2006 LIVER MEETING IN BOSTON

[JazzCat]

Newbies, in particular, might be interested in knowing about the annual "Liver Meeting" hosted by the American Association for the Study of Liver Diseases.  It will kick-off later this week in Boston. A lot of interesting research will be presented and discussed, including:

"Evaluation of the efficacy of an 18-week short treatment duration in HCV type 1 infected patients upon early viral kinetics: an approach to recognize 'super responders'."

Wow!  18-weeks for Genotype 1.  That's amazing.

This link will take you to the site where you can browse through all the abstracts of the studies that will be presented at the meeting.  Some exciting stuff is happening!

http://aasld2006.abstractcentral.com/login

[drofi]

I do not find the abstract of the 18 weeks study, could you post the direct link please?
drofi

[JazzCat]

The identification number for the abstract is #346.  Just enter that number into the abstract finder and it should take you there.  Let me know if that doesn't work

[JazzCat]

Here's the very compelling conclusion statement from that abstract:

"This analysis underlines the importance to determine viral kinetics at an early phase during treatment using quite sensitive HCV RNA assays.  By that means a subgroup of HCV genotype 1-infected rapid responder patients ("super-responders") may be identified (around 10% of the total population) which can achieve a SVR above 90% with a treatment duration of 18 weeks."

[NYgirl]

more and more it's looking like being REALLY UND (and that depends on the testing of course ie: PCR vs. TMA) at week 4 is coming in to play as ultra important.

For those of us who were not UND at week 4 (or 12) - thank God they have looked at the data of the studies as well so we know we need to treat longer.

If I were to be UND by PCR at week 4 - I would do whatever it took to get the TMA < 5 so I knew (but only because I am obsessive)

[jmjm530]

Jazz,

Thanks for the heads up. I had a bit of trouble finding the abstract right off, so maybe this will help others as well.


(1) Go here: http://aasld2006.abstractcentral.com/planner

(2) Then click on link to online Itinerary planner which is just above the "Log In" section

(3) Click on "Search" on left panel.

(4) In the case of the study abstract in question, enter "346" in the first column "Final?ID/Program Number"

(5) Click on "View Pres." at the end of copy block.

[JazzCat]

Thanks Jim.  BTW, were you previously aware of this 18-week tx study for 1's?  Interested in your take on it.

[susan400]

Yea, Debbie, I agree.  I'd love for them to keep up the research for people who don't respond right away, or, who, like me haven't responded at all.  I go to Mayo in Jacksonville on Oct. 31st.  Nope, it's not Schiff, but I do believe the Mayo has a good reputation and it being in the north part of the state (Fla.) works out better for me.  Anyway, who knows, maybe they will have some ideas.  I'm sort of ambivilent about treating again, but I'm trying to keep an open mind.  My doctor thinks I need to try to get into a study.  I'm not so sure I really want to, I guess it will depend on the study.

Susan (your HCV matching genotyper 1A/1B)

[jmjm530]

Not aware of this particular study other than a heads-up (I believe at the Clincial Options Website) that an early viral kenetics presentation was forthcoming.

That said, this particular study is much akin to the European "short course" directive that found I believe 90% SVR in a cohort of geno 1's who were serum negative at week 4 and also had pre-tx VL of under 600,000.

Haven't fully digested this yet, but it appears this study uses week 5 and a vl of <800,000 as one of its cut off points.

Was I still treating, a statment like this

"...In contrast patients being still positive with the sensitive TMA assay at week 5 hardly had any change to achieve SVR when treated for 18 weeks (29%; 4 out of 14 patients)..."

would have absolutely driven me nuts as I cleared at week 6 and my guess is they didn't test at week 6 :)

It certainly will be interesting to hear feedback from the meeting participants. Again, if I were still treating I would definitely be discussing the paper with my doctor as well as ordering up the full-text article. Abstracts often do not tell the full story such as the demographics of the study group -- age, stage, etc.

I know it's totally counter-productive, but I must admit I've thought more than once about the European Directive and how my life might have been different these past two years had I treated for only 24 (now 18) weeks instead of the 54 I did.

As a stage 2-3 (actually I was under the impression I was a stage 3) I did discuss with my treating doc some of the stopping rules and he argued that based on my stage (3) and age (59) that they didn't apply in his opinion. Even with my week 6 RVR. Being between stage 2-3 I differed to his judgement. Doing it all over again, and with a more recent/definite biopsy number (let's say stage 0-2), I would be untruthful to say I wouldn't be speaking to at least several doctors about trying a shorter course of treatment like the 18 weeks presented. I'm 7 months post treatment now, which means going on two years of being under the effects of these drugs including post treatment recovery. My guess would be that 18 weeks of treatment would have left me a lot better off in that regard.

Still, I'm grateful I did clear with my 54 week course and it still appears the right decision at the time I made it, or at least 48 weeks of it. Many here have treated longer, without success, so yes, grateful I am.

But moving forward, hopefully shorter treatment protocols, either like described in this abstract, or as in various trials right now, will be the future of Hep C treatment.

Even without this study, my treatment doc did weekly VL testing from week 1 until I was non-detectible. Montly VL testing after that. This study, among others, shows how useful early and frequent VL testing can be. Something for everyone treating to discuss with their doctors.

