Aa
Latest HepC research status on SVR = "cure" (eradication)??
Hey folks, DoubleDose mentioned something in another thread that HCV SVR apparently is now being thought of as "eradicative." That is, if you achieve long term SVR after HCV treatment (or are naturally cleared), the virus is truly cleared from your body - not just suppressed or "quarantined" by your immune system. Over the past several years there has been a lot of back and forth research on this subject. One side appearing to detect viable virus at very low levels (apparently contained ans controlled by the immune system) in SVR patients. The other side with results suggesting a complete clearance of the virus after achieving SVR (i.e. the virus was truly and completely eradicated with no possibility of relapse or reactivation later).
Anyway, I'm out of the loop and haven't kept up with the latest info on this topic. Can some of the HCV research nerds here reveal what the latest is? Is there a growing consensus forming (as DD suggested) in the HCV research/scientific community that it's looking like SVR *is* eradicative? Obviously great news for all heppers if this is the case.
Anyway, I'm out of the loop and haven't kept up with the latest info on this topic. Can some of the HCV research nerds here reveal what the latest is? Is there a growing consensus forming (as DD suggested) in the HCV research/scientific community that it's looking like SVR *is* eradicative? Obviously great news for all heppers if this is the case.
I think that personally, if I ever do clear this d*rn virus, that I will want to continue to check PCR's for like at least 2-3 yrs post TX, since it appears that I have had a very resistant strain. But, that's just me, I don't expect anyone else to see it from my point of view. I, like Dointime, am looking forward to the new treatments on the horizon, hopefully with Pharmasset. I would definitely consider doing a late stage trial with it though. That is because these drugs are so expensive whenever they finally make it to the market and unless I have fantastic insurance in place, 6 mon. prior to their FDA approval, then I'd want to go the free route and do another trial.
Susan400
Susan400
Hey nygirl great to see you again. What are you talking about? You're an HCV nerd too, I know you got those reading glasses tucked away somewhere. lol Everytime I hear an Aerosmith song I think of you. ;-)
Dointime glad to hear you're doing ok too. I haven't kept up with the emerging all oral therapies, sounds exciting. I imagine eventually HCV will be cured using pills with a treatment duration of a coupla months or even weeks. Halle-effin-lieua, it's about time.
Thanks for the nih report desrt. That's really interesting that the HCV sporadically shows up within an 8 year window (at very low levels) and then disappears afterwards. I've always wondered if after you are initially "cured" there are vestiges of inert or inactive HCV holed up in various compartments. And as normal cell division/death/replacement takes place over time, these "squatters" are disgorged from their final hiding places. And after their eviction, they're finally exposed to the full brunt of the immune system - just as their extinct ancestors once were. And since the immune system is already attuned to wiping out the virus because it has specific antibodies already in place for that specific strain of HCV, those stragglers are quickly identified and swept up before any new infection can get a foothold.
Eight years sounds about right for most cells in the body to turn over, especially those known to host HCV virus. I wonder if that's why no further virus is detected after 8 years? It would be interesting to see HCV antibody (AB) decay measured and plotted vs time in SVR's. It wouldn't surprise me to see a sudden increase in HCV AB decay rate after about the 8 year mark (coinciding with the complete disappearance of the virus).
Dointime glad to hear you're doing ok too. I haven't kept up with the emerging all oral therapies, sounds exciting. I imagine eventually HCV will be cured using pills with a treatment duration of a coupla months or even weeks. Halle-effin-lieua, it's about time.
Thanks for the nih report desrt. That's really interesting that the HCV sporadically shows up within an 8 year window (at very low levels) and then disappears afterwards. I've always wondered if after you are initially "cured" there are vestiges of inert or inactive HCV holed up in various compartments. And as normal cell division/death/replacement takes place over time, these "squatters" are disgorged from their final hiding places. And after their eviction, they're finally exposed to the full brunt of the immune system - just as their extinct ancestors once were. And since the immune system is already attuned to wiping out the virus because it has specific antibodies already in place for that specific strain of HCV, those stragglers are quickly identified and swept up before any new infection can get a foothold.
