Lab question

[candyce1953]

My viral load has bounced around from 115,000 to 869,000 for 41 years, currently back down to 159,000

They say this does not correlate to fibrosis ( I am2/2) I have never treated yet

So if there is no correlation to liver progression  then why do people say when you "treat your liver gets a rest?"

[candyce1953]

I am sorry you have diabetes and other AI diseases, glad nothing got worse from tx
I just had bx in fall
I will try to get another next year if I can't find an oral tx before
To keep eye on progression
Am afraid to risk tx

[candyce1953]

Thanks NY girl, I am going to try to wait for an all oral tx maybe phase 3 trial
I don't want to risk more autoimmune stuff !

[suezeeque]

Treatment with SOC did not make my autoimmune disease worse...  But type 1 diabetes can't get any worse.  ;)  My islet cells are toast and there's no degree to which they can be toast.  They just are.  :D

I have an autoimmune skin disorder that DID get worse.  But now that I've stopped treatment, it's the same as it was before treatment.

My autoimmune esophagus disorder didn't get any worse, either.

[candyce1953]

Yes I would be interested as an all oral trial for sure, but given the current problems I think I will wait till a phase 3 study
I am a good candidate, naive tx, etc

[willbb]

Hi candyce. Given your immune issues and that INF. may be a problem .possibly one of the "all oral " trials would be of interest seeing as you are St2 fib. and  the INf. free modalities may be  up to 5 years away..

Best to you..
Will

[candyce1953]

Thanks Mike that is what I decided to wait on to, till more direct attacking drugs are available

[mikesimon]

I agree that traditional treatment - pegylated interferon & ribavirin - can exacerbate pre-existing autoimmune disorders.

It is well settled that SOC treatment in an autoimmune hepatitis (AIH) setting can be damaging to the liver. It is a very difficult situation - coexisting AIH and HCV.

I do not know whether the new treatment drugs - DA's - would negatively impact an autoimmune patient. There seems to be reason to believe that it would not be harmful but I have no evidence to support that theory.

I try to refrain from advising people about treatment but, in your case, and, depending on your liver and overall health, avoiding interferon might be prudent.

Good luck,
Mike

[nygirl7]

Firstly you have a low viral load after a long infection.  This could mean that your immune system is trying to kill the disease but as it's in the chronic stage it just can't.  That was my case.  IF you have had this disease for 41 years, it will not be cured by your immune system.  I wish that were true.

As for this "I wonder if tx can make pre existing autoimmune issues worse"

Yes, definitely it can.  

[candyce1953]

Thanks for the link, I read it and
I see the connection of hep c to certain autoimmune illnesses

But i have a few questions the link didn't address
I wonder if tx can make pre existing autoimmune issues worse
Or if hep c related resolve after tx

I wonder if why a hyped up immune system is not clearing hep c but may infact be adding to the non clearance of hep c by attacking the WRONG things( not attacked virus but attacked organ, ie: liver fibrosis, or just creating autoimmune illnesses)

So in some ways if this theory of mine is possible

that I order for one to clear the virus then the new drugs that attack the virus itself rather than among up the immune system would work better in people with faulty immune systems

This could possibly explain why some people relapse and not just that the virus is hiding out( which it would with autoimmune disease anyway)

I have never treated but would have most probably failed to cause I am TT

But I think being TT and predisposed to autoimmune illness that maybe I should not triple tx and wait for more direct acting drugs

[mikesimon]

Autoimmune Diseases Co-Existing with Hepatitis C Virus Infection

The article is much too long to copy and paste so I'll only post the link.

http://hepatitiscnewdrugs.blogspot.com/2011/03/autoimmune-diseases-co-existing-with.html

Mike

[candyce1953]

Wow very interesting clip but way over my head

Could you please explain in laymens terms what this means?
Thank you

[candyce1953]

Just to add to the discussion (and my confusion :-)

I have autoimmune illnesses

Positive for hypothyroidism ,positive for Rhematoid arthritis,Epstein Barr, recently cleared drug induced lupus from my antidepressant , Possible other being tested for with dry eye etc,

Also mild asthma and had psoriasis as a child, and history of  family auto immune illness of all of these too

So given my body's autoimmune response with these illnesses

How does that correlate to immune response to viral load, and immune response to liver damage, and ultimate clearance ( I am also TT)
Thank you all!

