HCV Detected in Liver of HCV Antibody -Positive But HCV RNA Negative......hmmmm

Good Morning everyone.  I hope all is well with all of you.  I am doing much better.  I was doing some research and I came across this.  I was a bit surprised and somewhat confused and disappointed.  I want to know what any of you think of this article.  Thanks and have a wonderful Thursday.



http://natap.org/
On right hand side says "more hep c articles" click that then go down to #21,

[amommy]

If I am not mistaken, this is exactly what Mike is dealing with at this moment.  He may have some insight or opinion on this.

My personal opinion is that this type of info reinforces that infact we aren't necessarily CURED once achieving SVR.  

Thanks for posting the link.

[Upbeat]

This debate has been going on for sometime now.  All it tells me is they don't have a clue. I wonder if the doctor of anyone who has been cured would be willing to get a blood transfusion from them.

                                                        Ron

[fresnoborn]

LOL...That's a good question, Upbeat.

[mikesimon]

My personal opinion (and that's all it is) is that some, if not most, SVRs would show hepatitis on biopsy. What does this mean? It means that there may still be hepatitis in the liver of SVRs. I believe that if enzymes are normal and the serum is undetectable there is no harm being done. The risk is that a subsequent event might lead to increased hepatic activity and replication resulting in cellular death etc. I would not have known about the HCV in my liver had it not been for a big anti-rejection dose reduction. This apparently stimulated my immune system to attack the tiny bit of virus in my liver, which before the dose reduction had been doing no harm. My ALT, AST and GGT were consistantly (monthly) in the teens or low 20s since 2003. After the dose reduction my ALT went to 324 and my other enzymes increased substantially as well. This was counterintuitive to me because with the dose reduction my immune system should have beeen stronger - I suspected rejection. And my immune system was stronger. As I understand it, my immune system and the HCV had entered into a sort of truce whereby my immune system would overlook the HCV in my liver and the HCV wouldn't replicate and infect more cells. When my immune system was stimulated it broke the truce and attacked the virus which led to the elevation of enzymes signaling the cell death. It is important to note that the serum collected with the tissue sample showed only 30 IU/ml and this tells me that the virus had not been, and is not, replicating. This is a low level to be found at the site where replication is usually at its highest. Remember I was serum undetectable (<5 IU/ml) a month before my biopsy as well as 3 days after my biopsy. My hunch is that the risk that SVRs might face is if they get a jolt to their immune system, either a major suppression or stimulation. Otherwise I think they should be fine and that SVR should remain the primary goal of anyone with HCV. I certainly don't want to alarm anyone but neither do I want people to be ignorant of the possibilities.  This is merely my take on this subject. I have no studies or articles to cite. Mike

[Kalio1]

Hope you are starting to feel better, I know you have been having a rough time, I hope each day you get progressively better.

Thanks for posting the link.  I have read all I can find about "occult HCV" and I am glad to see more studies are being done.
The question to me is, what is the signifigance? They describe all patients in the study as "healthy" with normal ALT. ALT is the indicator of damage occuring in the liver, normal ALT would mean no damage is occuring in the liver, so to me at this point it is a distinction without a difference to all patients except transplant donors/recipients. They can detect it in liver tissue but the patients are healthy and no detection of ongoing damage is found nor can the virus be found in their serum. I thought we could never donate blood anyway since we have or had the virus, so finding it in liver tissue doesn't change that. If it isn't in the serum then they would not be infectious to others, right? Of course, in the case of a transplant the finding WOULD be significant as the liver tissue has detectable HCV so to me that would mean if the organ was used for transplant then it would infect the recipient.
Unless it is causing harm to have detectable HCV in liver tissue, what does it matter if the patients are all described as healthy and their ALT is normal idicating no ongoing damage? That is what I want to know, if the findings have any significance on the health of the patients aside from the obvious risks it would have to a transplant patient.

[jmjm530]

Thanks for posting the article and hope this finds you well.

I could be wrong, but I don't believe the article is talking about people who have treated for Hep C and have achieved SVR. It appears to be talking about those exposed to the virus who it was assumed spontaneously cleared the virus. Studies like this, as well as related studes on so-called "occult" and "persistent" HCV raise as many questions as they answer, including what clinical significance if any they have. It's an interesting subject and hopefully will lead to more understanding of both the virus and how it effects us all. Personally, I wouldn't get overly concerned, cause right now SVR is the only known cure for those that decide to treat.

From the article:

"However, up to now, the possible presence of HCV RNA in the liver tissue of healthy, anti-HCV antibody-positive patients with persistently normal ALT levels and no history of acute or chronic liver disease has not been studied. In the present study, we analyzed whether anti-HCV antibody-positive, serum HCV RNA-negative patients with persistently normal ALT levels have HCV RNA (genomic HCV RNA) in the liver and, also, whether HCV is replicating by detecting the antigenomic HCV RNA."

