Chronic or Acute?

[Claudio]

Hello. I really need some help!. About 5 days ago I started to notice jaundice in my eyes so I did a lab study which showed almost 3000 ALT and 2500 AST, Bili 8.
After this I did a HEP A, B and C serology and I got:
Hep A and C negative but:
AgS HBV +, Anti-AgC HVB +. So I thought about an Acute Hepatitis due to B virus.
The confusing thing is that FIVE years ago I got a positive Anti-AgS twice in the same lab.
I don't know the amount of the AntiBody neither the presence or not of AgS HBV.  
For that time (five years ago) I had never had sexual contact with anybody or any parenteral contact, and hadn't been vaccined either, I would like you to help me answer the cause of this (Could it be a lab mistake? does this mean I'm a crhonc sick, or carrier?)
One month ago I had to vaccine myself beacuase of my job (just the first dose) and now I have all this (which is also unexplainable) In this moment my enzymes are rising higher and also the Bilirrub.
I got a new Anti-AgS and it's NEGATIVE.  I got a Anti-AgC IgM and it's very high (does this mean it's an ACUTE HepB Please tell me! Is there a high level of IgM in chronic re-activation???) I have a couple since two years ago and she's asymptomatic. I work in a hospital (Surgery) but don't remember any puncture or accident.  Can I be a carrier since 5 years ago with a Anti-AgS that dissapeared?. Could it be the vaccine the cause of my actual dissease?? Excuse my english (I'm spanish speaker) And I really apreciate your help. Claudio

[cuteus]

check this site, it was created for prospective adoptive parents, but it had such a comprehensive explanation, I bookmarked it:
http://www.comeunity.com/adoption/health/hepatitis/smith.html

Buena suerte a ti.

[harley dude]

Sorry for the break in, but I have a quick question, I've probably seen it posted a hundred times (but I've been fog bound for quite some time). When can you actually take a deep breath and say I'm finally cleared of this HCV, is it 6 months post tx, 1 year post tx ect. In my case geno type 2b treated 48 mnths pegasys + copegus, cleared 3 mnths, and 6mnths, do I still have to sweat it out for another 6 months. I was under the impression clear 6mnths post tx your cleared- correct me if I'm wrong - what are my chances of staying clear.- Thank's Harley Dude

[jonihs]

Congratulations, you're SVR. When I got my 6 month PCR, the Dr. worded the letter this way. PCR RNA is negative 6 months following end of treatment, indicating eradication of the Hep C virus!"  Love Joni

[harley dude]

Thank's Joni - That made my day. - Harley

[doll face]

I have been told by my doctor that if your 6 month PCR comes back clear than you are considered cured. Congratulations !!!

[cuteus]

There is an abstract from the AASLD conference that might interest all of us interested in determining SVR:
http://hcvadvocate.org/news/reports/AASLD_2004/Posters_AASLD_2004.htm#A62

[harley dude]

Cuteus, I couldn't find out any info on what you posted about the svr study, let us know what was said- I looked all over- just couldn't find it - Thank's - Harley Dude

[cuteus]

This is part of the abstract at the AASLD, Boston.

THREE MONTH HCV RNA BY PCR POST IFN AND RIBAVIRIN THERAPY FOR SUCCESSFULLY TREATED CHRONIC ACTIVE HEPATITIS C (HCV) CAN BE USED TO DETERMINE SUSTAINED VIROLOGICAL RESPONSE (SVR)
 Lino J. De Guzman, Bradley Collins, Inland Empire Digestive Diseases & Liver Center, Redlands, CA.
 
AIM:
The purpose of this trial was to evaluate the earliest time point (one or three months) before patients (pts) can be classified as having a SVR after a complete response (CR) to HCV treatment (TX). Currently, the standard is to wait 6 months after TX before identifying pts with a SVR. It is estimated that 98% of pts with a SVR at 6 months will remain virus free indefinitely unless re-exposed and infected.
 
Methods:
A total of 60 HCV pts who had a CR had quantitative HCV RNA by PCR collected at the end of TX and at 1, 3 and 6 month intervals thereafter. There were 33 males, 35 pts were Genotype (G)1, 11 pts G 2 and 14 pts G 3. In order to qualify, pts must have completed 24 weeks if G2 or G3 or 48 weeks if G1 of either PEG IFN or standard IFN plus ribavirin. Metavir scores were the following: F0 (7 pts), F1 (22 pts), F2 (14 pts ), F3 (11 pts) and F4 (6 pts). This trial also examined if any underlying relationship existed between a pts total white blood cell count (WBC) and amino alanine transferase (ALT) levels after cessation of therapy to predict ultimate response or relapse.
 
Results:
HCV RNA by PCR taken at 1 and 3 months after completing TX correlated highly with viral loads obtained at 6 months. A total of 13 of the 60 pts (21.6%) with CR relapsed. All of the 3 month HCV RNA measurements were in exact agreement with those taken at 6 months (100% specificity). Only one (G 3) pt who had a CR after 24 weeks of TX became HCV RNA(+) between the 1 and 3 month blood draws (98% specificity).
 
Conclusion:
The specificity of the HCV RNA by PCR at 1 and 3 months post HCV TX for pts with a CR is similar to the viral load at 6 months. Based on the results of this data, we feel that SVR can be made with assurance at 3 months post HCV TX. and perhaps as early as 1 month after the end of TX. There was no significant relationships between WBC or ALT levels in predicting SVR.

[harley dude]

Cuteus, Thank's for the reply, hope you have a good week- Harley