Diagnosis of occult hepatitis C without the need for a liver biopsy

J Med Virol. 2010 Sep;
Diagnosis of occult hepatitis C without the need for a liver biopsy.
http://www.ncbi.nlm.nih.gov/pubmed/20648609

[nygirl7]

it's too scary that they could even find that many people with occult virus isn't it? I don't like to think about it - even if it's not harming anything (hopefully) the whole concept is too unnerving. I don't want to think about getting tested for it. I'd like to just put it all behind me now.

Of course this stuff goes straight over my head.  I like to say Gold Bond it's much easier ;)

Deborah

[nygirl7]

it's too scary that they could even find that many people with occult virus isn't it? I don't like to think about it - even if it's not harming anything (hopefully) the whole concept is too unnerving. I don't want to think about getting tested for it. I'd like to just put it all behind me now.

Of course this stuff goes straight over my head.  I like to say Gold Bond it's much easier ;)

Deborah

[RobertBeWell]

Interesting article.

BRING ON THE NANOBOTS!

[RobertBeWell]

Are you two in some sort of "star gathering conspiracy" ??

:-)

[mikesimon]

Well Robert, I didn't expect anyone to reply so I figured I may as well reward NYGirl for taking the time to post. If I'd have waited I might have bestowed that honor on you.

Really, the truth is I tried to post this on the health page about occult/persistent HCV but it wound up here. I have posted article links to the health page before but I seemed to have forgotten how to do it. Either that or the page has changed.

If this stuff interests you take a look at the health page on occult hcv.

http://www.medhelp.org/health_pages/Hepatitis/Detection-of-occult-hepatitis-C-and-hepatitis-B-virus-infections-from-peripheral-blood-mononuclear-cells/show/54?cid=64

Mike

[desrt]

Cool - an excuse to go pester gastro-doc. (He always gives this almost audible sigh of relief when he thinks he's seen the last of me.)
I can tell him I need this to make PCP-doc stop giving me silly@ss-pointless-long-distance-post-tx PCRs. If I'm negative, I get to tell PCP "Nanny nanny boo boo". If I'm positive, I can go back to my role as gastro-doc's least favorite patient.
Win-win situation ;-)

[banarep]

so, I have read the articles.  what does it mean for us, long term? or dothey know?  just when I thought I could breath and leave this crap behind.

[RobertBeWell]

"Well Robert, I didn't expect anyone to reply so I figured I may as well reward NYGirl for taking the time to post. If I'd have waited I might have bestowed that honor on you."

Damn. Day late and a dollar short.

:)

Thanks for the link... being a geek by nature, I'm always interested in the science.

[spectda]

No wonder they don't like to say cured when they can't detect hcv in our blood!

[desrt]

"what does it mean for us, long term"
Apparently, not much, if your ALT/AST remain in normal range and you're not infectious.
It's been known for a long time that 85-90% will show this whether you clear on your own or with IFN.
It's been known for a long time that SVRs have a slightly higher rate of HCC than the general population but way lower than people with active infection.
So get an ultrasound every few years, get your ALT/AST tested regularly, and don't let it bother you.

[mikesimon]

I agree with you. This issue is purely academic for me. I have been SVR since 2004 and I have been fine. I think SVR is durable and confers tremendous benefits. Can there remain traces of hep c post SVR? Perhaps, but it hasn't bothered me or any SVR I know.
I am always interested in anything concerning this topic but I never allow it to trouble me in the least.

Mike

[frijole]

Well I always like the occult sciences

But what does it mean? Nothing was said in the article - just that it is there (the truth is out there).

note to robertbewell
I wondered the same thing.  What to do?  I got am email to pick the best answer on my Fandago thread on the other side and there is none.  How about I auction it off?  Just call me gov.

frijole

[can-do-man]

LOL

[frijole]

hey friend.  Don't often see you on at the same time I am..   LOL yourself!