-- Jim

[jmjm530]

A couple of short points. This was a Peg Intron study meaning the results may have been different with Pegasys -- be it better, worse, or the same. Also, the 90% SVR figure for the 18 week group who started at <800,000 IU/ml, is just one of many useful derivites in the study. Lastly, besides weekly VL testing (from week 1) the study suggests the importance of SENSITIVE VL testing. This study used tests down to 5 IU/ml. Since these tests are readily available, it makes sense to ask your doctor for them. Heptimax by Quest Diagnostics is one such test. In the study, I believe they started with a Bdna , sensivity around 600 IU/ml and then if the patient was negative, they ran the same blood through a sensitive TMA with 5 IU/ml sensitivity. Same concept as Heptimax but with Heptimax you would always get a number regardless of the viral load.

[jmjm530]

I said previously: would have absolutely driven me nuts as I cleared at week 6 and my guess is they didn't test at week 6 :)

-----------------------------------------------------
Actually that doesn't make much sense, but what would have driven me crazy is the fact that from weeks 3-5 I was exteremely close to being negative -- 20 IU/mL to 100 IU/ml. The study on the other hand -- since it didn't use a sensitive quantitative -- would have pegged me as detectible somewhere between 5 IU/ml and 600 IU/ml for those three weeks. Did this mean that my results would have been closer to the five week non-detectible group or the five week detectible group? Another case where matching your stats to the study stats can drive you nuts :)

[JazzCat]

Thanks for your comments, Jim.  Yes, there's much about this disease, and the difficult choices it demands, that can drive one nuts.  For example, what if  someone does only 18 weeks of tx ...doesn't clear...and then has to make the difficult choice of starting over again for a 48-week course of tx.  There are just too many 'what if's' to contend with.

In your case, I wouldn't spend too much time looking in the rear-view mirror.  You're clear, in spite of the challenges you still face.  That's a blessing many of us can only hope for.

Good luck to you.

[jmjm530]

(Turning head 180 degrees around) Of course, you're 100% correct :)

Be well,

-- Jim

[PasoPerson]

Clinical Care Options sent out an email today about an interesting tool they will be using.  It's about HCV Treatment Guidelines Algorithm, An Interactive Decision Support Tool for medical personnel.  (I hope I don't get in trouble, always afraid what I post will be illegal or offending, but here's the link ...)

http://clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20Management%20Tools.aspx#{F15EC88A-3372-4F63-BF6C-9D1AD5235690}

From there, click on the algorithm to get to a larger view of same.  

When you're done looking at the algorithm, click on View Full Analysis for some very interesting info.  It's not good for me, but it sure is interesting.

[Kalio1]

Hey Paso, how's it shakin? Hope you are feeling good.

I love clinical care options too, I just wanted to mention to everybody out there in cyberland that anyone can sign up for their email alerts, it's simple, they can just register and check the "yes I want email alerts" box. Just in case they miss the post with the link in it. There are so many posts now it is hard to locate things and also easy to miss info. I have found such great info on that site too.

take care, nice to see you.

[willing]

Hi gang, I gathered the abstracts of a large subset of the HCV presentations scheduled for the upcomming AASLD into <a href="http://tinyurl.com/yms5nh">a single pdf</a>. Their itinerary planner software limits one to 250 abstracts, so this list is not exhaustive, but should be enough to exhaust most of us (search the file for "950", "HCC", "occult" or other favorite phrase for this year's crop of studies).

[Forseegood]

Just wanted to say it's good to see you all here...hope all is well with everyone...too hot here though, phew!

[Forseegood]

hey, thanks for that...good reading...

[willing]

yeah, but a little roasting before the elections is a good thing; beats any number of Sierra Club ads. good to hear from you, as always.

[mikesimon]

It's great to see your name and it figures that you'd have a bunch of information for us. Thanks. I hope you're doing well. Mike

[jmjm530]

Thanks for the file. Should make things a lot easier.

In case you haven't stumbled on it yet, a lot of useful info on the Clincal Options web site. Try "Doc Eye for the Hep Guy" with Dr's Dieterich and Jensen for starters.
http://www.clinicaloptions.com/Hepatitis.aspx

Hope this finds you well,

-- Jim

[willing]

best wishes guys, and I hope life is treating you well (and if not,  heck, living well is always the best revenge..). Thanks for the CCO site, the pace of new hcv development is overwhelming (though it doesn't seem to take that much to overwhelm me these days).

Here's another CME site, from "projects in knowledge", complete with test, that surveys the current crop of upcoming <a href="http://www.projectsinknowledge.com/init/G/1776/index2.cfm?jn=1751&sk=&init=G&action=online">hcv-targeted  drugs</a>. Methinks viral eradication is starting to look a bit like a video game and that perhaps the abstracts that review the long-term follow-up data that's starting to pile up may be a bit more to the point...

[Morgaina]

Hello all.............good info around here today. Just came from my doc, he's headed down to that conference. He said something today that I dont generally hear. He was worried about my lack of passion/interest in my work, music, life, everything since treatment ended. He doesn't think it bodes well for SVR unless a person is happy and hoppin'. I believe that but never heard it from a doc before. Anyone else ever had a doc think of their mental state as far as physical health goes??
Hey fisheress, dont care to hear how hot it is there. We already have snow on the ground! This winter is going to be a kicker! (SO, where do you live? Got lots of room??)

[Forseegood]

hmmm, your doc's clairvoyant huh? Can he tell me who's gonna win in the 6th race at Santa Anita? I'm gonna make some money on this guy! lol...just kidding Morgiana, please don't take offense....I know what he means about keeping a positive attitude and all that, but I just hope he doesn't spook you either..I know you'll feel better soon, good to see you! you don't post enough...

