Lost Post: Persistent HCV and Occult Issues; Mike, TnHep, Willing, Tater, etc.

Here is a post that was lost during the transition to the new format:

I  just returned to town yesterday only to read the recent threads regarding occult HCV and HBV issues. Thanks for bringing the 'old board' back to life!!! Good to hear all of you weighing in, and contributing material for the forum.

Now, as you all know, I have pretty adament opinions on HCV occult, and persistent viral behaviors. Of course my more radical suppositions are still very un-researched, and generally met with skepticism.....BUT each new research article on Persistence after SVR, and after spontaneous clearance, only lends more strength to my concerns.

I begin to see a potential cause for all the Post-SVR problems, that may go beyond Interferon hangover, and damage from tx. I think that the odd, infectious state that may exist after SVR, might well be responsible for many of our long term woes. I still believe that the virus does much more within our bodies than currently understood by mainstream HCV experts. I suspect that Central Nervous System issues, and infection are probably a reality, as well as the Lymphoid, connective tissue, and possibly Brain cell structures as well.

Whether lingering, low level virus causes actual damage in these organs, or causes an 'auto-immune' response is open to question...but I really believe there is something going on....in the SVR population. Maybe the 'liver/ blood' virus, is really a multi-faceted, multi-system infection, that only becomes highly visible, and detectable, when it overcomes the immune barriers, and becomes a chronic, and/or acute blood infection. Thus IVDU's are the most 'visible' group, and generally have the full bore infection!

I still strongly suspect other modes of infection, and transmission, that are NOT the typical, detectable 'Blood/ Liver' types of infection. If the virus can live, and reproduce in Lymphatic, Salivary, connective, and nerve tissue, then there is no reason it cannot be transmitted directly from these to similar tissues in others. It may just not become, nor provoke, a 'typical HCV blood infection', in those persons. Possibly sexual tissues, and gastric tissues could also become infected, and set up silent, undetected low level states of reproduction, causing vague digestive, and reproductive problems. All undetected by typical HCV testing.

I know this is somewhat of a stretch from the straight information the research studies have provided, but there is a LOGIC to what I am stating. And it all follows the findings of the research lately.

I would love to hear some discussion on these theories. I will accept the criticism as well, in advance! Just my individual take on what might be going on. I still can swear that I see odd symptoms in intimate contacts from over the years. Much like CFS, or CFIDS. All these contacts are 'undetected' for the typical blood HCV antibodies. But now, I have more ammunition for why this might be so. Maybe the infection is cellular, and localized. Maybe it is held 'in-check' like SVR's. It might cause NO antibody reaction whatsoever in the blood, but might cause lots of symptoms. (and provoke lots of immune system reactions)

Best wishes to all, and hopes that you are all well, and enjoying the holiday! Let's hear the hooting!

DoubleDose

[jmjm530]

Hi DD,

For me, SonicBandaid's answer to a similar one of your posts sums it up best. For those that aren't familiar with "Sonic", he's a hepatologist/researcher from another country who has posted here in the past.

Sonic's answer to DD:
(Complete thread here: http://www.medhelp.org/forums/hepatitis/messages/46794.html)

Hi DoubleDose,

I don't think HCV Docs deny the issues you raise, DoubleDose, its just they may not actually be very important, and its difficult to study these problems (anyone for brain biopsy so we could do the study? etc etc) in patients.  The techniques are also extremely difficult; I did a study about 15 years ago that I THOUGHT suggested convincingly HCV replicated in lymphocytes.  I took me a long time of thought and review of the data/ techniques and implications etc to realize I shouldn't publish the paper in full (it was published as an abstract) becuase I couldn't be ABSOLUTELY certain I wasn't looking at PCR contamination (we were using strand-specific priming, which, it turns out, isn't absolutely strand specific at all).

The issue for us is primarily, so what?  If the virus isn't actually causing any measurable problem (and the data long term in terms of liver function testing / repeat post-clearance biopsies etc etc) certainly suggests this IN MOST PEOPLE post SVR, why should we panic people into beliveing they have a problem?  Most people (most living things actually) harbour viruses of one form or another (with "endogenous retroviruses being most topical) and the evidence suggests most of these NEVER cause clinical problems. I harbour a suspicion, in fact, that some of them may actually be beneficial and exert a comensal antiviral effect on "nasty' viruses in the same sort of way that commensal gut bacteria (like the lactobacilli people take with yoghurt etc etc) do for bad intestinal "bugs".

