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Here’s my non-medical explanation of the difference between UND and < 15. * Once we get down to a very small numbers of virus particles, it is no longer a question of medicine or even biology. It all comes down to chemistry, equilibria, and probabilities. Anyway, I'm not a doctor, but I do know a bit about chemistry and biology, so here goes: * Its important to remember that both quantitative and qualitative HCV RNA tests measure the amount of RNA from the virus in the bloodstream. They do not measure the number of actual virus particles (virions). The viral RNA is just one part of the package, so to speak. * The qualitative test gives a yes/no answer, but a quantitative test gives a numerical count, unless it is less than about 15 units, in which case it is a yes/probably answer. But for someone on DAA treatment it is more like a "no" answer. Or more precisely, a "going to be no" answer. Confused? Don't be! * We normally think of the virus as a solid particle, but in fact it is better to think of it as a population of particles. Some of them are useless, some of them are falling apart, and some of them are spontaneously re-assembling into new viral particles again. But most of the time they just fall apart naturally. Otherwise, they would be perfectly harmless. So when a blood test detects viral RNA, it is actually detecting bits of RNA from those particles that just by chance have fallen apart at the time of the test. * Clearly, if there are no HCV virions present in the blood sample, then should be absolutely no HCV RNA present. * But suppose you have just dropped a strategic nuclear warhead on a few trillion virions. Most of them will be absolutely destroyed (cut to shreds, vaporised, atomised, whatever).... But quite a few will only be cut to shreds and not vaporised. In other words, many of the viral fragments can persist for quite some time in the body (and so are still detectable), even though there is not enough of the right pieces to make new virus particles. So it is quite likely that very low but still "detactable" levels of HVC RNA can mean no viable virions left - or not enough viral fragments are left to be able to spontanously re-assemble again, which comes down to the same thing. * On the other hand, maybe a few virions might survive the nuclear blast intact. But if you are down to just a very few, it is unlikely that there will be enough of them to replicate because a whole sequence of "chance" biological events have to take place in order for the virus to replicate successfully. And in order for that to happen, there needs to be enough copies of the virus (i.e. enough viable virions) in the first place so that all the necessary chance transfers and collisions and biological/chemical reactions can take place... And if you are down to just one virus particle, there is a very good chance that it will just fall apart and none of its components will ever arrive in the right place to re-assemble or to carry out the replication process. So once you are down to the last few stragglers, there is a good chance the virus will disappear naturally. * And also don't forget that once infected, the body has developed antibodies which hunt down and destroy most of the virions on a daily basis... The problem with chronic HCV infection is that the speed of the hunt-and-destroy process is about the same as the speed of the virion replication rate, so the body never manages to clear the virus by itself. But the nuclear blast does not affect the antibody system. So again, very low but "detectable" HVC RNA means a high probability that the virus will clear because the antibodies are still busy with their (less than perfect) detect and destroy mission... * This all means that it is quite possible to have "detectable" but very low (or even "unquantifiable") RNA tests all the way during treatment, and then only becoming "UND" several weeks or (even months) after the treatment has finished. Me, me viral load was < 15 after 4 weeks. So I am pretty confident that I will eventually become "UND" in a quantatitive PCR test. But it is just a matter of time... Oops, I mean it is just a matter of chemical equilibria... and at the end of the day, this means just a matter of probabilities.... So to cut a long story short, my (non-medical) advice is also if you get to < 15, don't worry! You're well on the way to "UND"... But nobody can promise how long it will take...
http://www.questdiagnostics.com/testcenter/testguide.action?dc=TH_HCV_RNA_QualTMA
http://www.hepatitis.va.gov/patient/hcv/diagnosis/labtests-RNA-qualitative-testing.asp
Ah, well! Maybe you also have some Scottish genes… It’s a well known problem, but easily cured with a wee dram after dinner…
Isn’t it strange how this bastard virus hits different people in different ways…?
I first learned that I had the virus only in January 2015 although, now that I look back, I have probably had it for many years. Maybe even for up to about 40 years. When it was first diagnosed last January, I thought I had caught it recently because all the symptoms seemed to indicate a recent “acute” attack. But then I remembered that I had a similar (but somewhat different) “acute” attack back in 2003.Back then, my GP pointed to my high GGT results and told me to quit drinking and smoking and come back and see him if still had a problem. Also back then, I had never heard of HCV, and probably neither had my GP. HCV never came into the picture…
…This all took place in Scotland (which explains the “Oor Wullie” icon), and no doubt my GP was sick of seeing patients with “alcohol-related” problems. So anyway I quit the booze and the cigarettes, and I quickly started to feel much better. One year later, still alcohol and cigarette free, I felt absolutely great. Clearly, it was the beer+cigs that were to blame. And my GP had diagnosed the problem. A no-brainer, right? … Oor Wullie had bin ha’en muckle tae much swalley!! So after one year of abstinence, the young Wullie slowly started hain a few drinks fae time-to-time, but he wis aye care-fool not to gae back tae his previous livels.
Fast-forward 15 years.
Just by chance, a few months after a trip abroad, Oor Wullie went tae see hus GP (a different one by now) on anither matter. The good GP was concerned that young William was losing weight and looked tired, so he ordered some LFTs… This time, bingo! HCV detected! … Crivvens! Ahd ner a thoot a thaat! (said Wullie).