[DoubleDose]

Thanks for the links, and the great info. on the Table of Contents and Abstracts for the AASLD Conference.  I have already read quite a few, and #227 is of interest...regarding natural history of those who spontaneously clear HCV.  Look at the reported symptoms, and percentages!  I wonder how that might compare to the current batch of 'SVR's'.  They may both have similar outcomes.

Interesting studies on household transmission (again) in Egypt (a retrospective), and no explanations for the continuing prevalance of household transmission without risk factors.....

Good studies on very long term fibrosis regression in SVR's....Good News for the long haul!!!!

This will make for some very interesting reading!!!



DoubleDose

[GrandOak]

There appears to be an abundant wealth of *VERY* good abstracts this year.  Even one on influence of Mary Jo Wanna on HCV (see 104), Coffee on HCV (see 109).

MBB might want to check 1133 and 1146 as they are looking at the Tribavirin (sic?).

[susan400]

My doctor's going to two conferences here in the next couple of weeks.  He left for last Thurs. to a conference in Las Vegas and the next one I believe was the one that you're referring to.  The one in Vegas was for endoscopic gastroenterology or something like that.  

Susan

[TnHepGuy_]

Really good to see you again. And I hope all is doing well with you and family these days.


I've been wondering - how did you make out with your most recent bx? Perhaps tx #2 was of some structural benefit, if nothing else?


Don't know if you've been keeping up on anything "occult-related" lately but here are some of the more recent (2006) papers I've run across (the first one being from this AASLD meeting). Some come to rather troubling conclusions:


<a href="http://aasld2006.abstractcentral.com/planner?NEXT_PAGE=ITINERARY_ABS_DET_POP&ABSTRACT_ID=162931&SESSION_ID=15952&PROGRAM_ID=2016">Ultracentrifugation of serum samples allows detection of HCV-RNA in patients with occult HCV infection</a>

<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17021056&query_hl=1&itool=pubmed_DocSum">Combined Hepatitis C Virus (HCV) Antigen-Antibody Detection Assay does not Improve Diagnosis in Seronegative Individuals with Occult HCV Infection</a>

<a href="http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2893.2006.00783.x">Comparative study between occult hepatitis C virus infection and chronic hepatitis C</a>

<a href="http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2036.2006.02886.x">Effect of anti-viral therapy for occult hepatitis C virus infection</a>

("<i>Conclusion: The biochemical, virological and histological response to therapy achieved in patients with occult hepatitis C virus infection demonstrates the pathologic effects of occult hepatitis C virus.</i>")

<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16685484&dopt=Citation">Virus persistence in hepatitis C: lifelong infection despite therapy?</a>

("<i>CONCLUSION: The precise significance of the HCV persistence in the host organism is still inconclusive; according to first research results, however, it can lead to a deterioration of the liver histology. At present, it is also unclear if patients with occult hepatitis C as well as with evidence of HCV RNA in the liver and/or extrahepatic compartments after seemingly successful antiviral treatment are to be regarded as infectious.</i>")

<a href="http://jcp.bmjjournals.com/cgi/content/abstract/59/5/526">HBV, HCV, and TTV detection by in situ polymerase chain reaction could reveal occult infection in hepatocellular carcinoma: comparison with blood markers</a>

("<i>Conclusions: These findings provide further evidence for occult HBV and HCV infections in cancerous tissues from patients with hepatocellular carcinomas.</i>")


TnHepGuy


P.S. - Have you ever heard anything back from Radkowski?

[TnHepGuy_]

.....the AASLD paper # for the first one I posted above is <b>233</b>.

And there is also paper # <b>401</b>, titled: "Assessment of antiviral treatment efficacy in patients with chronic hepatitis C by immunohistochemical detection of NS3 HCV antigen in liver tissue" - from which this conclusion is reached:

("<i>Conclusions: Results of our study show the possibility of HCV infection persistence in 30 % of pts with negative HCV RNA in serum after antiviral treatment. Persistence of NS3 HCV occurs more frequently in genotype 1 and 4 than in genotype 3. Assessment of SVR by detection of serum HCV RNA seems not to be sufficient.</i>")

And in paper # <b>LB13</b> they reach this conclusion:

("<i>Conclusions: OHBV and OHCV infections were found in as many as 7.4% and 9.4% of HERS participants who were HBsAg- and HCV Ab- respectively. HIV+ status was associated with OHBV but not with OHCV. Our findings suggest that among persons with or at risk for HIV, OHBV or OHCV is not rare, and if confirmed, that routine testing of such persons for occult viral hepatitis should be considered. OHCV may be a cause of unexplained elevated ALTs in this setting.</i>")



Also, I saw mention in one paper describing what appears to be a definitional difference between occult in patients who have it after spontaneous (and I would also imagine after tx'ing) and those that have occult on it's own. Primary Occult Infection (POI) is defined as those that have it without having cleared any "greater" infection. Secondary Occult Infection (SOI) is defined as those that have it after having cleared either spontaneously (or via tx).


TnHepGuy

[mikesimon]

Thanks for the links. This subject interests me greatly due to my own circumstances. Mike

[DoubleDose]

All of which only serves to point out that there are many forms of HCV infection, some more detectable...some less detectable, all of which may be responsible for long term physical and psychological problems.  

Look at abstract #227 on the natural history of spontaneous clearers.  Their ongoing symptoms are similar to todays SVR's...which leads one to question whether the HCV is really 'gone' at all on clearing, in either case!

Studies on sporadic transmission are also covered this year, and there are more research studies 'in the works' regarding an undetected form of possible transmission among close and familial contacts.  If it is proven to be real, this may be more a tissue or fluids based infection, and not the typical blood infection.  Plans are underway to research this issue in a large controlled study.