Eight years sounds about right for most cells in the body to turn over, especially those known to host HCV virus. I wonder if that's why no further virus is detected after 8 years? It would be interesting to see HCV antibody (AB) decay measured and plotted vs time in SVR's. It wouldn't surprise me to see a sudden increase in HCV AB decay rate after about the 8 year mark (coinciding with the complete disappearance of the virus).
desrt - yes that's the link. Great job finding it thanks.
mre - willing debunked to Nomads if you want to find him.
I don't forget those 'back in the day' days either. I am looking forward to SVR within the next 5 years with the new non-ifn tx, so watch this space for a pm from me. However, I've dropped the evangelical zeal we all had as first-timers to the trials and I'm letting others lead the way nowadays. Great to hear that you are doing ok, as I am too,
dointime
mre - willing debunked to Nomads if you want to find him.
I don't forget those 'back in the day' days either. I am looking forward to SVR within the next 5 years with the new non-ifn tx, so watch this space for a pm from me. However, I've dropped the evangelical zeal we all had as first-timers to the trials and I'm letting others lead the way nowadays. Great to hear that you are doing ok, as I am too,
dointime
You pose many interesting questions. I don't think its a closed book yet on the eradication issue, though for all means and purposes it seems eradication is the term du jour. On the cellular immunity issue, my understanding was that they were testing various tissue sources, of which I thought salivary, sexual and lymphoid were easiest to access and were what was tested. I am not certain each study used the same sources, and I have no idea how the current studies are being conducted. I do also agree that the finding of 'cellular immunity' to HCV may well be an indicator of a past attack or exposure to the virus, and may not indicate ongoing infection. That's where they need to really follow up with the most ultra sensitive PCR testing to determine if there is 'anybody home'...are there actual HCV virions or is it just a positive antibody indicating a successful warding off of the virus. Then the only question would become whether having that 'cellular response' activated, even without active virus present...whether that alone might cause any symptoms or changes at the cellular level. I would settle for just having them find no virus present....and call it a day .And yes, I agree that maybe some other viruses could create cellular immune responses that might mimic HCV antibody reactions. They need to fine tune the testing to make sure they are not seeing something else....although in the tests done, it seemed the close contact groups came up with the positive cellular immune responses in very high %, as compared to outside control groups who generally had very few, or no HCV cellular immune responses....which to me indicated the tests are measuring a reaction specific to HCV.
Other more esoteric questions, as to whether the virus could live on, after SVR, in deep bone marrow, central nervous system, spinal fluid, or brain tissues should easily be answered in coming years by doing detailed autopsies on deceased SVR's. All in all I am hoping for more good news, but am still quite leery of just saying the virus must be absolutely eradicated from our entire body...until we get more proof. It won't change my life either way in the interim, nor even after we have all the answers....but I still have lingering concerns. I would LOVE to find that we are indeed cured, eradicated, and absolutely virus free...so let's all hope for that final outcome.
Now the Interferon, that is another story....and I wish someone out there would start analyzing long term outcomes for SVR's in terms of side effects, return to health, resultant medical changes and issues, etc. I know I have been adversely affected, and I believe a number of others have had similar problems from the tx. I really think it should be an area of serious medical research. It has taken many decades for the medical establishment to finally acknowledge the impact on Cancer patients of chemotherapy, and to start studying the long term impact of their treatment.....let's hope it doesn't take forty years for us!!!!
DoubleDose
Other more esoteric questions, as to whether the virus could live on, after SVR, in deep bone marrow, central nervous system, spinal fluid, or brain tissues should easily be answered in coming years by doing detailed autopsies on deceased SVR's. All in all I am hoping for more good news, but am still quite leery of just saying the virus must be absolutely eradicated from our entire body...until we get more proof. It won't change my life either way in the interim, nor even after we have all the answers....but I still have lingering concerns. I would LOVE to find that we are indeed cured, eradicated, and absolutely virus free...so let's all hope for that final outcome.
Now the Interferon, that is another story....and I wish someone out there would start analyzing long term outcomes for SVR's in terms of side effects, return to health, resultant medical changes and issues, etc. I know I have been adversely affected, and I believe a number of others have had similar problems from the tx. I really think it should be an area of serious medical research. It has taken many decades for the medical establishment to finally acknowledge the impact on Cancer patients of chemotherapy, and to start studying the long term impact of their treatment.....let's hope it doesn't take forty years for us!!!!
