Viral Load - Quantitative vs Qualitative

This topic has 17 replies, 12 voices, and was last updated 8 years, 8 months ago by Dr James.

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26 November 2015 at 5:11 pm #4706
Dr James
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- Guardian Angel
@fixhepc
Hep C Viral Load can be quantitative (undetectable, <15, or 15-100,000,000) or qualitative (undetected/detected).

In Australia Medicare will pay for 2 quantitative and 4 qualitative tests a year. Note that Medicare will only fund Hep C viral load testing when it is a) ordered by a specialist or b) ordered by a GP for a patient having treatment so please make sure you add "Having DAA treatment for HCV" in the clinical notes or you patient will get either a bill or the test won't get done. Also note that for quantitative testing you need a specialist to authorise it (they don't have to order it) but you need to add something like "Having DAA treatment for HCV. Authorised by Dr John W Freeman FRACP". Apparently GPs can't be trusted by the HIC to order this test alone....

So unless you are willing to pay you can have:
- Start: Quantitative – some number like 1,000,000 (log 6)
- 4 weeks: Quantitative – some number like Undetected (0), < 15 or 15-200 (usually)
- 12 weeks: Qualitative – Undetected (UND) – yet to see Detected
- SVR4: Qualitative – Undetected here is a 96% chance of absolute cure
- SVR12: Qualitative – Undetected here is a 99% chance of absolute cure
- SVR24: Qualitative – Undetected here is a >99% chance of absolute cure and the gold standard
YMMV
3 December 2015 at 8:33 am #5140
Bloot
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- Recovery Champion
@bloot
Thanks for this – I had no idea

Do you know the cost of a quantitative test in NSW?

52 y.o. G3a for about 30 years
Previous tx 2004 interferon/ ribavarin
2004: ALT 624 AST 263

Pre tx test 23/10/15: ALT 153 AST 128 VL 11 849 493
6/11/15: Sof/ dac started
26/11/15: ALT 41 AST 41
7/12/15: ALT 36 AST 30 Virus undetected

2004 biopsy F3
Fibroscan appt Jan 11 2016.
5 December 2015 at 1:38 pm #5281
Dr James
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@fixhepc
The list price is $180-200 AUD but if you ask nicely I know Sonic (blue disc with red double helix) labs – the have many different brands – have been doing them for around $135. Ask for a quote is my tip!

YMMV
5 December 2015 at 1:51 pm #5282
Jimmy6429
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- Recovery Champion
@jimmy6429
Yeah I got quoted $200 from Douglas Hanley in Sydney

3 years cured, Sof/Dac, thanks Doc Freeman, hepc only a distant memory, go for it ppl
5 December 2015 at 3:43 pm #5286
Dr James
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@fixhepc
Tell them they are dreaming! Ring Laverty and say you’ve been quoted $140 and ask if they can do better.

In case of emergency ping me and I will ask for you.

YMMV
16 December 2015 at 1:29 pm #6434
isaing4
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@isaing4
Thanks for this very useful presentation.
Before treatment VL 9 million. I can not wait and want to do 2 weeks VL. To see how the treatment goes.
I hope the result will be encouraging!
Fingers crossed.

HCV since I don’t know. Diagnosed in 2010.
GT1b, F0/F1, VL 9M, ALT 44, AST 42, Tx naive,
started 12 wks Twinvir on 06.12.2015. Feeling great and grateful 🙂
virus not detected 06.02.2016 & SVR24
isaing4@gmail.com
6 January 2016 at 4:56 am #8122
Hamilton-Gray-facebook
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- Treatment Warrior
@hamilton-gray-facebook
I just got a quote from S&N Pathology Brisbane for $92.20 & QML Pathology Brisbane for $158.38 for a HCV, PCR, RNA VIRAL LOAD (QUANTITATIVE ) Blood Test.
So you can see the price difference just between these 2 Pathology Labs.

Male aged 66, contracted hepC 45 years ago
Failed treatment interferon and Ribavarin 2003
Started treatment 22 October 2015, 24 week, Dr Freeman
Sofosbuvir and Ledisbovir plus 12 weeks Ribavirin
Geno 1a
Fibrosis F3/4
VL <12 at 4 weeks
VL – negative at 12 weeks
12 January 2016 at 9:20 am #8759
Joy
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@joy
Went to see the GI specialist at the Gold Coast University Hospital today. Results from EOT blood tests show I am still UND. I know that was to be expected, but still felt a teeny bit of anxiety beforehand.

