Aa
How avoid reinfection?
On Harvoni now, 4 weeks. Low viral count so encouraged. Wondering how often should throw away toothbrush to avoid reinfecting? Or is this even an issue? 4 more weeks to go...
You're very welcome Pat! I think this really clears things up and saves us all from overly worrying about the possibility of re infection..
Basically, you need TWO factors at the same time to 'reinfect' yourself. You need to have both gum disease so that you are bleeding, but also a viral load of over 1 million. As most of us get below that amount in the first couple of weeks of treatment on these new drugs, it's pretty clear that the most anyone needs to do is change their toothbrush once - and that is if they were over 1 million VL in the first place.
Toothbrushes always been a low risk vector for transmission, but this study shows us just how low risk it really is.
Basically, you need TWO factors at the same time to 'reinfect' yourself. You need to have both gum disease so that you are bleeding, but also a viral load of over 1 million. As most of us get below that amount in the first couple of weeks of treatment on these new drugs, it's pretty clear that the most anyone needs to do is change their toothbrush once - and that is if they were over 1 million VL in the first place.
Toothbrushes always been a low risk vector for transmission, but this study shows us just how low risk it really is.
I found this info on hepatitis central and think it has a lot of scientific info that is pertinent to the discussion. For me it's not just about cheap, Its about avoiding unnecessary plastic waste wherever possible.
http://www.hepatitiscentral.com/news/can_saliva_tran/
In September of 2003, evidence that saliva contains the Hepatitis C virus was disclosed at the Interscience Conference on Antimicrobial Agents and Chemotherapy. Scientists from the University of Washington in Seattle concluded that while saliva may be infectious, the strongest predictor of viral presence in the saliva is serum viral load. Researchers found that Hepatitis C was not found in saliva if the person’s viral load was under one million. Additionally, any risk of acquiring infection through salivary contact existed only in the presence of gum disease. Investigators attribute this risk to microscopic amounts of blood in the saliva and visually undetectable open mouth wounds present in gum disease.
All possibilities must be considered in trying to determine how unknown sources of Hepatitis C infection took place. Although Hepatitis C has been detected in saliva, the necessary conditions render it unlikey—but not impossible—to be transmitted by kissing or through the sharing of a toothbrush. Before anybody panics about these potential risks, remember that there are conditions accompanying these possible modes of transmission:
The person with the virus must have a viral load over one million.
Both parties involved have gum disease.
http://www.hepatitiscentral.com/news/can_saliva_tran/
In September of 2003, evidence that saliva contains the Hepatitis C virus was disclosed at the Interscience Conference on Antimicrobial Agents and Chemotherapy. Scientists from the University of Washington in Seattle concluded that while saliva may be infectious, the strongest predictor of viral presence in the saliva is serum viral load. Researchers found that Hepatitis C was not found in saliva if the person’s viral load was under one million. Additionally, any risk of acquiring infection through salivary contact existed only in the presence of gum disease. Investigators attribute this risk to microscopic amounts of blood in the saliva and visually undetectable open mouth wounds present in gum disease.
All possibilities must be considered in trying to determine how unknown sources of Hepatitis C infection took place. Although Hepatitis C has been detected in saliva, the necessary conditions render it unlikey—but not impossible—to be transmitted by kissing or through the sharing of a toothbrush. Before anybody panics about these potential risks, remember that there are conditions accompanying these possible modes of transmission:
The person with the virus must have a viral load over one million.
Both parties involved have gum disease.
Other earlier conversations on this topic, again, I still stay in the camp that you may be worrying too much, but whatever makes people happy :
http://www.medhelp.org/posts/Hepatitis-C/reinfection-while-on-treatment/show/1713200
http://www.medhelp.org/posts/Hepatitis-C/reinfection-while-on-treatment/show/1713200
T:I saw, on another thread, yesterday (?) - no memory - could have been earlier), someone who also uses an electric tooth brush, but for tx, she did like kOkO and I - she ybought the cheapies and used those for thr duration of tx. I thought that was a great idea and an inexpensive but effective solution.
Sa & T: Do either/both of you have dry mouth? That is one BIG reason for being so thorough with dental care. If you have that problem, try Biotene or some similar brand - there are several around - to brush, rinse, spray to moisten your mouth. The point of all this is dry mouth leads to caries and gum problems. If you can keep you mouth as clean as possible, and moistened, then, chances are, that won't happen.
I have not heard that mentioned as a side for Harvoni or Vierkira Paks so don't know - might no longer be a problem. Just thought I would mention it.