DoubleDose
Meet certainly I'm no hepper nerd with any knowledge here but I wanted to say hi it's great to see you again! :)
Thanks for the post DD, appreciate the update from your perspective. But I guess I'm still not sure why you appear to have changed your mind to the extent you have (even with the * ). The fact that antibody taper/decay in long term SVR/naturally cleared patients is strongly suggestive of eradication is something we've discussed many times in the past and it didn't seem to sway you then. It also appears as if at least some of these most recent research papers (that you have linked) are still claiming to find viable/reproducible virions in longstanding SVR's (as they have in the past).
So I was expecting more of a "smoking gun" revelation suggesting an eradicative outlook than what appears to me to be the same mixed bag of competing theories as it has been in the past. Sounds like there isn't a smoking gun bolstering eradication yet (?). But is there a growing consensus that the legitimacy of the lab findings of the persistence crowd are now being questioned due to what they're finding possibly being other similar viruses like HPV etc? And the antibody taper/decay in long term SVR's is now being viewed with more weight than before?
Another thing I was wondering about: when some of these studies find viral presence in HCV sero-negative sex partners or even casually contacted family members of a chronically infected person...are they finding viral presence in localized tissues, or are they finding it in only liver cells and blood? I recall HR referring to all the various immune system "pathways" of which there are many. I never understood most of what he was referring to, but I recall on a localized tissue level there can be an immune response specific to HCV (or any other pathogen). I recall he mentioned a test that showed that certain exposed cells "glowed" (under a certain test) indicating they had been exposed to HCV. But he said that just because certain externalized tissues were exposed it did not mean a global infection necessarily was established in the host. In other words, the virus was likely stopped at the first pathway it encountered as long it wasn't able to bypass the first pathways and directly access bloodstream.
And concerning the latest paper posted, I wonder if the sero-negative close contact people will be tested (or have been tested) after departing company with their actively infected partners. In other words, it would be interesting to see if the positive exposure test results will still come back positive, say, if an uninfected person broke up with his/her infected partner and was tested a few years later.
So I was expecting more of a "smoking gun" revelation suggesting an eradicative outlook than what appears to me to be the same mixed bag of competing theories as it has been in the past. Sounds like there isn't a smoking gun bolstering eradication yet (?). But is there a growing consensus that the legitimacy of the lab findings of the persistence crowd are now being questioned due to what they're finding possibly being other similar viruses like HPV etc? And the antibody taper/decay in long term SVR's is now being viewed with more weight than before?
Another thing I was wondering about: when some of these studies find viral presence in HCV sero-negative sex partners or even casually contacted family members of a chronically infected person...are they finding viral presence in localized tissues, or are they finding it in only liver cells and blood? I recall HR referring to all the various immune system "pathways" of which there are many. I never understood most of what he was referring to, but I recall on a localized tissue level there can be an immune response specific to HCV (or any other pathogen). I recall he mentioned a test that showed that certain exposed cells "glowed" (under a certain test) indicating they had been exposed to HCV. But he said that just because certain externalized tissues were exposed it did not mean a global infection necessarily was established in the host. In other words, the virus was likely stopped at the first pathway it encountered as long it wasn't able to bypass the first pathways and directly access bloodstream.
And concerning the latest paper posted, I wonder if the sero-negative close contact people will be tested (or have been tested) after departing company with their actively infected partners. In other words, it would be interesting to see if the positive exposure test results will still come back positive, say, if an uninfected person broke up with his/her infected partner and was tested a few years later.
The link dointime referred to from willing's posts:
http://www.ncbi.nlm.nih.gov/pubmed/21040725
"CONCLUSIONS: Trace amounts of HCV RNA of pretreatment sequence persisted and reappeared sporadically in the circulation within 8 years after recovery from hepatitis C but not thereafter, indicating that patients are cured of HCV infection. Reappearance of HCV RNA induced HCV-specific T-cell responses."
http://www.ncbi.nlm.nih.gov/pubmed/21040725
"CONCLUSIONS: Trace amounts of HCV RNA of pretreatment sequence persisted and reappeared sporadically in the circulation within 8 years after recovery from hepatitis C but not thereafter, indicating that patients are cured of HCV infection. Reappearance of HCV RNA induced HCV-specific T-cell responses."