I was offered a Fibroscan, accepted of course, and it showed a reduction from 6.2 to 4 (kPa). I hadn’t expected this to happen so quickly, a big bonus and feeling very happy. illy:' />

ALT = 16 and AST = 23 (34 and 41 a year ago).

They are monitoring several others on generics and said that SVR24 ‘has gone out with interferon’ and is no longer necessary on DAAs. SVR12 is now considered sufficient.

So I have a pathology request for end of March and then it’s all over red rover.

Edit: dear mods, I’m not sure if this post should be here, feel free to move it…
12 January 2016 at 11:42 am #8766
coral
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@coral
That’s such great news Joy and what a bonus to get the Fibroscan results as well. Interesting about the SVR24 comments and it indicates their confidence in the DAAs.
12 January 2016 at 2:13 pm #8782
IRMA88
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- Recovery Champion
@irma88
Great news Joy

G2B – DIAGNOSED 2014, STARTED SOF/DAC 11/11/15 VL 6M
UND @ WEEK4
FINISHED TREATMENT 26/4/16
UND @ WEEK 24
ALT 12 AST 15
MY ETERNAL GRATITUDE TO GREG JEFFERYS & DR FREEMAN
12 January 2016 at 3:34 pm #8785
Joy
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@joy
I think if I had cirrhosis and/or had relapsed from interferon I would probably still want to be tested at 24 weeks after EOT. There’s a psychological hangover from interferon that will take time to clear. But yes Coral, it’s reassuring that specialists are confident about DAAs, and are preparing for the PBS rollout. I expect the EOT Viral Load test will also be eliminated if UND is achieved earlier.

The staff at the GCUH today were wonderful. I haven’t had to pay for any tests or doctors visits, and am very grateful for that. Hearing how difficult and expensive it is for people in other parts of the world makes me appreciate Australia even more. Might stick around.
12 January 2016 at 5:17 pm #8792
dointime
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@dointime
“I think if I had cirrhosis and/or had relapsed from interferon I would probably still want to be tested at 24 weeks after EOT. There’s a psychological hangover from interferon that will take time to clear.”

You are right about that Joy. I would be one of those of the old school of interferon. No way could I walk away from an UND test at 12 weeks and be confident that it was over. Probably irrational given the stats on SVR12, but that’s how it is.

dt
28 January 2016 at 9:07 am #10639
pat1
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@pat1
Hi
Could some one please help me read the results that are in the attached file. Understand ‘not detected’ but not the quantification analytical range.
Attachments:
gt 1a VL 6m
F2/3 FibroScan – 9KPa in 2011 and 7KPa in 2015
sof/dac 10 December for 12 weeks
pre tx alt 85 ast 51
4 wk alt 34 ast 31 UND <35
8 wk alt 29 ast 32 UND <15
12wk alt 25 ast 25 EOT 3.3.16
SVR24 UND KPa5.3 F0 in normal range
I am well
.forever grateful to fixhepc
28 January 2016 at 10:21 am #10643
Dr James
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@fixhepc
If you have a look here you will see what it actually looks like:

http://fixhepc.com/forum/viral-load-and-svr/563-understanding-viral-load-testing.html

So the 35 refers to <35 being the lower limit of quantification. Below this we can often still see a "smudge" and that is <35 detected. You have a full "Not detected" although there was a technical problem with the test so they are saying "if it had worked properly we might have detected it".

Simple solution: Just do a qualitative detected undetected repeat.

YMMV
28 January 2016 at 1:05 pm #10663
pat1
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@pat1
Thank you so much Doc James
My specialist wouldnt discuss it with me and I don’t know why. I will ask for a repeat test.

gt 1a VL 6m
F2/3 FibroScan – 9KPa in 2011 and 7KPa in 2015
sof/dac 10 December for 12 weeks
pre tx alt 85 ast 51
4 wk alt 34 ast 31 UND <35
8 wk alt 29 ast 32 UND <15
12wk alt 25 ast 25 EOT 3.3.16
SVR24 UND KPa5.3 F0 in normal range
I am well
.forever grateful to fixhepc
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