I develop more concerns, and more anxiety every year!  Being SVR is not quite the nirvana many of us had hoped for.  Not to even open the subject of possible interferon induced long term effects.  Pretty soon I think the medical community will start raising the red flags, and see the HCV issue for what it really is: a major threat and a very misunderstood, and under-rated disease.

Thanks for the abstracts.

DoubleDose

[niceguy2007]

hey guys...maybe taking lifelong milk thistle after SVR could do the trick?  

cuz milk thistle (Carduus Marianus) and other stuff like Chelidonium, Lycopodium and Myrica Cerifera have proven effects on the liver.  

deep down i beleive there IS  a cure, even if a HYBRID one.

[mikesimon]

Here is another link on occult HCV which goes into some detail.
<A HREF="http://www.mlo-online.com/articles/0206/0206clinical_issues.pdf/">Occult hepatits C virus persistence</A>

Mike

No niceguy, I don't believe milk thistle will do it.

[mikesimon]

The link doesn't work for me so you'll have to copy and paste if you're interested.
http://www.mlo-online.com/articles/0206/0206clinical_issues.pdf

Mike

[cuteus]

I was hoping for that nifty list that willing always gathers for us, TY!  and tnguy, what a great surprise, did your wife make the lottery for the marathon? and thanks for the links!

does anyone know if a layperson can attend the meeting? if one day was to be chosen, which one looks good?  I think I would like to attend, and I know exactly where the convention center is, since we visited it a year or so ago.

[willing]

tn: thanks for asking; I hope all goes well with you and yours and that the lingering tx effects have finally dissipated. My latest biopsy came in at grade 1-2 "piecemeal necrosis that is mild in degree" and stage 1 "mild priportal fibrous expansion". This is now my third bx  (from ungraded "early cirrhosis" to stage 2, with no commentary, to the above). By now I'm quite skeptical of pathologists, so took my slides to some heavier-caliber specialists at the Stanford liver-transplant center for a 2nd look (still waiting). If I can find a microscope with the right magnification I'll post them and perhaps others can do the same. The blue trichrome stain that marks fibrosis is pretty easy to pick out; maybe  we can all get to know each other a little more intimately as it were.. Per my earlier plan, those results are grounds for waiting for the new crop of drugs to mature, which, given that I don't want to do more than 3 months of ifn, might mean 8-10 years. The  fly in the ointment is quick progression; so I'm keeping an eye on the fibro* tests and wondering whether statins or alinia are worthwhile maintenance (my take from studies like 377 and 356 is that waiting for fibrosis to progress to 3 or above is risky, SVR doesn't seem to have a conclusive impact on the HCC/HD rates). And a confession, I started drafting that Radkowski letter but didn't mail it (also couldn't figure out if he's at Mayo or in Warsaw currently). My goof, I'll send if off, and also send one Pham (that review that Mike linked is still one of the best sources on the topic, pretty hard to argue with a photograph of a  gel).

dd: it looks like there's a steady accumulation of data to support your concerns. I was thinking about you recently while reading a review by Michael Oldstone (<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16364742&query_hl=3&itool=pubmed_docsum">Viral persistence</a>) who's been studying the topic for years (in a more general setting than HCV). The review opens with "One of the remarkable advances in modern virology is the realization that persistent viral infections exist and are common...The continuous replication of a viral, i.e.,foreign gene, in a differentiated cell can selectively disorder the functions of that cell without destroying it..The result is a disturbance in the host’s biologic
equilibrium". Still, I think it'll be many years before clinicians will consider this something to go after...Good to hear from you!.

cuteus - hope all is  well with you. I'd be great to hear about what these presentations are like in person (do they argue about the same stuff we do?). The website talks about drop-in registration but the price is fairly steep...

[mikesimon]

I know that everyone thinks their guy is THE guy but I have heard  many accolades about this pathologist. My transplant surgeon thinks he's one of the best pathologists, if not the best pathologist, in the world. He reviews slides sent to him from everywhere - in the US and outside. If you ever want another reputable opinion try this man.

<A HREF="http://path.upmc.edu/cmp/fac07.htm/">Liver Pathologist Demetrius</A>

Mike

[mikesimon]

None of my links seem to be working today. Here it is again:
http://path.upmc.edu/cmp/fac07.htm
Mike

[willing]

thanks Mike - that's a great referral. One of the many things I don't understand about pathologists is why they make so few slides. You'd think to reduce sampling error they'd mount the entire core sample into slides...

[mikesimon]

It almost seems that liver pathology (perhaps all pathology though I'm not familiar with anything but liver) is a closed and secret society. But, since there is often significant variance in slide interpretation, maybe it's just too complex for us lay-people to grasp. I have tried but without any success. Mike

[DoubleDose]

I hope that everyone will take a look at one of the last abstracts in the AASLD information linked above by Willing.
It is Study LB9, and it involves long term eradication studied in 345 patients with long term SVR's.  They looked at serum samples, liver samples, and PBMC samples, and found NO relapses, and only a couple of cases where the liver or PBMC's were found to be HCV+.  The rest of the study group were negative in all compartments studied.  Now maybe tremendous amplification of the samples might have turned up a different result, but who knows....They seemed to use pretty sensitive tests, and seemed to look at a large number of samples, and patients.

The tangible, and unquestionable good news was NO RELAPSES in 345 patients!  As to whether there were still undetected amounts of HCV at infinitesimal levels under the testing thresholds, we will never know.  I am just happy to see that there was no HCV found in any, but a very few, of the many different types of samples.  

Comments????  Interpretations???  