Here I am, back out of the woodwork! And here's my take on the whole issue. I do believe that the medical community is now considering SVR, especially after 8-10 years out, to be equivalent to eradication. Some of the reasoning appears to be the extremely low number of 'relapses' in the SVR groups, and the fact that various antibodies to HCV RNA seem to fade away in many SVR's over long periods of time. I think that there seem to be one or two antibodies that linger even longer in many SVR's, so its not really a reading that tells us a complete story anyway. It IS good if the 'antibodies' to HCV go away, even if 20 years later, since it supports the eradication theory. I think we will get more support or dissent for this issue over coming years as we observe many SVR's who undergo long term immuno-suppression for other diseases, and determine if HCV re-occurs in any of them..
As for my theories on 'close contact infection',.... that observation was developed, as you know, from my first hand experiences with various intimate and familial relations...all with zero risk factors. Now, it may be coincidence, or it may just be some other chronic virus (as one doctor I met suggested), but I have definitely seen a development of identical 'extra-hepatic' symptoms in many close contacts. They have, by the way, all tested NEGATIVE for HCV on blood/antibody testing, the standard HCV tests.
Now.....all of that leads to a subject that is being studied by several researchers, and a prominent HCV doctor and hepatologist. That is "cellular immunity to HCV", or testing 'positive' to HCV exposure in various tissues and cells....like salivary, sexual, lymphatic, etc. Past studies of this nature, have indeed shown a pattern of positive for HCV results for the close contact and family member groups, in the few studies that have been done in the past. Current, larger scale studies are being done to better determine and validate what is happening in this group.
Here's where the questions come in. What to make of this phenomenon? Does it only represent 'exposure' in the past to HCV in these cells or organs? Could there be ongoing low level HCV infection occuring in those tissues, that remains isolated? If so, what damage or symptoms are a result? Could this potential, low level tissue infection ever migrate into the blood and become a full blown chronic HCV serum/liver infection??? Could this 'cellular immunity' positive test result lead to findings that the virus could enter the nervous system, or brain?? Independently of a blood infection??
These are all the questions being considered by researchers, and medical HCV experts. I don't think any of them have a remote clue as to the answers to these questions, but I do believe in time we will know one way or other what is going on. And so, this line of research could be a factor in my 'perceptions' of close contact infection and symptoms...and again...it may not!! I have no conclusion, only ongoing questions. Its not an obsession or major issue for me, but is an ongoing, lingering concern that I try to avoid thinking about.
So back to the original question: Do I believe in HCV Eradication? Yes with an * asterisk. I think the blood/liver infection is gone, maybe forever, and maybe fully eradicated for all practical means and purposes. Could there be lingering virions that hide in organs or tissues??? That's still the million dollar question. Is there any chance of ongoing infection for SVR's in the brain or nervous system??? We all hope the answer is "NO" but they are doing brain studies currently to provide real answers down the road. I am going to keep an open mind, hope for the best, and keep watching the research. There's more to learn about this virus, as all major diseases, I am sure.
The other collateral subject of interest, especially for SVR's who still feel horrible after years of virus free life.....is just what does the Interferon do to our systems long term, and why does a group seem to experience devestating after-effects from the tx? Why is there an opposite result from 'recovery and regaining good health' for this tx group?
Its good to hear from some of the old crowd. I hope all of you are doing well out there, and either are cured, or getting cured. Of course, as always....with an * !!!! LOL
Regards to all
DoubleDose
As for my theories on 'close contact infection',.... that observation was developed, as you know, from my first hand experiences with various intimate and familial relations...all with zero risk factors. Now, it may be coincidence, or it may just be some other chronic virus (as one doctor I met suggested), but I have definitely seen a development of identical 'extra-hepatic' symptoms in many close contacts. They have, by the way, all tested NEGATIVE for HCV on blood/antibody testing, the standard HCV tests.
Now.....all of that leads to a subject that is being studied by several researchers, and a prominent HCV doctor and hepatologist. That is "cellular immunity to HCV", or testing 'positive' to HCV exposure in various tissues and cells....like salivary, sexual, lymphatic, etc. Past studies of this nature, have indeed shown a pattern of positive for HCV results for the close contact and family member groups, in the few studies that have been done in the past. Current, larger scale studies are being done to better determine and validate what is happening in this group.
