SVR or cure? explained to a dummy like me

[aprildone]

my gi/ pharm never explained it to me norI have not been on here long enough to have learned or understand the difference between SVR  and "cured". the article below was easy for a dummy like myself to understand

http://heplikeme.com/2012/09/05/hepatitis-c-does-no-detectable-virus-equal-cure-or-is-it-smoke/

[notsoeasy]

I've been reading long enough to understand how much protocols make as feel comfortable.
But protocols are not everything; besides many countries have different approach and so do hepatologists.
Having no recommendation or not testing after SVR12 explain why there are not big numbers out there on relapse afterward; it doesn't mean there are not relapse/reinfections. You simply don't know.

I am aware measles ecc. are a solved problem after CURE (meanining after infection/vaccination) :-) I just mentioned it as an example of something you do not have worry about because is under control for life. Hep C is NOT.

“In a few people, hepatitis C has found a sanctuary site and can remain dormant for a length of time,” Theo Heller, MD, chief of the translational hepatology unit at the Liver Diseases Branch of the National Institute of Diabetes & Digestive & Kidney Diseases at the NIH, told Infectious Disease News. “This is important both biologically and clinically, even in the approaching era of direct-acting antivirals, where relapse may still be a problem. We already know it can and does occur.”

In a follow up analysis, the researchers evaluated HCV RNA sequences in serum and liver tissue from 103 patients who achieved SVR after receiving interferon-based therapy between 1985 and 2005. Three of the patients had a late relapse, testing positive for HCV RNA at 8 months, 75 months and 78 months, after persistently testing negative previously. Four patients had an early relapse and were used as controls.

The serum samples taken before treatment and after relapse were sequenced and compared. Among the early relapse patients, the sequence identity between the pretreatment and relapse samples was more than 99.4%. Among the late-relapse patients, the sequence identity between the samples was more than 98.8%. The genotypes were also identical before treatment and after relapse for both early and late relapsers.

Heller said that these findings have raised several important questions that should be the focus of future research. These include why the immune system does not finish off HCV, why the virus persists at low levels for so long, and why it does not recur sooner.

http://jid.oxfordjournals.org/content/early/2013/10/14/infdis.jit541.abstract


Another question might arise:

Is your blood still infectious after being cured of Hepatitis C?

In general, we are more comfortable living in a world of absolutes than acknowledging several shades of grey. Unfortunately, the potential for infectivity following a Hepatitis C cure lies somewhere in the grey category. It would be easy to assume that being cured of Hepatitis C totally removes any likelihood of being infectious, but experts’ opinions on this matter vary.

http://www.notwithoutafight.org/after-the-cure.html

[Dee1956]

Hi I was tested at 6 months, then 12 months then a year after that
This past visit, he said we no longer need to test.
I will still see him every year for sono and blood work to test for liver cancer

[aprildone]

thanks lynn, I with go and get the results from my ultrasound to be clear as to what level I was diagnosed. pharm was vague about my liver cpndition other than having no apparent  cirrhosis. don

[AWorriedMom]

Where are you seeing the recommendation for yearly viral load tests in patients who have an SVR? I was in the Abbvie clinical trial and neither my doctor, Abbvie, or the clinical trial doc, have stated that I need yearly PCR's. So, I don't agree with your analogy about measles, mumps, etc. Besides those antibodies are protective, hep C antibodies are not. Either way, munless I missed a big message, I do not see anyone suggesting yearly PCR's.

[flyinlynn]

AASLD


http://www.hcvguidelines.org/full-report/monitoring-patients-who-are-starting-hepatitis-c-treatment-are-treatment-or-have

SVR typically aborts progression of liver injury with regression of liver fibrosis in most but not all treated patients. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Because of lack of progression, patients without advanced liver fibrosis (ie, Metavir stage F0-F2) who achieve an SVR should receive standard medical care that is recommended for patients who were never infected with HCV.

[flyinlynn]

Annual retesting is not a protocol unless you have risk factors for becoming reinfected.

In fact the recommendation from the AASLD for people with little liver damage once SVR has been acheived is to follow as though the patient was never infected

[notsoeasy]

"In my opinion, SVR is a good prognostic sign. But whether "SVR" means "cure" - remains controversial in "scientific" world... "

Yeah, I totally agree on that,

And, if we are CURED, why we undertake regular (at least yearly) RNA HCV tests? Looking for reinfections? Nahh. That would be an infortunate event, although occours.
The vast majority of us had measles, rubella, chicken pox ecc.. and yes we are antibodies positive to those yet we are cured..... but nobody tests you yearly to check whether viruses are back..... think about.

[aprildone]

you go gittum girl

[aprildone]

great comment keepingon:)

[keepingOnkeepingOn]

My doc kept telling me over and over, "You are cured". That was SVR12.

SVR12=12 weeks AFTER the end of treatment (EOT). If no viruses are found at that time you are considered cured like my doc said.

Now whether the liver rebounds is yet to be seen but we'll keep a close watch on it. Everything functions much better though, without this parasite eating away at my life force, if you know what I mean. It may be a slow moving bug but the damage can come on strong and persistent once it happens. Stopping the replication of this deadly virus has brought my body much needed relief. I'll settle for that. The bug died and I live. See how that battle goes? Either you die or the virus dies.