Pat
Sa & T: Do either/both of you have dry mouth? That is one BIG reason for being so thorough with dental care. If you have that problem, try Biotene or some similar brand - there are several around - to brush, rinse, spray to moisten your mouth. The point of all this is dry mouth leads to caries and gum problems. If you can keep you mouth as clean as possible, and moistened, then, chances are, that won't happen.
I have not heard that mentioned as a side for Harvoni or Vierkira Paks so don't know - might no longer be a problem. Just thought I would mention it.
Pat
Boy that's deep however one doesn't know the exact moment of clearing this monster with these new meds. It could be three days or 2 weeks. How would you know? The most anyone would know they were UD is at week 4. It's an individual chance that each person decides. The virus lives on the blood stained toothbrush. If it was a day the gums bled I threw the brush away right after use. Just being aware helps. It's everyone's own decision. I understand your thinking of not being able to re-infect yourself. But can we be sure?
I was thinking about the question of infecting oneself today when in the car, and realized how impossible it was physiologically. A person can't give themselves an infection they already have, and they can't give themselves an infection they don't have. In this case, if you have HCV, you can't give yourself it again as you already have active virus, so no point changing your brush until you test undetectable. When you clear the virus in your blood, it doesn't matter if your gums bleed, or whatever, if you changed your brush once, there has been no virus since then to catch from your clean brush. You can't reinfect yourself with a virus that you no longer have. I would think we can carry on brushing as usual. After you become undetectable it makes sense to change especially if you have bleeding gums etc and maybe one again at EOT, otherwise, changing daily after then in my opinion is overkill.
But peace of mind as has been said can be had for very little in some cheap toothbrushes, and if that takes some worry out its fair enough. I'm not a doctor, but just trying to think in terms of common sense. Personally I don't bleed a lot and don't consider it a likely vector for infection for myself. I will change as a celebration after getting my First UND though! A nice idea.
But peace of mind as has been said can be had for very little in some cheap toothbrushes, and if that takes some worry out its fair enough. I'm not a doctor, but just trying to think in terms of common sense. Personally I don't bleed a lot and don't consider it a likely vector for infection for myself. I will change as a celebration after getting my First UND though! A nice idea.
Very interesting that you and keepingon had sensitive gums during treatment. I am only a week in and haven't noticed any problems with mine. I guess it's another case of the many variables that can happen. Thanks for sharing. It can help whoever else that might experience this symptom.
Sorry, thought I responded yesterday to your statement about flossing. My dentist also says you should floss even using the water pic, but I have tried several different times, a week or two at a time to floss - doing it lomg enough that the gums should have toughened up. The never bleed much, but do bleed so I just gave up until the meds are out of my system to try again, because I used to floss with no problem.
Pat
Pat
Gums were sensitive during tx. Brushing them made them bleed when they otherwise did not. I got 2 six packs from dollar store and changed it every week. Saturday night after my last brushing of the day I tossed the brush. Started a new brush every Sunday morning. Total cost $2
Refrained from using my electric brush because it had a new brush on it and those are spendy. Now I'm back to using my good brushes. I didn't want to take any chances of reinfection. Though it is not proven it's better to be safe than sorry.
Refrained from using my electric brush because it had a new brush on it and those are spendy. Now I'm back to using my good brushes. I didn't want to take any chances of reinfection. Though it is not proven it's better to be safe than sorry.
Isn't it the truth? : -)
It is funny as how even the most sanguine pf personalities get a little OCD when treating. We just want it to work so much that we impart every little thing with almost ritualistic import.
Ah, well, we are only human.
It is funny as how even the most sanguine pf personalities get a little OCD when treating. We just want it to work so much that we impart every little thing with almost ritualistic import.
Ah, well, we are only human.
Yes mom, particularly if it would have helped you relax and taken your mind off worrying for a while and just made you feel 'normal' for a bit. There is just no denying how feeling positive and stress free can do for your body to help it heal.
Obviously this is true for those of us without fibrosis or cirrhosis. Those with cirrhosis/fibrosis or a problem with drinking would want to even avoid the tiny amount of alcohol in 'alcohol free' wine to be on the safe side.
Obviously this is true for those of us without fibrosis or cirrhosis. Those with cirrhosis/fibrosis or a problem with drinking would want to even avoid the tiny amount of alcohol in 'alcohol free' wine to be on the safe side.
It is amazing how all of us HCV patients take so many things to the extreme. I know I did. I wouldn't touch a non-alcoholic beer or wine. Looking back, I think one of those on a hot summer afternoon, once in a blue moon, would have been fine. At least my hep doc thought so.