DoubleDose

[willing]

DD: good find - I'm sure that one will get picked up by the hcv web sites. If you can go back and compare the RNA detection protocol in that abstract with the one in the Pham review Mike posted, it seems that the inconsistency may be explained by (1) the different  RNA amplification techniques used and (2) Pham's use of immune stimulants. I've never seen printed criticism of Pham's (RNA->cDNA->PCR->NAH) technique so my interpretation is that the standard VERSANT TMA test simply doesn't detect HCV RNA  at the  occult/silent level. The unchallenged durability of  suppression of detectable levels and the accompanying improvement in liver cell health probably explains why most clinicians are happy with the word cure. Oldstone might quibble about this, but whatever damage any residual virus is up to seems far less than what it's doing pre-SVR. Maybe we can get cuteus to talk to these guys after their presentation and ask why they didn't run Pham's amplification protocol...

Mike: I think that's why I'm planning to shop those slides around a bit. Truth is elusive and if I get different different readings from different high priests there goes my faith in the secret society.

[TnHepGuy_]

<u>cuteus</u> - my wife got shut out on the lottery for the marathon, which she was told was pretty much par-for-the-course for first-year applicants. She was also told that they "only" do three denials in a row before they guarantee you a slot. I hope all is doing well with you and your daughter these days out on The Island.


<u>willing</u> - real glad to hear of your initial bx results. Hopefully that will be confirmed (perhaps even better) with the upcoming read(s). The possibility for human error seems to be ripe in just about every step/stage of the bx process. You would think that by now they could have a (supposedly) unbiased computer/scan program that could rate slides against a standard, thereby minimizing that particular step. But I guess that's the true key, though - having that one, true "gold standard" that all clinicians/researchers would agree upon.

I think your line of thought on not wanting to see any further progression take place is a good one, since in waiting until such a time the odds of further damage/HCC and the like are then on the increase, while the odds of a successful tx (or re-tx) drop dramatically. You would hate to be caught with your "liver down" (so-to-speak) at stage 3 or beyond, having failed current protocol with the options - and the odds - at that point then being rather minimal. Maintenance and anti-fibrotics certainly seem to be key for relapsers and those unable to tx.

One thing about waiting for the newer Rx's to "mature" is that as they come on-line, docs will (at first) follow the trial protocols - in terms of which drugs in combo will they will use on which type patients, in which type dosages, etc. As time passes and more studies, info - and anecdotal clinical experience - come in, more docs will be willing to deviate from the norm-of-the-moment and add or juggle things to increase the odds (e.g. - the use of rescue drugs becoming the norm over the last few years, even though they are and "off-use" application). Plus, in waiting you can possibly gain valuable info gleaned from relapsers thing with the newer Rx's. I would suspect that the majority of the new rx trial patients will continue to be tx-naive, with less data (dolled out over a longer period of time) being published for relapsers as a result.

As far as how I'm doing - thanks for asking. Pretty much the same as prior. Still slightly anemic, bone pain in my hip, skin eruptions, periods of lethargy, bouts of "frain bog", joint and muscle pain - many of the usual suspects in the post-interferon gift department. I'm mostly hoping that one gift that passes me by is anything auto-immune-related. There's a family history of that already and I'd hate to have awoken a new dragon.


I'm not checking in here (MedHelp) with all that much frequency these days. And I'd really like to learn what you may hear back from any of the occult researchers. Would you mind e-mailing me anything they send along?


TnHepGuy

[cuteus]

you know willing, you just gave me an idea. I see Dr Bernstein's name in one of the abstracts with Dr Afzal, Jacobson and others, not sure if he will be up there, some of the conferences are only 50 bucks or so, so it could be doable to go on Sat, when Bernstein presentation is scheduled...we'll see. but in any case, my follow up appt with him is in Dec, I asked specifically for him, not the associate, so that I can ask him questions. I have printed the Pham article and will ask him at that appt your question and his opinion as to why that test was not utilized.  good suggestion

DD; I was scanning through the abstracts for articles like the one you mentioned, and it is appreciated that you posted the number of reference. Thanks.  maybe i will print that and also bring it with me.  I plan on asking that he consider me for any studies that deal with the aftermath of hcv.

tnguy, there is another way to qualify, but it seems strenous. somoething about placing in the top three in a number of races? I hope she makes it!
so you are still slightly anemic, how odd!  hopefully, no RA has awaken in your case. My friend has it and tests low in the hgb dept most of the time, not sure why.  Did they ever do an MRI of any other part, besides the hip?  I hope the discomfort is manageable.  Do check the sites on 'brain retraining' for ideas on how to improve the fog and cognitive issues. sounds plausible to do.
take care, all

[willing]

tn : be glad to, but I don't have an address for you (also, after DD's post I'd like to read up a bit more on the detection method used so I can ask them to comment on that aspect).

