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Treatment for HCV with low PCR and no liver disease
Aug 26, 2001

Hello Drs. thank you for your time. I have a few questions after reading the CDC update on HCV. I am a 33yr old female and was first tested positive with HCV, and negative for all other diseases, in 1994. I am still negative for all other diseases and I live in Southern California. Subsequently I have seen many diferent Drs, who have differently levels of knowledge of HCV. I am a little confused as to what tests are needed to follow the disease and if a liver biopsy is the only difinitive test. I have had normal liver enzymes every time I have been tested and the last HCV RNA by PCR quant was <2000 copies/ml and my HCV RNA log 10 was <3.3 log 10. My questions are: 1. what is considered a high viral load? (please explain both tests) 2. is there a more sensitive pcr test that will tell me exactley what my viral load is? (instead of just less than 2000) 3. should I have a liver biopsy, since the disease can be asymptomatic? 4. are there any trials being done on asymptomatic HCV positive people to irradicate the virus BEFORE it causes any disease? 5.lastly, what is the test called to findout what genotype of HCV I have, and is it necessary to know this for treatment.

Thank you again for your time, I am again going to a new Dr. and would like to tell him exactly what tests I need done and how frequently I will need them.

Response from Dr. Rodriguez-Torres

The test to check the genotype is exactly that:HCV genotype. There are tests that measure as low as 50iu or copies.The only test that gives definite information of the liver status, is the biopsy.Patients can have severe liver disease with normal blood tests.The biopsy can be done easily ,with sonographic guidance,its safe and ambulatory.If the disease is minimal ,patients can be observed and biopsy repeated every 3 years. There was a study of normal ALT patients ,with (Pegasys),but I am afraid, it closed enrrolment recently.



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