Full-length article re: post-SVR study of occult/persistent in liver

[TnHepGuy_]

For those with an interest, here's the full article of the recent study by Castillo, et al:

<a href="http://www.natap.org/2006/HCV/120606_11.htm">Hepatitis C Virus Replicates in the Liver of Patients Who Have a Sustained Response to Antiviral Treatment</a>


From the paper:

"<i>We also found that the loads of positive- and negative-strand HCV RNA in our patients were significantly higher in PBMC samples than in liver biopsy samples, which suggests that the HCV strain detected in our sustained responders replicates more efficiently in PBMCs than in livers.</i>"

"<i>...15 patients had continued liver necroinflammation, and 1 patient had liver fibrosis; however, there was an overall improvement in histological damage. So, it is difficult to know whether persistence of HCV infection and replication has a clinical relevance until more data become available.</i>"

"<i>In summary, HCV persists and replicates in the livers and PBMCs of a high percentage of patients who received antiviral treatment for years after normalization of liver enzyme levels and clearance of serum HCV RNA. Although it may be suspected that the risk of HCV reactivation is smaller than the risk of hepatitis B virus reactivation, persistence of HCV in these patients should be taken into account under special circumstances (e.g., immunosuppression or chemotherapy).</i>"


TnHepGuy

[Skepsis]

I am definitely not the "watch and wait" type of HCV-veterans, having received 5 therapies, the last two being completed full time PEG-Combos (classified as "partial responder"/relapser).
I guess about half of us (or more, a rapidly increasing population anyway) are non-responders. This is the most significant portion of HCV patients seeing the hepatologists, including the most interested and in HCV-issues educated patients  - the most readers here on this forum are by now non-responders, I guess. Our dilemma is not "to treat or not to treat", but what can we do to prevent or postpone liver fibrosis until we get some cure.

It is a purist attitude, that can easily be hurt by perpectives having to live with persistent virus remnants. This is a psychological pitfall of our half digested school education, the same one which turned out to be very harmful for provoking allergies:  excessive disinfecting behavior (or EDB :-).

It is a more mature attitude to accept our live is worth living in symbiosis with a virulent virus population.  

My CONCLUSIONS:

1. Achieving SVR is a worthwhile aim for all HCV-infected people, despite of limitations.

2. There is a double motivation for having our liver in good shape: beside increasing our general living capacity the chance for a cure is depending on it directly!  

3. Therapy is a good opportunity for treatment-naive people.

4. For Non-Responders should any other measures with a potential halting fibrosis be of interest.

I personally drink now more coffee and green tee, have recently changed my blood-pressure medication to losartan (irbesartan could be another option), because these all have potential antifibrotic capacity attributed.

[GoofyDad]

Still makes sense to me that a stage 1 or 2 has the option of waiting it out. Lots depends on rate of progression, lifestyle and what they're waiting for. I don't think anyone has advocated knowingly waiting for cirrhosis before treating. Interferon would not be my recreational drug of choice.

[Eisbein]

Haha, I used to encourage tx till blue in the face. Gotten myself into arguments or got ignored. The "Interferon is poison, and stage 1 and 2 can wait" crowd outnumbered Cuteus and myself almost all the time.
Maybe some 'watch and wait' members see your post and listen up.

Ina

[Eisbein]

I saw my hematologist/medical/oncologist about unrelated hepc stuff yesterday.
He knows I am SVR. Thought I quiz him a little.
Do you think I have remnant virus in liver, PBMC, lymph tissue, etc....of course you do, hope you weren't told otherwise.

How come you know, you are not specializing in viral hepatitis...I treat liver cancer, don't I, got to know all this stuff.

I think it is a good idea to treat prophylactically with low dose Interferon should I ever be in need of immunosuppressive therapy...you have any studies on that...no, but it makes sense....maybe, you see me when you get a cancer. In the meantime I will look into that.

So you don't think I am talking of the wall...absolutely not, but you may have to pay out of pocket for Interferon.

I call that a forward thinking doc.

Thanks Tnguy, you know how much I appreciate your posts and links.

Ina

[Hepatitis Researcher]

HERE IS A BARE BONES VERSION OF THIS IMPORTANT PAPER

HUGE STUDY  NOT VERY GOOD NEWS

IT GIVES A NEW ARGUMENT TO THE DECISION MAKING PROCESS TO WAIT OR TO TREAT WHILE FIBROSIS IS STILL LOW

[chcnme]

I had no clue what PMBC was either and still don't know, but after I read the clinical trial, for me it began to take on the meaning, People Might Be Crazy.  Seriously though, I googled it, and it took me to

http://www.clinicaltrials.gov/ct/gui/show/NCT00188201

"peripheral blood mononuclear cells (PMBC)"

I'm feel like Bob (just not SVR).  Overload overload.  The  more I read the more confuddled I get.  I have a headache now, and I know now it's probably because the virus has crossed the blood brain barrier and is in my brain.  

Seriously again though - this is something for everyone to think about  (the findings of the study TNGuy posted), but I just don't think it's wise to try to apply the findings to.... nevermind.  I don't know what I think anymore.