[mikesimon]

"Immune-Mediated Liver Damage

The exact mechanism by which hepatitis C virus (HCV) causes liver cell damage is unknown. High levels of HCV replication have been reported in both immunocompetent and immunosuppressed patients with little or no intrahepatic damage, including inflammation.[McGuinness 1996] Indeed, in patients receiving liver graft as a result of chronic hepatitis C, where HCV infection recurs in virtually all patients, ~ 30% of patients fail to develop recurrent hepatitis 1 year after transplantation despite high levels of HCV replication.[Demetris 2009] It appears as if the host immune system tolerates high levels of intrahepatic HCV replication without killing the infected cells. Putting these observations together, HCV-associated cell damage seems to be largely mediated by the host immune response. Indeed, the hallmark of liver damage associated with HCV infection is a lympho-mononuclear infiltrate mostly represented by CD8+ T cells that are thought to play a major role in viral containment, although other subsets can be detected, such as CD4+, natural killer, and especially regulatory T (Treg) cells.[Spengler 2007] Several investigators have indeed reported how intrahepatic CD4+ and CD8+ cells are specific for different structural and nonstructural HCV antigens.[Koziel 1992; Schirren 2000] Why this immune reaction cannot resolve the infection in most patients is unclear. A predominant Treg response may blunt CD8+ cytotoxic T cell–mediated killing, but the mechanisms underlying this Treg response are unknown.[Alatrakchi 2009]

Hepatic fibrosis occurring in the setting of chronic hepatitis C is a typical model of wound-healing response to persistent liver injury.[Bataller 2005] Inflammatory cells of the intrahepatic infiltrate secrete cytokines and chemokines capable of activating hepatic stellate cells to secrete collagen.[Heydtmann 2009; Zeremski 2008] Because the latter are a major source of proinflammatory chemokines, a vicious circle ensues, whereby liver inflammation and fibrogenesis amplify each other (Figure 2).[Bataller 2005] Thus, in chronic hepatitis C, the fibrogenic process seems to be linked to viral expression through indirect mechanisms, ie, mediated by virally driven inflammation. A direct role of viral factors in fibrogenesis and disease progression has been debated. Several viral proteins may occasionally induce cell injury, such as oxidative stress and steatosis, probably in a sequence-specific way, and directly activate hepatic stellate cells without the participation of the inflammatory response.[Ming-Ju 2011; Clément 2010] These observations may explain why some patients with chronic hepatitis C may present with significant fibrosis by histology despite persistently normal liver enzymes and minimal/mild inflammation. The mechanisms underlying the direct fibrogenic effects of HCV are undefined."

http://www.clinicaloptions.com/inPractice/Hepatology/Hepatology/ch7_Hepatitis_C_Epidemiology_Pathogenesis_Diagnosis_and_Natural_History/Pages/Page%203/subpage%201.aspx

[1oftheclub222]

So it's your immune system that causes damage to your liver really?  Your immune system will kick in wether you 100 HCV virus or 1,000,000?

[willbb]

Just to add to Mikes"s and OH"s responses..possibly think of it this way.

VL of 869,000 and 115,000 are basically the same amt. when it comes to the  immune systems response, remembering the VL numbers they give us are in I.U  in one mm of blood.

We have about  22,000 mm of blood in our system   so therefore your viral load  ,given the numbers you gave above are fluctuating from about  one billion to about 4 billion virions on your different PCR's which is quite normal ..but really no difference to the immune system response(before any help is introduced from the drugs) as Mike  explained so well..

Best..
Will

[mikesimon]

This is the way I understand it.

The primary mechanism by which HCV damages the liver is immune mediated. Our immune system attacks HCV infected cells and uninfected cells come under attack as well - collateral damage. Actually our immune response is not effective at eliminating or "killing" the virus. With the help of treatment drugs our immune system becomes effective and starts "killing" the virus. An effective immune response gives the liver a rest by stopping the damage which results from an ineffective immune mediated response. And, of course, in the process the viral load declines reflecting the fact that an effective immune system is "killing" the virus - there is less and less of the virus/infected cells.

Mike

[SVRtyGOD]

no matter if your viral load is 100 or 1 million you getting same damage...but i assume while you are undetected your liver is getting relief from those little dragons...

[orphanedhawk]

The resting the  liver idea is not about lower viral load it's about being und.
Although viral load does not equate the amount of liver damage, while und your liver receives a rest from the virus and being the amazing organ that it is, it can begin to regenerate itself.

There have been forum members here who were und during tx, relapsed afterwards and found their livers in better condition than when they originally began tx.

[candyce1953]

Thank you I know it has to do with Clearing but people also refer to resting the liver in reference to lower viral load during tx

How is that possible? If VL does not correlate to liver fibrosis ,progression or damage a.

[SVRtyGOD]

no matter what your viral load is doesnt correlate to liver damage...viral load is used to see how well you are responding to treament...