Aa
Cured or not?
Hello everyone,
I have a question about insurance. I was diagnosed HCV 1a 6mil VL mild stage 1 biopsy 18 months ago. I started treatment ten months ago with assistance from Commitment to Care, because I have no insurance. I am self-employed and went through some lean times and allowed my insurance to lapse before I got diagnosed. I have read in several articles lately that Doctors are now calling an SVR with genotype 2 or 3 a cure. With type 1 they seem to be much more divided or reserved on when or if at all you are cured. Douglas Dieterich MD at HIVandHepatitis.com says SVR is a cure even for type 1. Some others are saying you need to test for 5 years after treatment and even then they consider it just an SVR not a cure. My question is have any SVR
I have a question about insurance. I was diagnosed HCV 1a 6mil VL mild stage 1 biopsy 18 months ago. I started treatment ten months ago with assistance from Commitment to Care, because I have no insurance. I am self-employed and went through some lean times and allowed my insurance to lapse before I got diagnosed. I have read in several articles lately that Doctors are now calling an SVR with genotype 2 or 3 a cure. With type 1 they seem to be much more divided or reserved on when or if at all you are cured. Douglas Dieterich MD at HIVandHepatitis.com says SVR is a cure even for type 1. Some others are saying you need to test for 5 years after treatment and even then they consider it just an SVR not a cure. My question is have any SVR
The pegylated interferons were only FDA approved in the USA about August 2001. PegIntron came on-line first, then in late 2002 we got Pegasys. (People new to HCV don't realize that the stuff we know now is all very recent!) This means we have a rather short "track record", and the insurance industry will go for the long record... CYA, etc.... $$$$$
Another consideration is the sensitivity of tests used to determine if one has the HCV virus or not. Several years ago - my timeline is shakier on this - PCR tests commonly had 600 IU/mL as their lowest level of detection. That left a lot of room for residual virus, even with an "undetectable" test result. Most people tested 5 or more years ago were measured with such "coarse instruments", by today's standards.
Lets hope that NIH or one of the high councils of docs, at one of their conferences, soon declares a shorter SVR period as a cure.
Maj Neni
Another consideration is the sensitivity of tests used to determine if one has the HCV virus or not. Several years ago - my timeline is shakier on this - PCR tests commonly had 600 IU/mL as their lowest level of detection. That left a lot of room for residual virus, even with an "undetectable" test result. Most people tested 5 or more years ago were measured with such "coarse instruments", by today's standards.
Lets hope that NIH or one of the high councils of docs, at one of their conferences, soon declares a shorter SVR period as a cure.
Maj Neni
"<i>...long term follow up studies of genotype 1 patients that achieved SVR show a 7 to 10% relapse rate within 5 years.</i>"
I've never seens any study (nevermind 'studies') that would validate such a high rate of relapse. All the studies I have seen put the long-term rate (i.e. - anything beyond 6 months post tx) as in the 1% - 2% range - including those studies that have followed those cured 10+ years via taking mono interferon. I've seen a few very small studies where the numbers might jump up to 4% or so - but the number of patients used in these studies is so small they they cannot be considered representative of the Hep C population as a whole.
The medical community uses the phrase 'sustained viral responder' strictly as a CYA measure. Imagine if, for example, they were telling patients that 5 years after finishing tx they were 'cured'. But imagine further if they discovered later on that somehow there were 'remnants' of virons left with the 'potential' of replicating (nevermind that the potential is nil to virtually nil). Well, since those 'remnants' remain, it's much safer - especially from a legal (read - CYA) aspect to label a patient as a kind of 'perennial responder' - with the potential of relapsing 5, 10, 50 years out - rather than call them 'cured' - and leave yourself open for potential lawsuits.
TnHepGuy
I've never seens any study (nevermind 'studies') that would validate such a high rate of relapse. All the studies I have seen put the long-term rate (i.e. - anything beyond 6 months post tx) as in the 1% - 2% range - including those studies that have followed those cured 10+ years via taking mono interferon. I've seen a few very small studies where the numbers might jump up to 4% or so - but the number of patients used in these studies is so small they they cannot be considered representative of the Hep C population as a whole.
The medical community uses the phrase 'sustained viral responder' strictly as a CYA measure. Imagine if, for example, they were telling patients that 5 years after finishing tx they were 'cured'. But imagine further if they discovered later on that somehow there were 'remnants' of virons left with the 'potential' of replicating (nevermind that the potential is nil to virtually nil). Well, since those 'remnants' remain, it's much safer - especially from a legal (read - CYA) aspect to label a patient as a kind of 'perennial responder' - with the potential of relapsing 5, 10, 50 years out - rather than call them 'cured' - and leave yourself open for potential lawsuits.
TnHepGuy
I agree, A sustained viral response = cure. My point was the medical community chose those words for a reason. Why would you need a sustained response to a virus that isn
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