Here's where the questions come in. What to make of this phenomenon? Does it only represent 'exposure' in the past to HCV in these cells or organs? Could there be ongoing low level HCV infection occuring in those tissues, that remains isolated? If so, what damage or symptoms are a result? Could this potential, low level tissue infection ever migrate into the blood and become a full blown chronic HCV serum/liver infection??? Could this 'cellular immunity' positive test result lead to findings that the virus could enter the nervous system, or brain?? Independently of a blood infection??
These are all the questions being considered by researchers, and medical HCV experts. I don't think any of them have a remote clue as to the answers to these questions, but I do believe in time we will know one way or other what is going on. And so, this line of research could be a factor in my 'perceptions' of close contact infection and symptoms...and again...it may not!! I have no conclusion, only ongoing questions. Its not an obsession or major issue for me, but is an ongoing, lingering concern that I try to avoid thinking about.
So back to the original question: Do I believe in HCV Eradication? Yes with an * asterisk. I think the blood/liver infection is gone, maybe forever, and maybe fully eradicated for all practical means and purposes. Could there be lingering virions that hide in organs or tissues??? That's still the million dollar question. Is there any chance of ongoing infection for SVR's in the brain or nervous system??? We all hope the answer is "NO" but they are doing brain studies currently to provide real answers down the road. I am going to keep an open mind, hope for the best, and keep watching the research. There's more to learn about this virus, as all major diseases, I am sure.
The other collateral subject of interest, especially for SVR's who still feel horrible after years of virus free life.....is just what does the Interferon do to our systems long term, and why does a group seem to experience devestating after-effects from the tx? Why is there an opposite result from 'recovery and regaining good health' for this tx group?
Its good to hear from some of the old crowd. I hope all of you are doing well out there, and either are cured, or getting cured. Of course, as always....with an * !!!! LOL
Regards to all
DoubleDose
Thanks for the responses everybody. I was hoping DD and perhaps willing would come out of the woodwork and clarify this issue. DD said in a recent post:
"And, remember all the major medical bodies are now stating that SVR is equivalent to eradication."
As many of the old timers here know, DD has long felt that the symptoms of a chronic HCV infection (namely fatigue) can be passed from an infected person onto another uninfected person by almost any type of physical contact - even casual contact completely devoid of any sexual dimension. He believes he has witnessed this phenomena in his own partners and children and therefore has researched the topic heavily (understandably). And up until recently I was under the impression he still believed it because of the numerous reports he has posted here (including the one referenced above on Sept 15 of this year). Reports that suggest trace amounts of viable/reproducible virus have been found not only in SVR patients, but also in sero-negative uninfected partners of chronically infected HCV+ people.
And I'm not trying to stir the pot or generate another silly argument over it. It's just that if DD - of all people - is saying: "...remember all the major medical bodies are now stating that SVR is equivalent to eradication" something must have changed fairly recently in the scientific outlook concerning this matter. Otherwise why would he have said such a thing? I'm very curious what that change might have been, because the DD I've come to know would not lay down his sword so readily unless a significant revelation contradicting the quarantine theory has surfaced and convinced him otherwise. If there is new information to suggest SVR is truly eradicative, that would be great news for everyone (hence this query).
desrt/spectda - Thanks for the linkage. I often get confused about the use of the term "occult." I thought back in the mid-2000s' "occult infection" meant that someone was actively/chronically infected with HCV, but they had normal liver enzyme levels and a low VL - sometimes very low, even slightly below the threshold of detectability of certain normally available PCR tests. But then in some research papers "occult" seems to mean not detectable with any normal PCR blood test. The only detectability is through the use of hyper-amplified PCR tests and often the virus is found only in liver cells or certain antibodies. But I dunno, I haven't kept up with it and I've already forgot some of what I once knew.
Willy - great to see you too, hopefully you're hangin in there. Have you gotten treatment yet? Looks like a good time to jump into the fray with all these new PI's coming available. What's a little rash or GI issue to worry about? ;-) Yeah, I recall several papers that DD had posted that were very similar to what you have posted. But again, why has DD apparently had a change of heart recently? Just curious if he discovered some new research that suggested the tide had turned more in favor of eradication.
dointime great hear from you, glad to see you're keepin on keepin on. I'm doing ok, going forward with my life, but at the same time looking back once in a while. It's not possible to forget this whole experience or the people that helped me through the most traumatic thing that ever happened to me. Thanks for your help and support "back in the day." Hopefully you're putting together a plan for own SVR sooner rather than later. I'll look up the post you referenced. The 8 year eradication thing sounds interesting, just 3-4 years more to go. Almost sounds a bit like the 7 year itch, although I could do without any more itchies at 7 years or any other year. ;-)
"And, remember all the major medical bodies are now stating that SVR is equivalent to eradication."