So the good GP sent Oor Wullie to a specialist who quickly ordered lots of tests – endoscopy, gastroscopy, coloscopy – the lot! Poor old Wullie had tae sit on his buckit fi a hale wik affie ah tha! But the tests came in, and bingo again – only F0/F1! No need to worry, no treatment advised at this early stage! The specialist ordered Wullie to cut out the swalley (ah jings! not again!), and advised the boy-hero to hope he would clear the virus naturally,… ah by hisell.
But also by this time, Oor Wullie wasnae as stupit as ye thunk, an he had din the ole 2+2=4 calculashun ah by hissel. An he new there was nae way he was gain tae cleer the virus natrelly. He also new that the swalley wisnae the real problem. So he got oot his pet moosie, wee Jeemie, an he startit searchin o the internet for a solution… But meenwhile, thanks tae hus specialist, Wullie had lots an lots of tests din, so fae the furst time in his life, he cood aktchelly see whit the fuk was gaen on wae hus luvver.
Heer’s a wee tabel o Wullie’s results fae 2015 (plees dinna spred this aroon, cus its still ah medikal-cofidenshul):
Date AST ALT GGT Lipase V-Load Comment 40 40 52 60 0 Reference 23-dec-14 108 180 67 95 Fatigue+Myalgia 06-jan-15 126 190 62 68 HCV suspected 10-jan-15 139 219 70 0.2M HCV confirmed 13-jan-15 280 335 119 Stopped swalleyin 17-jan-15 127 229 63 116 No swalley 23-jan-15 113 222 152 6.9M Still no swalley 24-feb-15 84 107 107 No swalley + feel OK 23-mar-15 84 134 46 109 No swalley + feel OK 05-jul-15 55 91 37 91 3.7M No swalley + Feel OK 01-aug-15 Resumed swalleyin 09-sep-15 127 193 50 108 Still feel OK 01-oct-15 Discovered FixHepC! 15-oct-15 82 133 52 135 1.9M Swalleyin + Feel OK 10-nov-15 Started Sof+Dac 01-dec-15 47 63 46 74 Still swalleyin 10-dec-15 47 58 44 < 15 Feel great Jus for the rekord, “swalley” in the tabel means Wullie was swallyin aboot 2 or 3 wee tins o beer per nite, on averidge. Not reelly tae much, eh Jeemie?
Enny-way, ye kin see fae this tabel tha after aboot 6 months off the swalley, Wullie’s LFT figgers wer back doon tae almost resonnibel levils (but still abuv normel). An he had startit tae feel much better, maybe even kyurd. But durin ah that time, hus viral load aktchelly went up!! So if Wullie hidnae seen ah the figgers fae hissel, he micht hae thoot tha he wis reely kyurd jus like be-foor…
Ye kin also see fae the tabel that Wullie had high lipase levils, which indikates a problem wi his pancreas. But ye kin also see that cuttin oot the swalley didnae dae onything tae change the lipase levils signifikantly.
An I hope finally ye kin ah see that, even if most ay the figgers are aw skew-whiff an dinna mak much sens, the onny thung that brings doon ah the enzymes toggither is the Sof+Dac treetment… Thank god for FixHepC!
So, pittin aside aw the stupit spellin, in case you are wondering what is the point of this post, what I really want to say is that if your GP or your insurance company tell you to cut out the booze and then maybe they will think about a treatment, you have to tell them this is all wrong… Wrong, Wrong, Wrong! If you are feeling unwell with anything that even remotely relates to the liver, you have to demand a HCV test.
And if HCV is detected, you have to tell him/them that the only solution is to cut out the HCV. Forget any questions about alcohol. HCV is the primary problem! And if they tell you to wait, dinna listen cus it jus meens there skert ah PC Murdoch an the like! Nah, ye’ll jus haff tae get yer ain moossie oot an dae it fi yersell, jus like Oor Wullie! Then ye’ll be feeling richt as rain in jus a fuw days!
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After-thought #1
For sensible advice about alcohol during treatment, please see
http://fixhepc.com/kunena-2015-11-10/faq.html#
After-thought #2
I’m not a medical expert, but since I am “only” F0/F1, I suspect that quite a few of my previous symptoms like losing weight (despite eating 3 meals per day) were probably due to lipase/pancreas problems. In other words, it seem that the HCV was hitting the pancreas as well as the liver, at least in my case…
After-thought #3
Come to think about it, I haven’t seen anyone else post results for “lipase” in this forum. This seems a bit strange, since my gastro-hepato-specialist always seemed more concerned about my lipase levels than the other LFT results. He now seems happy enough with the latest value (down to 74, compared to a reference value of 60).
After-thought #4
Next blood tests scheduled for 4 weeks. I will report if any damage was done during Christmas and New Year…
After-thought #5
Sorry for the long post!
Yes, it would be great to know some statistics about all the people who are being treated by – or thanks to – fixHepC.
How many Australians and how many “foreigners” are now on treatment thanks to fixHepC? How many are UND after the famous 12 week stage? This kind of info could really help to encourage all those guests who come and sit by the pool, but who are still wondering about whether to take the plunge?
For many of us (why not all?) who have registered here, a lot of the necessary data is already in our signatures.
[Hmmm, isn’t it just great to sit back and propose even more work for Dr James and his team?]
…Sorry, James!