all: as of this am, ISI references 41 peer-reviewed citations to Pham'04 (sorry I didn't have time to reformat them into pubmed links)
<table border="0" cellpadding="2" cellspacing="0"><tr><td>FN</td><td>ISI Export Format</td></tr><tr><td>VR</td><td>1.0</td></tr><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Ciancio, A<br>
   Smedile, A<br>
   Giordanino, C<br>
   Colletta, C<br>
   Croce, G<br>
   Pozzi, M<br>
   Cariti, G<br>
   Macor, A<br>
   Biglino, A<br>
   Di Napoli, A<br>
   Tappero, GF<br>
   Andreoni, M<br>
   Manca, A<br>
   Prandi, G<br>
   Calleri, G<br>
   Orsi, PG<br>
   Ciccone, G<br>
   Rizzetto, M<br>
   Saracco, G</td>
</tr>
<tr>
<td valign="top">CA </td>
<td>WIH Grp</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Long-term follow-up of previous hepatitis C virus positive
   nonresponders to interferon monotherapy successfully retreated with
   combination therapy: Are they really cured?</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>AMERICAN JOURNAL OF GASTROENTEROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>AUG</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>101</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>8</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>1811</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>1816</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000239962000019</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Quiroga, JA<br>
   Llorente, S<br>
   Castillo, I<br>
   Rodriguez-Inigo, E<br>
   Lopez-Alcorocho, JM<br>
   Pardo, M<br>
   Carreno, V</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Virus-specific T-cell responses associated with hepatitis C virus (HCV)
   persistence in the liver after apparent recovery from HCV infection</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF MEDICAL VIROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>SEP</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>78</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>9</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>1190</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>1197</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000239404400007</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Morishima, C<br>
   Morgan, TR<br>
   Everhart, JE<br>
   Wright, EC<br>
   Shiffman, ML<br>
   Everson, GT<br>
   Lindsay, KL<br>
   Lok, ASF<br>
   Bonkovsky, HL<br>
   Di Bisceglie, AM<br>
   Lee, WM<br>
   Dienstag, JL<br>
   Ghany, MG<br>
   Gretch, DR</td>
</tr>
<tr>
<td valign="top">CA </td>
<td>HALT-C Trial Grp</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>HCV RNA detection by TMA during the hepatitis C antiviral long-term
   treatment against cirrhosis (Halt-C) trial</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>HEPATOLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>AUG</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>44</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>2</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>360</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>367</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000239523200010</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Amor, A<br>
   Toro, C<br>
   Jimenez, V<br>
   Simon, A<br>
   Ramos, B<br>
   Soriano, V</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Seroreversion of HIV antibodies in patients with prolonged suppression
   of viraemia under HAART</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>AIDS</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>JUN 26</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>20</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>10</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>1460</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>1462</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000239358100016</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Di Liberto, G<br>
   Roque-Afonso, AM<br>
   Kara, R<br>
   Ducoulombier, D<br>
   Fallot, G<br>
   Samuel, D<br>
   Feray, C</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Clinical and therapeutic implications of hepatitis C virus
   compartmentalization</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>GASTROENTEROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>JUL</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>131</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>1</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>76</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>84</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000238983300017</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Blackard, JT<br>
   Kemmer, N<br>
   Sherman, KE</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Extrahepatic replication of HCV: Insights into clinical manifestations
   and biological consequences</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>HEPATOLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>JUL</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>44</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>1</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>15</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>22</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000238690900004</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Carreno, V<br>
   Pardo, M<br>
   Lopez-Alcorocho, JM<br>
   Rodriguez-Inigo, E<br>
   Bartolome, J<br>
   Castillo, I</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Detection of hepatitis C virus (HCV) RNA in the liver of healthy,
   anti-HCV antibody-positive, serum HCV RNA-negative patients with normal
   alanine aminotransferase levels</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF INFECTIOUS DISEASES</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>JUL 1</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>194</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>1</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>53</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>60</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000238337400009</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Gockel, HR<br>
   Heidemann, J<br>
   Lugering, N</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Virus persistence in hepatitis C: Lifelong infection despite therapy?</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>MEDIZINISCHE KLINIK</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>MAY 15</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>101</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>5</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>378</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>383</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000238060700008</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Elliott, LN<br>
   Lloyd, AR<br>
   Ziegler, JB<br>
   Ffrench, RA</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Protective immunity against hepatitis C virus infection</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>IMMUNOLOGY AND CELL BIOLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>JUN</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>84</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>3</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>239</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>249</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000237063000112</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Sansonno, D<br>
   Tuca, FA<br>
   De Re, V<br>
   Lauletta, G<br>
   Montrone, M<br>
   Libra, M<br>
   Dammacco, F</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Association between mixed cryoglobulinemia, translocation (14;18), and
   persistence of occult HCV lymphold infection after treatment - Reply</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>HEPATOLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>MAY</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>43</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>5</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>1167</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>1168</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000237327200035</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common">
<table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Nishida, N<br>
   Komatsu, Y<br>
   Komeda, T<br>
   Fukuda, Y</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Interferon-alpha improves bone resorption and osteopenia in patients
   with chronic hepatitis C</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>HEPATOLOGY RESEARCH</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>APR</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>34</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>4</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>222</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>227</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000236803000003</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Pardo, M<br>
   Lopez-Alcorocho, JM<br>
   Castillo, I<br>
   Rodriguez-Inigo, E<br>
   Perez-Mota, A<br>
   Carreno, V</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Effect of anti-viral therapy for occult hepatitis C virus infection</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>ALIMENTARY PHARMACOLOGY &amp; THERAPEUTICS</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>APR 15</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>23</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>8</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>1153</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>1159</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000236392800014</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Wang, Y<br>
   Kato, N<br>
   Jazag, A<br>
   Dharel, N<br>
   Otsuka, M<br>
   Taniguchi, H<br>
   Kawabe, T<br>
   Omata, M</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Hepatitis C virus core protein is a potent inhibitor of RNA
   silencing-based antiviral response</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>GASTROENTEROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>MAR</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>130</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>3</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>883</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>892</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000236210100029</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Scott, JD<br>
   McMahon, BJ<br>
   Bruden, D<br>
   Sullivan, D<br>
   Homan, C<br>
   Christensen, C<br>
   Gretch, DR</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>High rate of spontaneous negativity for hepatitis C virus RNA after
   establishment of chronic infection in Alaska Natives</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>CLINICAL INFECTIOUS DISEASES</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>APR 1</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>42</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>7</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>945</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>952</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000235777100008</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Maheshwari, A<br>
   Thuluvath, PJ</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Cryptogenic cirrhosis and NAFLD: Are they related?</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>AMERICAN JOURNAL OF GASTROENTEROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>MAR</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>101</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>3</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>664</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>668</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000235659500037</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Pawlotsky, JM</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Therapy of hepatitis C: From empiricism to eradication</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>HEPATOLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>FEB</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>43</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>2</td>