Do you floss too Patra? My dentist believes you still have to floss even if you use the water pic, because there's nothing like manual scraping. My sore fingers can't manage floss too well, but I can use the little ones that come pre loaded on a little pic thing, and I really like the brushes on the ends too. I think the more you do this, the healthier your gums. Bit off topic for re infection just thought I'd mention because you said you have a bit of bleeding. I did too before I started religiously flossing. My water pic wasn't quite as good as the real thing - although very nice to use.
Different story! I was talking about standard toothbrushes - ones I get at WalMart 6 in a pack for $4.
Of course, you are right about common sense and healthy gums. I just have gums that tend to bleed a little once in a while, even though I use a water pic and brush - did both at least twice a day while on tx. Not so careful about that now, Often only use the water pic at night.
Of course, you are right about common sense and healthy gums. I just have gums that tend to bleed a little once in a while, even though I use a water pic and brush - did both at least twice a day while on tx. Not so careful about that now, Often only use the water pic at night.
There are no documented cases of re infecting AFTER SVR from a toothbrush. I think common sense would tell us we don't have to go overboard with worry about that scenario. I am told, though do NOT have documentation, that once you are undetected, below the level of quantification, the patient's immune system will get rid of that last tiny bit of virus. How that fits with relapse is beyond my level of understanding.
I think it depends if you have gum disease and tend to bleed or not. If your gums are healthy and dont bleed, surely the risk of infection is very low after becoming UND. I use a sonicare toothbrush which is absolutely wonderful at cleaning my teeth and keeping my gums healthy, but they are far too expensive to change weekly, unless the perceived risk was real. I will certainly change my toothbrush after testing comes back UND, and then again, towards or at the end of treatment, so perhaps twice during treatment I would consider a good idea, but I'm not sure I will follow the once a week rule unless someone has some convincing stats. Surely once you test undetectable the viral levels are so low in the blood that it would be incredibly difficult to reinfect yourself this way unless you had gingivitis or other gum disease that caused bleeding - and still chances would be low if highly sensitive blood tests couldn't pick up any virus. I believe at the stage you test UND any remaining virus is likely 'hiding' in organs etc and no longer circulating free through your blood, so risk for transmission, especially through a relatively low risk route already must be next to nil. If someone has medical info to contradict my thinking I would like to hear it as I have just started treatment. If risk is really obvious, I can use disposables in the meantime (though I would be sad!).
Another option is a weak bleach soak after use followed by a very good rinsing and cleaning. if you were a bleeder, any little viruses wouldn't survive this. The problem with the change weekly option is that if the risk was real, it wouldn't happen to a time schedule. You could be reinfected anytime within the week that you were re-using your toothbrush. That is why for me it makes sense to change at landmarks such as going UND, or you would need to change or disinfect daily if you were genuinely concerned about your toothbrush.
Another option is a weak bleach soak after use followed by a very good rinsing and cleaning. if you were a bleeder, any little viruses wouldn't survive this. The problem with the change weekly option is that if the risk was real, it wouldn't happen to a time schedule. You could be reinfected anytime within the week that you were re-using your toothbrush. That is why for me it makes sense to change at landmarks such as going UND, or you would need to change or disinfect daily if you were genuinely concerned about your toothbrush.
I asked that question before I started tx last June. Heard anything from 'don't worry , change as normal every 3 months' to 'change daily', however, the consensus seemed to be that most people felt comfortable with changing once a week.
I am still doing that 11 weeks after tx, even though I have been UND since at latest, Wk 7 of tx. Plan to continue until the Dr gets my Labs, now or sometime in the future, if I have relapsed, and tells me that I am SVR.
Good luck on your treatment - and on to SVR!
Pat
I am still doing that 11 weeks after tx, even though I have been UND since at latest, Wk 7 of tx. Plan to continue until the Dr gets my Labs, now or sometime in the future, if I have relapsed, and tells me that I am SVR.
Good luck on your treatment - and on to SVR!
Pat
Darn, I thought I wrote I would throw it away as soon as I got to undetected. Sorry.
Hey soldier,
Good to see you! Sounds like you're doin great.... Yes!
AGREE with mom, but I couldn't help jumpin on here...... LOL
Before I started Tx, I bought new soap, razors etc..AND ...grin....
12 shiny new toothbrushes! 12 weeks Tx, of course... Oh I'm laughing out loud now.... Sooooo, there they were, how could I not use them? :-)
Well, in week 12 now.... Last brush in holder HA HA HA.... OCD but teeth squeak when I talk!!!.............WHAT A NUT!
Keep up the SVR march,
Blessings,
Randy
I wouldn't throw it away as soon as you get that undetected. And, congrats on your awesome results so far.
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