatitis B Surface Antibody - immunity marker
- HEP B SURF AG W/CONF - $15 Hepatitis B Surface Antigen - active Hep B marker
- TSH - $10 Thyroid Stimulating Hormone - thyroid gland function
- AFP, TUMOR (CHIRON) - $20 Alpha FetoProtein - HCC tumour marker
- PRO TIME WITH INR - $10 Prothrombin Time with International Normalised Ratio - blood clotting
Bundle 2 - CBC, CMP, PT/INR, HbsAg, HBsAb, HIV - $85 pretreatment (add Hep B core Antibody +/- genotype/viral load if not known)
Bundle 4 - CBC CMP HCV RNA Quant - $90 routine monitoring and SVR12
The genotype test is done by PCR and if a genotype can be detected then there is absolutely a viral load. While it has been suggested that patients who have genotype 1 and low fibrosis and are treatment naive and have a viral load of less than 6 million can be treated with only 8 weeks Harvoni the clinical results are not as good as using 12 weeks treatment. In other words having an exact viral load does not inform treatment choice or duration.
There are now pan-genotypic treatments (treat all type of HCV) so it is possible (but not recommended) to skip the genotype test. The reason it is not recommended is that we know we need to work a little harder to cure patients with genotype 3, so knowing if a patient has this genotype is still helpful.
Cirrhotic patients need and INR and AFP but in patients earlier in the disease course these can be skipped.
There is an association between HCV and thyroid problems so this is nice to check but not essential.
With the Hep B tests the reason for doing them is because of the possibility of Hepatitis B reactivation during treatment. Doing all 3 tests at once provides and instant answer, however it is possible to just check Hep B core antibody. If this is negative there has been no exposure to Hep B and therefore is no risk.