</tr>
<tr>
<td valign="top">SU </td>
<td>Suppl. 1</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>S207</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>S220</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000235193700029</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Formann, E<br>
   Steindl-Munda, P<br>
   Hofer, H<br>
   Jessner, W<br>
   Bergholz, U<br>
   Gurguta, C<br>
   Ferenci, P</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Long-term follow-up of chronic hepatitis C patients with sustained
   virological response to various forms of interferon-based anti-viral
   therapy</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>ALIMENTARY PHARMACOLOGY &amp; THERAPEUTICS</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>FEB 15</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>23</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>4</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>507</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>511</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000234795200007</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Tan, YJ<br>
   Lim, SG<br>
   Hong, WJ</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Understanding human immunodeficiency virus type 1 and hepatitis C virus
   coinfection</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>CURRENT HIV RESEARCH</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>JAN</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2006</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>4</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>1</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>21</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>30</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000234501900003</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>D'Amico, E<br>
   Chincoli, C<br>
   Cacciatore, P<br>
   Di Pasqua, G<br>
   Cosentino, L<br>
   Riario-Sforza, G<br>
   Pennese, E<br>
   Capani, F<br>
   Palazzi, C</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Effects of combined antiviral therapy on asymptomatic mixed
   cryoglobulinemia in naive patients with chronic hepatitis C virus
   infection: A preliminary study</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>DIGESTIVE DISEASES AND SCIENCES</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>DEC</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>50</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>12</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>2344</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>2347</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000234380200027</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Yamabe, H<br>
   Nakamura, N<br>
   Nakamura, M<br>
   Shimada, M<br>
   Kumasaka, R<br>
   Fujita, T<br>
   Osawa, H<br>
   Okumura, K<br>
   Oyama, N<br>
   Momose, A</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Hepatitis C virus-associated glomerulonephritis without hepatitis C
   virus in the blood</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>AMERICAN JOURNAL OF KIDNEY DISEASES</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>OCT</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>46</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>4</td>
</tr>
<tr>
<td valign="top">AR </td>
<td>e65</td>
</tr>
<tr>
<td valign="top">DI </td>
<td>ARTN e65</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000233933300034</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common">
<table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Laskus, T<br>
   Radkowski, M<br>
   Adair, DM<br>
   Wilkinson, J<br>
   Scheck, AC<br>
   Rakela, J</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Emerging evidence of hepatitis C virus neuroinvasion</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>AIDS</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>OCT</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>19</td>
</tr>
<tr>
<td valign="top">SU </td>
<td>Suppl. 3</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>S140</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>S144</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000233570900022</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Zachary, P<br>
   Ullmann, M<br>
   Djeddi, S<br>
   Meyer, N<br>
   Wendling, MJ<br>
   Schvoerer, E<br>
   Stoll-Keller, F<br>
   Gut, JP</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Evaluation of three commercially available hepatitis C virus antibody
   detection assays under the conditions of a clinical virology laboratory</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF CLINICAL VIROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>NOV</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>34</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>3</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>207</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>210</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000233297200006</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Soriano, V<br>
   Maida, I<br>
   Nunez, M<br>
   Garcia-Samaniego, J<br>
   Barreiro, P<br>
   Martin-Carbonero, L<br>
   Gonzalez-Lahoz, J</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Long-term follow-up of HIV-infected patients with chronic hepatitis C
   virus infection treated with interferon-based therapies</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>ANTIVIRAL THERAPY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>DEC</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2004</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>9</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>6</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>987</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>992</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000231616000015</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Cruise, MW<br>
   Melief, HM<br>
   Lukens, J<br>
   Soguero, C<br>
   Hahn, YS</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Increased Fas ligand expression of CD4(+) T cells by HCV core induces T
   cell-dependent hepatic inflammation</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF LEUKOCYTE BIOLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>AUG</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>78</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>2</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>412</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>425</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000230860700012</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Gordon, SC</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Occult viral hepatitis and noncirrhotic hepatocellular carcinoma</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>AMERICAN JOURNAL OF GASTROENTEROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>AUG</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>100</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>8</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>1754</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>1757</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000230992100018</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Bare, P<br>
   Massud, I<br>
   Parodi, C<br>
   Belmonte, L<br>
   Garcia, G<br>
   Nebel, MC<br>
   Corti, M<br>
   Pinto, MT<br>
   Bianco, RP<br>
   Bracco, MM<br>
   Campos, R<br>
   Ares, BR</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Continuous release of hepatitis C virus (HCV) by peripheral blood
   mononuclear cells and B-lymphoblastoid cell-line cultures derived from
   HCV-infected patients</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF GENERAL VIROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>JUN</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>86</td>
</tr>
<tr>
<td valign="top">PN </td>
<td>Part 6</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>1717</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>1727</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000229575500016</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Tester, I<br>
   Smyk-Pearson, S<br>
   Wang, P<br>
   Wertheimer, A<br>
   Yao, EM<br>
   Lewinsohn, DM<br>
   Tavis, JE<br>
   Rosen, HR</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Immune evasion versus recovery after acute hepatitis C virus infection
   from a shared source</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF EXPERIMENTAL MEDICINE</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>JUN 6</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>201</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>11</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>1725</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>1731</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000229600300005</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Roque-Afonso, AM<br>
   Ducoulombier, D<br>
   Di Liberto, G<br>
   Kara, R<br>
   Gigou, M<br>
   Dussaix, E<br>
   Samuel, D<br>
   Feray, C</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Compartmentalization of hepatitis C virus genotypes between plasma and
   peripheral blood mononuclear cells</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF VIROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>MAY</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>79</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>10</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>6349</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>6357</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000228814400045</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Pham, TNQ<br>
   MacParland, SA<br>
   Coffin, CS<br>
   Lee, SS<br>
   Bursey, FR<br>
   Michalak, TI</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Mitogen-induced upregulation of hepatitis C virus expression in human
   lymphoid cells</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF GENERAL VIROLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>MAR</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>86</td>
</tr>
<tr>
<td valign="top">PN </td>
<td>Part 3</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>657</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>666</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000227367500016</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Pachiadakis, L<br>
   Pollara, G<br>
   Chain, BM<br>
   Naoumov, NV</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Is hepatitis C virus infection of dendritic cells a mechanism
   facilitating viral persistence?</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>LANCET INFECTIOUS DISEASES</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>MAY</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>5</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>5</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>296</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>304</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000228750500026</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common">
<table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Radkowski, M<br>
   Horban, A<br>
   Gallegos-Orozco, JF<br>
   Pawelczyk, A<br>
   Jablonska, J<br>
   Wilkinson, J<br>
   Adair, D<br>
   Laskus, T</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>Evidence for viral persistence in patients who test positive for
   anti-hepatitis C virus antibodies and have normal alanine
   aminotransferase levels</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF INFECTIOUS DISEASES</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>MAY 15</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>191</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>10</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>1730</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>1733</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>ISI:000228465000020</td>
</tr>
<tr>
<td>ER</td>
<td></td>
</tr>