Its early days, but I agree with JmJm's Doc contacts that the late / latent HCV issue may be a furphy, at least for most folk.
Cheers,
Sonic

[CockSparrow]

My view on Occult HCV is that if it were an issue more people would relapse after 6 months post svr than the 1% that do. And that 1% includes reinfection.

Most of the post Tx Sx that I have seen are also symptoms of the disease, so I think its our own bodies INF that hasnt shut down properly that causes most post Tx issues. We do after all make quite a lot of the stuff while infected.

Probably why I hated INF being called toxic garbage by abyss.
That and the fact that I have had hardly any sides.
I actually feel better after Tx. Almost a pity i didnt cure.
My thoughts only.

CS

[frijole]

So it did get lost.  That thread was a mystery to me.  I could find it on my home computer but not here at work.  Glad you reposted, although I am not sure there is any new news on it.  Just, as Jim posted, quoting SonicB, that it is there.  I would be interested in Sonice's lymphocyte replication study.

The issues should stay close to the surface, especially with the implications that occult hepatitis B may influence one's ability to clear hepatitis C with interferon.

frijole

[mikesimon]

I really don't have anything new to add to this subject. When I do I will post it to your attention DD. I hope you're doing well. Mike

[desrt]

HCV RNA has between 9000 and 10,000 nucleotides depending on genotype. Everything I've read about RNA found in SVRs and people who clear on their own, speaks of RNA 'fragments', both + strand and - strand (implying ongoing replication). If the HCV has had to make some sort of genetic changes to cross the interface into the compartmentalized systems of the body, it could be trapped in these areas, having some type of low grade effect such as you speak of without the full blown problems of HCV. I'm thinking it would also not be contagious, but this is all just my speculation.

[willing]

hmm - hope that thread isn't lost. I've had it on my todo list to go back and read  those hbv papers since on first impression the ones mike and tn posted seemed to be pointing in opposite directions - but I've gotten swamped and probably won't get a chance for another couple of weeks. However, I don't  necessarily see a conflict between this ongoing line of research and SonicB's comments. There's usually (at least ) a couple of  year gap between primary research and clinical relevance.

For anyone who doesn't quite feel back together post-SVR, it may be worth keeping an eye on what turns up in this area. At a minimum, that SF study underscored, once again, that there's a  lot more going on in the way of hcv activity than is measurable via a std. serum test. The good news is that *if* it turns out durable SVR is consistent with on-going low-level infection, there is a growing armament of non-ifn "supplements" to make life hard for the hcv holdouts.

[desrt]

You've been reported.
Again.

[niceguy2007]

i don't think occult hcv can reproduce outside the liver.  its a hepatotropic virus, which means it lives primarily on the liver and is found in the bloodstream as a result.

however, it may be possible that tiny amounts of hcv may be reproducing INSIDE the liver, without making it into the bloodstream, thereby going undetected by PCR tests.  however, this represents is a qualitative difference from the regular HCV chronic reproduction in untreated patients, which may also imply that the rate of liver damage is significantly reduced or even eliminated as a result of SVR.

then there is the possibility that HCV may damage the liver not as a result of reproduction, as is the current medical understanding, but as a result of other activity it may undertake while being present in the liver.  if this is the case, then occult HCV may actually result in liver damage.

i believe whether HCV lives in the nervous system or lymph or other tissues depends on its ability to reproduce.  if it cant reproduce ouside the liver, it cant live in other tissues either.

[DoubleDose]

The unanswered question is just whether it can reproduce in other tissues.  Just because it is Hepatropic does not preclude it from being sialotropic, and lymphotorpic as well!  Many recent medical journals have indeed been categorizing HCV as being all three of the above!  It may also reproduce in bone marrow, and CNS tissues, including the brain.  These issues HAVE NOT been ruled out.  Again, being Hepatropic only means that it 'likes' those tissues, NOT that it cannot reproduce in any others.