As many of the old timers here know, DD has long felt that the symptoms of a chronic HCV infection (namely fatigue) can be passed from an infected person onto another uninfected person by almost any type of physical contact - even casual contact completely devoid of any sexual dimension. He believes he has witnessed this phenomena in his own partners and children and therefore has researched the topic heavily (understandably). And up until recently I was under the impression he still believed it because of the numerous reports he has posted here (including the one referenced above on Sept 15 of this year). Reports that suggest trace amounts of viable/reproducible virus have been found not only in SVR patients, but also in sero-negative uninfected partners of chronically infected HCV+ people.
And I'm not trying to stir the pot or generate another silly argument over it. It's just that if DD - of all people - is saying: "...remember all the major medical bodies are now stating that SVR is equivalent to eradication" something must have changed fairly recently in the scientific outlook concerning this matter. Otherwise why would he have said such a thing? I'm very curious what that change might have been, because the DD I've come to know would not lay down his sword so readily unless a significant revelation contradicting the quarantine theory has surfaced and convinced him otherwise. If there is new information to suggest SVR is truly eradicative, that would be great news for everyone (hence this query).
desrt/spectda - Thanks for the linkage. I often get confused about the use of the term "occult." I thought back in the mid-2000s' "occult infection" meant that someone was actively/chronically infected with HCV, but they had normal liver enzyme levels and a low VL - sometimes very low, even slightly below the threshold of detectability of certain normally available PCR tests. But then in some research papers "occult" seems to mean not detectable with any normal PCR blood test. The only detectability is through the use of hyper-amplified PCR tests and often the virus is found only in liver cells or certain antibodies. But I dunno, I haven't kept up with it and I've already forgot some of what I once knew.
Willy - great to see you too, hopefully you're hangin in there. Have you gotten treatment yet? Looks like a good time to jump into the fray with all these new PI's coming available. What's a little rash or GI issue to worry about? ;-) Yeah, I recall several papers that DD had posted that were very similar to what you have posted. But again, why has DD apparently had a change of heart recently? Just curious if he discovered some new research that suggested the tide had turned more in favor of eradication.
dointime great hear from you, glad to see you're keepin on keepin on. I'm doing ok, going forward with my life, but at the same time looking back once in a while. It's not possible to forget this whole experience or the people that helped me through the most traumatic thing that ever happened to me. Thanks for your help and support "back in the day." Hopefully you're putting together a plan for own SVR sooner rather than later. I'll look up the post you referenced. The 8 year eradication thing sounds interesting, just 3-4 years more to go. Almost sounds a bit like the 7 year itch, although I could do without any more itchies at 7 years or any other year. ;-)
Hi mremeet, great to hear from you again.
There was a post by willing in the last 6 months, made in a thread which asked a similar question. It quoted a study which showed that some virus was found in people up to 8 years after SVR. The 8 years was the limit, nothing found after that.
I was interested from the point of view that I'd want to be 100% sure of not being infectious after SVR before indulging in anything even remotely risky to another person.
Sorry I don't have a link to the post. Maybe you can do a search through willing's recent posts.
dointime
There was a post by willing in the last 6 months, made in a thread which asked a similar question. It quoted a study which showed that some virus was found in people up to 8 years after SVR. The 8 years was the limit, nothing found after that.
I was interested from the point of view that I'd want to be 100% sure of not being infectious after SVR before indulging in anything even remotely risky to another person.
Sorry I don't have a link to the post. Maybe you can do a search through willing's recent posts.
dointime
I'm not exactly certain that all answers are addressing the same question, but my link does not address "occult" (depending upon one's definition of what that means).
