Aa
Full-length article re: post-SVR study of occult/persistent in liver
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
<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
yes I do feel fortunate to be SVR but reading this,,,always does make you wonder,,,what will become of us after being SVR say 5 to 10 years. Really,,,it is something that we can not forget and I'm sure that all of us realize that we will always have an ongoing check in with our drs through the years and thats about the best we can do. As far as leftover sides,,,knowing that others are experiencing same,,,this place is great for us to meet and keep up with ongoing health. I have wondered also about transmission even though there is no viral load,,,I still am very cautious!
By coincidence I asked my consultant just this week if SVR's who subsequently required liver transplantation ever relapsed in the face of the immuno-suppressive drugs.He replied 'Surprisingly no!'
I wouldn't worry too much about this issue.
I wouldn't worry too much about this issue.
I think the research is interesting, but as the researcher himself says:
"persistence of HCV in these patients should be taken into account under special circumstances (e.g., immunosuppression or chemotherapy)."
unless we are in this situation or have these special circumstances, dealing with some other illness and/or treatments, this research does not impact someone who has treated their HCV and achieved SVR.
Even if you do end up facing a situation like this, it is still very very unlikely you would have HCV begin replicating again after acheiving SVR. We have enough to worry about as it is, no need to worry about this or worry that once you acheive SVR it might return, chances are very good it will not.
"persistence of HCV in these patients should be taken into account under special circumstances (e.g., immunosuppression or chemotherapy)."
unless we are in this situation or have these special circumstances, dealing with some other illness and/or treatments, this research does not impact someone who has treated their HCV and achieved SVR.
Even if you do end up facing a situation like this, it is still very very unlikely you would have HCV begin replicating again after acheiving SVR. We have enough to worry about as it is, no need to worry about this or worry that once you acheive SVR it might return, chances are very good it will not.
had to look this up: peripheral blood mononuclear cells (PBMCs), hmmm have to ponder the signifigance of lurking there as opposed to liver cells.........
Hi TN. I read some of the links you have provided here (someone put a URL up where you had given links to abstracts, etc.) Great reads. Thanks for all you do.
I talked to my doc a few weeks ago about this occult stuff, and he said they did one of the largest studies there (at Duke) on this and that yes -- it has been found in the livers of patients who are SVR but that it had to be looked for very hard (many many samples) to find it. He didn't minimize the importance of this data but said that it needs to be put in perspective. He put it in perspective for me by making the analogy that they can look at slices of breast tissue in breast cancer patients who have undergone chemotherapy and are in remission, and that they can find CA cells if they look for it hard enough. He ended by saying that the very best thing a Hep C patient can do is to treat and achieve SVR regardless of this data.
hmmm :) Interesting stuff.
I talked to my doc a few weeks ago about this occult stuff, and he said they did one of the largest studies there (at Duke) on this and that yes -- it has been found in the livers of patients who are SVR but that it had to be looked for very hard (many many samples) to find it. He didn't minimize the importance of this data but said that it needs to be put in perspective. He put it in perspective for me by making the analogy that they can look at slices of breast tissue in breast cancer patients who have undergone chemotherapy and are in remission, and that they can find CA cells if they look for it hard enough. He ended by saying that the very best thing a Hep C patient can do is to treat and achieve SVR regardless of this data.
hmmm :) Interesting stuff.
You have voiced all of my concerns very clearly. You make excellent points on each of these issues, and I am completely with you in feeling a great need for further study, better understanding of the implications of persistent HCV, and the development of more complete treatments or even a real 'cure' for this disease.
By now it should be plainly apparent to everyone on this forum that there is ample, and growing evidence that the virus is indeed NOT GONE after we achieve SVR, and is still replicating quietly in selected blood components, organs, and tissues.
For people to assume that it will do no harm is really denial at its best, in that we have no clear idea of what the long term implications of this lingering viral state might be.
Sure, I want to be as healthy as I can possible be after my SVR, and do not want to obsess endlessly about the virus, but this information clearly puts us on notice that there is more after SVR to take into account, than was previously thought in medical circles. We will need to know what we are up against, and we will need ongoing medical advances that will deal with these issues.
We also need to find out whether or not the virus continues to inhabit and replicate in other compartments after SVR, such as the brain, connective tissue, eyes, CNS, bone marrow, etc. We really have no clear answers to these questions at this point.
An open question remains: why do so many people retain severe fatigue related sx for years after SVR? and other symptoms as well?
DoubleDose
By now it should be plainly apparent to everyone on this forum that there is ample, and growing evidence that the virus is indeed NOT GONE after we achieve SVR, and is still replicating quietly in selected blood components, organs, and tissues.
For people to assume that it will do no harm is really denial at its best, in that we have no clear idea of what the long term implications of this lingering viral state might be.
Sure, I want to be as healthy as I can possible be after my SVR, and do not want to obsess endlessly about the virus, but this information clearly puts us on notice that there is more after SVR to take into account, than was previously thought in medical circles. We will need to know what we are up against, and we will need ongoing medical advances that will deal with these issues.
We also need to find out whether or not the virus continues to inhabit and replicate in other compartments after SVR, such as the brain, connective tissue, eyes, CNS, bone marrow, etc. We really have no clear answers to these questions at this point.
An open question remains: why do so many people retain severe fatigue related sx for years after SVR? and other symptoms as well?
DoubleDose
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