[amirtracy]

Hi mike. Just saw your post and wanted to say hello. That's all. Hope you're doing well today.   tracy

[mikesimon]

I'm doing well Tracy and I thank you for asking. How have you been feeling? I should know but I forget a lot these days. Mike

[jmjm530]

I think this particular study only deals with those who have spontaneously cleared, not those who treated and are SVR. It's a bit of a confusing read but pretty sure that's what this is about.
Hope this finds you well.

-- Jim

[mikesimon]

Do you mean "there's no pain like my pain"? That is one of the very few original lines I've come up with that I still believe is absolutely on point. Should I give you another? No, I better refrain form any more self indulgence. I might drag one more out later when I'm feeling feisty. You are way too kind Tracy but I appreciate your complimentary words. I don't post nearly as much as I used to but everyone knows so much more than they did when I started coming here that I don't really have much to offer. I told one member here that I post largely because I feel like I may be a lot of people's worst nightmare (being a transplant recipient) and perhaps if I pop up here and there it might ease someone's anxiety about the future. You know, if I'm still here there must be reason for hope -and indeed there is. Stay well my friend. Mike

[amirtracy]

That is exactly the phrase I was speaking of and any time you feel like throwing some more pearls my way go for it! and as far as giving people hope- you do. There's alot to be said for hope. And frankly, I like you. I like reading your opinion on things. It helps me. take care mike.

[Snookmiester]

Well, I for one love to see different takes on this, especially when hypocrisy comes to play..
Just the other day, when I was debating supplements and there effect on normalizing ALT readings, Kalio went as far as saying that they where meaningless. That the normalization in ALT readings DID NOT suggest that the supplements where in fact beneficial to halting, or slowing progression..

Today, Kalio states:
"They describe all patients in the study as "healthy" with normal ALT. <strong>ALT is the indicator of damage occuring in the liver, normal ALT would mean no damage is occuring in the liver"</strong>

This is damn near word for word what she just agrued with me previously..Because in fact if what she is now stating is true, the benefits of supplementation do in fact effectively, "keep the virus at bay".. Would they not?

[fresnoborn]

Thanks to all who responded to my post.  In a way, it puts my mind at ease......or does it?  Oh well, who knows, lost my mind during tx anyways and 3 weeks post tx i'm still trying to find it.  Thanks again

[DoubleDose]

The article cited above is important to all of us, and should be read carefully, because IF it proves to be a valid study, and if it applies to those who spontaneously clear, AND those who clear through tx (SVR's), then we have yet another major support for HCV persistence after supposed clearance from the serum.  

Here is an exerpt from the article:

HCV is Detected in Liver of HCV Antibody-Positive But HCV RNA Negative Patients, so don't assume HCV has been cleared if viral load is undetectable


  
  "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"

".....the majority of healthy patients who test positive for anti-HCV antibodies and have normal ALT levels but who do not have HCV RNA detected in serum have an ongoing HCV infection because HCV RNA is detected in the liver. The epidemiological and clinical relevance of this finding should be studied in the future....."

The Journal of Infectious Diseases July 1, 2006;194:53-60

Please read the full article, available as indicated above in this thread, and think about the implications.  Also, consider the fact that a large majority of those studied had no 'risk factors' for HCV.  They were apparently NOT IVDU's and had not been transfused in the past.  Could this study, and the studies on Occult HCV be indicators that HCV is even more prevalent in the general population than current blood testing indicates?  Many may not be antibody positive on testing, or many may have normal ALT's (which does NOT preclude liver disease or fibrosis in all cases), and also many may be additionally HCV serum negative.  

My concerns over the past few years are that HCV MAY indeed infect many people WITHOUT actually always being detected in the blood, either by antibody tests, or by PCR testing, OR by the give away of elevated LFT's.  There seems to be much 'trickier' stuff going on with this virus than heretofore understood.

I am quite sure that this subject will receive lots of scrutiny, attention, and research in the next few years.  We will then find out what we are really dealing with.  At this point, WHO KNOWS if this manifestation of the virus is dangerous, or even deadly over time....it just has not been studied or even vaguely understood to date.

DoubleDose

[amirtracy]

I'm doing alright Mike. a little winded - hmg just hovers above 10 so no procrit for me yet. I feel like an idiot complaining sometimes. So many people have much bigger problems. Your fundamental axiom still applies i guess ;) you take care of yourself and i always look for your posts. You provide alot of help to people here and i, for one, appreciate you tremendously. have a great day!   tracy

[mikesimon]

I suspect that you've realized the futility of trying to reason with the unreasonable. Perhaps it's just a bit of - whichever way the wind blows. But, then again, facts are facts - if they are indeed facts. Take care Snook, Mike

[Snookmiester]

LOL!!! Yup, whichever way the wind blows indeed!!
Hope all is well with you, and that you are making progress with your new tx..