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http://jvi.asm.org/content/78/11/5867.full
(This appears at the very bottom of the paper, under discussion; the last paragraph. Willy)
"The present study shows that HCV RNA can persist, albeit at very low levels, in the serum and circulating lymphoid cells for years after apparently complete clinical and virological resolution of chronic hepatitis C. If the present findings reflect the existence of the biologically competent, infectious virus, this silent persistence may have important epidemiological and pathogenic implications. Among other factors, these trace amounts of the virus may lead to reactivation of hepatitis C after termination of antiviral therapy or due to severe immunosuppression and may support perpetuation on the subclinical level of liver disease which becomes symptomatic years after exposure to the virus. They may also constitute a source from which HCV may spread through blood and organ donations to susceptible individuals. "
+++++++++++++++++++++++++++++++++++++++++++++++++
Nice to see you, hope that you are well and that this is along the lines of what you were looking for. I'll let others speculate as to the ramifications.
willy
++++++++++++++++++++++++++++++++++++++++++++++++++++
http://jvi.asm.org/content/78/11/5867.full
(This appears at the very bottom of the paper, under discussion; the last paragraph. Willy)
"The present study shows that HCV RNA can persist, albeit at very low levels, in the serum and circulating lymphoid cells for years after apparently complete clinical and virological resolution of chronic hepatitis C. If the present findings reflect the existence of the biologically competent, infectious virus, this silent persistence may have important epidemiological and pathogenic implications. Among other factors, these trace amounts of the virus may lead to reactivation of hepatitis C after termination of antiviral therapy or due to severe immunosuppression and may support perpetuation on the subclinical level of liver disease which becomes symptomatic years after exposure to the virus. They may also constitute a source from which HCV may spread through blood and organ donations to susceptible individuals. "
+++++++++++++++++++++++++++++++++++++++++++++++++
Nice to see you, hope that you are well and that this is along the lines of what you were looking for. I'll let others speculate as to the ramifications.
willy
There are still those who believe in the occult, low level theory. the longer the SVR the more possibility of it being durable. Although SVR 24 seems is almost 100 % durable. Whether it is irradiated or suppressed is still a debated subject by some.
here's a recent thread about it:
http://www.medhelp.org/posts/Hepatitis-C/Occult-HCV-discovered-in-intimate-partners--a-research-study/show/1594081
http://www.intechopen.com/source/pdfs/21442/InTech-Occult_hepatitis_c_virus_infection_where_are_we_now_.pdf
Conclusion
Most reports of HCV RNA sequences in cell or liver specimens despite HCV RNA being undetectable have come from a relatively few teams studying small cohorts of patients, but none of these patients experienced a real virological relapse. The clinical impact of low levels of HCV replication is not yet well defined. It is not clear whether these findings are replication-competent virus, have any clinical significance, or whether the situation predisposes to virus breakthrough. However, the majority of data from long-term follow-up studies on large cohorts of patients have failed to confirm occult HCV infection. Patients achieving a sustained virological response are very unlikely to suffer a relapse. Very few of them had detectable HCV RNA in their livers, the main replication site, and the liver histology of the majority of them improved. Further well-designed, multicenter, prospective trials are necessary for interferon-based therapies and also in the future for antiviral therapies based on specifically targeted antiviral therapy for HCV to finally resolved these conflicting data."
here's a recent thread about it:
http://www.medhelp.org/posts/Hepatitis-C/Occult-HCV-discovered-in-intimate-partners--a-research-study/show/1594081
http://www.intechopen.com/source/pdfs/21442/InTech-Occult_hepatitis_c_virus_infection_where_are_we_now_.pdf
Conclusion
Most reports of HCV RNA sequences in cell or liver specimens despite HCV RNA being undetectable have come from a relatively few teams studying small cohorts of patients, but none of these patients experienced a real virological relapse. The clinical impact of low levels of HCV replication is not yet well defined. It is not clear whether these findings are replication-competent virus, have any clinical significance, or whether the situation predisposes to virus breakthrough. However, the majority of data from long-term follow-up studies on large cohorts of patients have failed to confirm occult HCV infection. Patients achieving a sustained virological response are very unlikely to suffer a relapse. Very few of them had detectable HCV RNA in their livers, the main replication site, and the liver histology of the majority of them improved. Further well-designed, multicenter, prospective trials are necessary for interferon-based therapies and also in the future for antiviral therapies based on specifically targeted antiviral therapy for HCV to finally resolved these conflicting data."
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