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717272 tn?1277590780

Input please on low VL, Acute Hep c

I have been puzzling over my own situation and not finding any research that pertains to it.  I had an acute hep C infection 38 yrs. ago.  Treating now, very low VL (under 100,000), cleared immediately.  Help me make sense of this, please!

Some papers have said that those with acute infections (jack-o-lantern skin, itch all over, exhausted) were the most likely to clear the virus on their own.  If I had the virus for 38 years and maintained very low levels, does that mean that I've had hyped levels of interferon all those years to keep it down so well?  Does the quick clearance mean I nearly destroyed it on my own and just needed a little outside interferon to push it over the edge?  Should people like me be treating for 48 or a lot less time?  I am following medical instructions to the letter but want things to make more sense.

I don't find any research that relates to acute cases, explains low VL or RVR.  Perhaps they can't find enough patients to develop a study.  Has anybody come across any papers relating to these issues that could help myself and others like me make sense of it all?
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9648 tn?1290091207
On SOC I hardly dropped at all, though. But once I started the boceprevir the VL dropped like a stone into a deep, deep pool.

My group hasn't been stingy with the procrit, and even at a 20ml dose it still makes me feel crummy. Don't. Want. To. Take. It. Anymore.

/whining
Helpful - 0
717272 tn?1277590780
30M to 150K!!  GreatBird's remained mostly below 700k except for one entry, over 6 1/2 yrs.  If low VL increases clearing you can certainly see the appeal to the Alinia.  I would never have the nerve to hang out and wait for a low count to start treating, but then I was pretty freaked out by the bad biopsy.  Wish I'd never read that cirrhotics respond less; just made me more anxious.

I hate to seem ungrateful for the wonderful opportunity for the triple drug tx, but I cleared so early that I can only view it as poisoning me unneccessarily now.  I was born with ethics so won't drop out but I sure hope I am in Arm 2 (28 weeks).  

And Procrit?  They are so stingey with it I almost cried with joy when the nurse said start using it again.  Thank heavens you can harmlessly inject an air bubble into belly fat; I'm not good at getting it out of the vial.
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9648 tn?1290091207
You want viral loads? I'll give you viral loads.

28-Aug-02 266000 5.42
24-Mar-03 659000 5.81
20-Oct-03 319000 5.5
15-Mar-04 165000 5.22
20-Sep-04 276000 5.44
31-Mar-05 303000 5.48
14-Oct-05 1170000 6.07
06-Apr-07 73760 4.87
17-Dec-07 634000 5.8
02-Jun-08 399000 5.6
01-Dec-08 664000 5.82

I'm all worn out by this too. If I have to take another Procrit shot, I may just lose my willingness to go on. And now I have an eye that's behaving weirdly.

I didn't clear as early as you did, but I'm not sure I care at this point. I feel like I've been on the merry-go-round too long already and I'm tired of being sick.

THank you. :)
Helpful - 0
Avatar universal
I never read that asymptomatic acute was more likely to SVR; I read the opposite.
----------------------
you are correct, I meant a *symptomatic* acute but I guess my voice dictation software disagreed :) as the viral load, yes it can bounce around a lot. In a three-year period, my viral load went from 30 million to hundred fifty thousand.

The 24 month short course studies I was referring to pertain to SOC. Triple may be different although I believe many here cleared with 24 weeks triple but you really have to compare drug for drug, protocol for protocol.
Helpful - 0
717272 tn?1277590780
Anyone have PCR tests going back years that bounced from under 200,000 into the millions?  Guess it would be inhumane to study that without treating.  I never read that asymptomatic acute was more likely to SVR; I read the opposite.