[Sarah1949]

I think at this point it boils down to semantics as far as patients are concerned. I've heard some doctors consider SVR 24 a cure, but then there are others who don't. For one thing, the DAA's just have not been around for that long for us to see if we maintain a SVR over several years.

So, I guess it comes down to how you define "cure". My virus is presently gone according to my lab tests but I'm very aware it can still be tucked away in tissues waiting for the day it can raise its ugly little head again. Many don't believe it can hide, but many do. So, it's pretty much all speculation at this point in time imo.

That said, I think of myself as cured with only 8 weeks of SVR. I mean who draws the line and where is it drawn?

[dontworry_behappy1]

Confirmation and concerns about possible reinfection.   Those are the only reasons I can think of.  

[dontworry_behappy1]

As far as donating blood if you show you have Hepatitis C antibodies.  First off it would be unknown if you had chronic hepatitis C.  So the blood bank has to do more testing and retesting to confirm your not  currently infected or if you have chronic hepatitis C.   These procedures are costly.   And for legal reasons it's easier.   It sure not a good marketing campaign.   I would pick the best option too.   No question and no money spent.  

Also, we are talking about a virus that has to do with blood filtration and has many extra heptitic  manifestations.   It's not unusual for donations of blood to be denied from persons with illness connected to possible blood functions.
Or ones who have been treated or taken certain drug therapies.

The world is changing about Hepatitis C and so are the rules.  There are newer better treatments release every year in my country.  Times are changing quickly.  Blood donation my change requirements in the future as the world become more educated about hepatitis C.

[AWorriedMom]

Super post Don't Worry. I just have one quick question. Why are you still going with the 24 weeks as the surrogate marker for cure? I have been reassured that only two people in all the trials combined had late relapse and none of them were genotype 1. Are you just being super cautious?

[dontworry_behappy1]

People come to this forum because they are looking for answer concerning hepatitis C.   Many are currently treating hepatitis C.  Many are in the United States and afforded the most current treatment.  Many people here no longer have hepatitis C.   You can call that event anything you want.   The fact is....
our country is working overtime to eradicate hepatitis C.  Everyday I see
TV commercials about Hepatitis C treatment and how to find help.  It's a all out effort to enrich people's lives by getting rid of the hepatitis C virus.  I don't  have the hepatitis C virus anymore.  I don't worry about hepatitis C anymore destroying my liver.   I don't worry about it coming back anymore.   I don't worry about giving Hepatitis C to someone else anymore.  Finally,  I don't worry about if I've been cured of Hepatitis C anymore.    I know I have.   My body has told me so along with the latest and greatest advancements in detecting Hepatitis C in your blood.   The world has advanced.  Treatment for Hepatitis C is highly successful.
___________________

How are we sure it's not replicating in small concentration?

If you had active hepatitis C come back after treatment....it comes back  with a vengeance.   You wouldn't have a small count of copies.   You would either have Hepatitis C or not.   That's why SVR/CURE is after you are undetected 24 weeks after ending treatment.   3 months is a pretty good indicator you will be declared SVR/CURED at 24 weeks EOT.  

FYI:  My doctor told me I was "cured" when my test came back undetected at 12 weeks  EOT.   That was over two years ago.  My doctor had no problem saying the word "cured".  He is a Gastrointestal Specailists and understand that SVR in relationship to Hepatitis C.....is now proof of cured.   Now my Family Doctor is very old school and just can't bring himself to saying "cured".
He isn't as educated as my specialist who treated my Hepatitis C.   Seems we have many of those.  There stuck in the past.

The world is progressing daily and if your haven't heard that medical technology has found a SVR/CURE for hepatitis C?   I'm sharing with you that we have a cure for Hepatitis C.  Hope it will be available in your county soon and you will be cured.

Best to you

[AWorriedMom]

At this point, my well-respected doctors and many doctors I have heard speak at AASLD have called SVR a cure. They have no reason to be untruthful. So, in my book, there is a cure.

[patra_]

If it walks like a duck and quacks like a duck and eats duck food, I think we can call it a duck.

If our livers are are not progressing to cirrhosis, and in fact, Fibrosis improves as much as it has in some folks, I think I will consider it a cure - at least in my own mind.

[Serg67]

I think this is a "marketing" point of view. People with SVR cannot donate blood. How can we be sure that HCV does not replicate in very small concentrations after SVR?

[dontworry_behappy1]

Successful hepatitis C treatment results in sustained virologic response (SVR), which is "tantamount" to virologic cure, and as such, is expected to
benefit nearly all chronically infected persons.  

http://www.hcvguidelines.org/full-report/when-and-whom-initiate-hcv-therapy
_________________________________

tan·ta·mount/ˈtan(t)əˌmount/
adjective
equivalent in seriousness to; virtually the same as.
_________________________________

[AWorriedMom]

That worked. Thanks.

[Serg67]

I typed  story 2015 01 18 lack good medical evidence new 100000 hepatitis c drug    query in Google search - and first link in search results points to this article...

[AWorriedMom]

Below is what I got on the last link you just posted. But thanks for trying.


The page you requested does not exist. For your convenience, a search was performed using the query story 2015 01 18 lack good medical evidence new 100000 hepatitis c drug.
HOME
Page not found

[Serg67]

The article was republished here - http://www.openhealthnews.com/story/2015-01-18/lack-good-medical-evidence-new-100000-hepatitis-c-drug-treatments  Maybe this link will work.

[AWorriedMom]

I am getting a 404-not found message. But thanks anyway.