</table><hr xmlns:exsl="http://exslt.org/common"><table xmlns:exsl="http://exslt.org/common">
<tr>
<td valign="top">PT </td>
<td>J</td>
</tr>
<tr>
<td valign="top">AU </td>
<td>Di Liberto, G<br>
   Feray, C</td>
</tr>
<tr>
<td valign="top">TI </td>
<td>The anhepatic phase of liver transplantation as a model for measuring
   the extra-hepatic replication of hepatitis C virus</td>
</tr>
<tr>
<td valign="top">SO </td>
<td>JOURNAL OF HEPATOLOGY</td>
</tr>
<tr>
<td valign="top">PD </td>
<td>APR</td>
</tr>
<tr>
<td valign="top">PY </td>
<td>2005</td>
</tr>
<tr>
<td valign="top">VL </td>
<td>42</td>
</tr>
<tr>
<td valign="top">IS </td>
<td>4</td>
</tr>
<tr>
<td valign="top">BP </td>
<td>441</td>
</tr>
<tr>
<td valign="top">EP </td>
<td>443</td>
</tr>
<tr>
<td valign="top">UT </td>
<td>IS

[TnHepGuy_]

<u>cuteus</u> - she's not quite that much of a diehard marathoner. She does maybe one to two per year. Her main reason for wanting to participate in the NYC marathon is because she grew up in Queens. So, she'll just keep plugging away and re-submit each year until it happens. Then while she's in the race, I can sneak off to DiPalo's down in Little Italy for a mini-feast.

As far as further testing goes on any of my ongoing issues, my docs (Internist and GI) prefer to just tack things up to age rather than any post-tx issues - no surprise there. And the Hematolgist I've seen says he has no concerns with the mild anemia. These remaining sx's are individually livable, but collectively an anchor.


<u>willing</u> - here's an e-mail address that I rarely use: yankee_in_knoxville at comcast dot net. If you would send me a quick -email there, I'll look (either today or tomorrow) and reply with my regular address, if that works for you. You could then use my main one to forward any response(s) you may get. Don't rush to get a note off to Radkowski, et al. Whenever you feel like you have all the Q's you want to ask, fire away. I'm just thrilled you decided to contact them.

Sure does look like Pham's work carries respect within the research community.


TnHepGuy

[mikesimon]

When I saw the Tram article I emailed it to my surgeon and he replied in about 10 minutes with "that's why I wanted you back on treatment". I mentioned in June that he thought 75% of SVRs would show HCV on biopsy so he is acquainted with occult/persistent HCV. I am going to ask him soon why he put me on 200 mg ribavirin daily. Do any of you have a clue? I have never seen any suggestion that this dose is appropriate in any setting. I really don't know why 90 mcg Pegasys other than to halt any further fibrosis. Biopsy June 2006 showed stage 1-2 on a scale of 6. Any ideas? Mike

[willing]

Boy, I really butchered the html by including that table of refs! Sorry about that. I'd guess your surmise is correct; he's trading off the aggravation of maintenance tx against the possibility of rapid damage by unchecked viral infection. As to any  rational basis for picking 200 and 90mcg however, I'd assume it's  a judgment call since to the best of my knowledge there isn't any quantitative data about the efficacy of different maintenance dosing. It might be worth talking to him about the same progressive reduction protocol you did with the immune meds : keep lowering the   riba/ifn and testing VL until you get to detectable, then go up a bit and stay there.