I wish I could choose to end at 24 weeks but I'm in a boceprevir study and won't find out if I'm in that arm for another 2 weeks.  Being super-responsive has been a big drag.  I have crashed and crashed and crashed the whole time on the boceprevir and may melt down if I find I have to take it for another 20 wks.  I am very grateful but, come on.  Volunteering to be neutropenic, anemic and platelet free for 5 more months looks almost unbearable.  And what kind of bizarre bone marrow diseases do I have to worry about from 5 more months of the rescue meds?  Ooops. Venting again. Sorry.
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Avatar universal
as to why someone with asymptomatic acute phase has a better chance of SVR, it's probably quite technical. But but to simplify it, as I understand it, having a symptomatic acute stage means that the immune system was launching a full out attack on the virus but ended up failing. So so in a sense, it's possible that those of us with the symptomatic acute stage are in a sense piggybacking SOC on top of previous attempts to rid the virus by our own immune system. It's like some suggest that one reason people do better the second time around is in part because the immune system has already been primed the first time. Well in our case perhaps priming was done naturally. I can't cite any studies here, this is just how I see it.
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Avatar universal
yes, papers suggest that those with a full-blown symptomatic acute stage (like you and me) have a better chance of SVR. They also suggest that either you were infected at an early age you have a better chance of SVR. low pretreatment viral load is also a positive predictor of SVR. These are pre-treatment predictors which are generally trumped by viral response once you start treating.

in your case, you probably have all these positive predictors, including being female, another positive predictor.

But as far as using the study materials as a guide, the two two items studied in terms of shortening treatment are only low pre-treatment viral load and RVR. It's possible that you could get away with less treatment because you are asymptomatic acute, but it hasn't been started.

Bottom line, you were RVR and had a low pretreatment viral. Study data suggests that you have an excellent chance of SVR with only 24 weeks of treatment.

-- Jim
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96938 tn?1189799858
Mrs. FLGuy,

In case you are reading this, someone stole my password.
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96938 tn?1189799858
For acute vs. chronic think in terms of duration, not severity.  Chronic hcv is an infection that has existed for more than 6 months.  Acute is less than 6 months. So, 38 years ago (if you've been able to isolate the point of infection) you were acute, now you are chronic. Kind of like my wife.
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Avatar universal
I've had Hep C my entire life (since a transfusion I had as an infant 54 years ago) and I didin't find out about my Hep C until April of last year.  In July of 2008, my first VL was 30,100.  I have no explanation for why some of us can have Hep C for so many years and still end up with very low VLs.  I was UND at week 4 (which was the first time my VL was check after I started TX).
Helpful - 0
717272 tn?1277590780
I'll take non-academic.  I'm a logical person and this is not a logical disease.  I believe in science and think there's an answer to everything if we just study it long enough and we study the right things.  Our country has been moving to less and less basic research, more applied.  I am personally grateful for all of the uproar over HIV as it inspired a closer look at all virusses.  

If you had an acute case (and here I mean showing symptoms from the initial infection), I'd guess your overall poor health at the time kept you unable to mount an immunological defense.  Can't figure how you had low VL and did not RVR, though.  Maybe going all the way back to the initial immuno-response?  Did we always have low VL or did we sometimes have high viremia?  This drives me nuts.

Yeah, I started with 3/4 and was not supposed to respond well but actually freaked the researcher out with my response, clearing immediately on SOC.  They take pretty close care of me because I think I am making interesting case notes for them. Ha! Nothing in my case makes sense and it's my logical nature that I NEED it to.
Helpful - 0
Avatar universal
Newleaf, just a quick non-academic comment, since I'm in and out of peat moss and clay today, thanks to you.

I'd think everyone with chronic HCV initially had acute HCV. Right?

Perhaps some had no symptoms or more likely had no way of recognizing their condition at the time for what it was.

I myself was close to death for other reasons (severe malnutrition), but I remember being sick in the way you describe, along with other unrelated symptoms.

I had HCV for forty years and had low viral load when finally tested in 1995. I had almost no liver damage. I did NOT RVR. Do I remember correctly that you have more advanced liver staging?

Why did you RVR and I didn't? I don't know. What made you a quick responder that I lacked. I know I didn't have symptoms or progression all those decades, like many other people. Something was helping me out but not in such a way to RVR.  I don't know if it was genetic advantage, lifestyle, immune system or sheer luck.

Must run, although the temptation is very great to slip in a gardening question. No, no, not here.

Hope someone can help out with this.

TTYL
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