[Trish77]

SVR's who were more advanced with their liver damage at time of cure have a greater risk of HCC, not just any SVR.  I don't have to have any ultrasounds or follow-ups for HCC since I was Grade 1, Stage 1 when I went SVR.   Yet another reason to catch this before it advances too far along if possible.  

For me, this article doesn't change much.  It's been established that HCV can be detected in organs and tissues even after SVR although the implications of that are unclear.  It doesn't seem to impact the durability of SVR all that much as the extremely low recurrence of HCV after a six-month post treatment SVR is a constant.  I'll get tested again at some point within the 4 years after my SVR to put my mind at ease that I'm not one of that tiny percentile that recurs - as stats seem to show that the recurrence rate after 4 years is 0% - but I'm not going to concern myself with occult HCV as it being a threat to SVR.  I'm interested to know what exactly the implications are in other ways - does it impact the body itself in some way? -  and will continue to read the science as it comes out.

Trish

[desrt]

Could you cite a reference that stage 1 SVRs are not at higher risk of HCC than the general population, please. I'm finding lots of studies showing increased risk of HCC, but nothing breaking it down by stage. Thanks.

[Trish77]

I stated that Stage 1 SVR's are not at higher risk of HCC than SVR's who were further along in liver damage.  

"Hepatocellular carcinoma accounts for 85 to 90% of the cases of primary liver cancer. Chronic hepatitis and cirrhosis constitute the major preneoplastic conditions in the majority of HCC. The risk of developing HCC for a patient with HCV-related cirrhosis is approximately 2-6% per year. [20] HCC risk increases to 17-fold in HCV-infected patients compared to HCV-negative subjects. [21] In general, HCC develops only after two or more decades of HCV infection and the increased risk is restricted largely to patients with cirrhosis or advanced fibrosis. [22]"

"There is currently no evidence that HCV by itself is oncogenic; however, HCC may rarely develop in non-cirrhotic HCV-infected individuals, so a direct oncogenic effect cannot be excluded. [27] However, in the pathogenesis of HCC associated with HCV, it remains controversial whether the virus plays a direct or indirect role. Recent studies using transgenic mouse models, in which the core protein of HCV has an oncogenic potential, indicate that HCV is directly involved in hepatocarcinogenesis, albeit other factors such as continued cell death and regeneration associated with inflammation would also play a role. [7],[28]"

"http://www.jgid.org/article.asp?issn=0974-777X;year=2009;volume=1;issue=1;spage=33;epage=37;aulast=Andrade"

In this article - "Interferon Therapy reduces risk for Hepatocellular Carcinoma"

"Results: Hepatocellular carcinoma developed in 89 interferon-
treated patients and in 59 untreated patients.
Among untreated patients, the annual incidence of hepatocellular
carcinoma increased with the degree of liver
fibrosis, from 0.5% among patients with stage F0 or F1
fibrosis to 7.9% among patients with stage F4 fibrosis. The
cumulative incidence in treated and untreated patients
differed significantly for patients with stage F2 fibrosis
(P 5 0.0128) and for those with stage F3 fibrosis (P 5
0.0011). In multivariate analysis, interferon therapy was
associated with a reduced risk for hepatocellular carcinoma
(adjusted risk ratio, 0.516 [95% CI, 0.358 to 0.742];
P , 0.001), especially among patients with sustained virologic
response (risk ratio, 0.197 [CI, 0.099 to 0.392]), among
those with persistently normal serum alanine aminotransferase
levels (risk ratio, 0.197 [CI, 0.104 to 0.375]), and
among those with alanine aminotransferase levels less
than two times the upper limit of normal (risk ratio, 0.358
[CI, 0.206 to 0.622]).
Conclusions: Interferon therapy significantly reduces the
risk for hepatocellular carcinoma, especially among virologic
or biochemical responders."

http://www.annals.org/content/131/3/174.full.pdf

There would be others - it is known that the risk of HCC increases with the amount of fibrosis and a particular risk for cirrhotics.

Trish