I have been reading on this forum for a while and have seen the term "occult HCV mentioned many times. Try as I might, I still don't have a very good understanding of what it means. Can someone please explain in terms that I can understand?
Rev said: and that one should never let their guard down regarding HCC (liver cancer) because of it.
Exactly - and this is one of the BIGGEST reasons I believe doing tx is so important. Doing tx GREATLY lowers the odds of getting liver cancer - and truthfully THAT scares me even more than liver damage.
I too agree that there is way too much "social drinking" considering one never really knows. But that argument has been played to death.
I just am trying to say that to ME - protecting my liver and SVR if I manage to attain it finally...will be of the UTMOST priority - taking chances with it is just not worth it.
Sorry if this is off subject but I didnt want to just open another thread, maybe I should have?
Herpes, I have had 4 out breaks since being in treatment the past 5 months. Before treatment, only 1 or 2 a year and always in the same two small spots. Now different areas, Does anyone know why
Question for you - If you are not able to take prednisone for the AIH because of the hep C, how do you treat the AIH? Arent' steroids the only way to treat AIH? This sounds like an awful catch 22, Scott.
friole: I completely missed your thread below. I know nothing makes that news better other than time, but if you've got to relapse, the outlook today is as good as its ever been. Thanks for your great attitude (and invaluable flatulence counseling) and don't beat yourself up about the 72; remember even extending to the full 72 only put you at 30% odds if I'm remembering Berg correctly. I was so sure you were OK I even pointed to your high ALT as probable evidence of a non-HCV spike to Mike - wrong! Anyway, for what's it's worth, you've got lots of company.
forseegood: yeah, we'll see, but thanks for the encouraging word ("One of these days they know they gotta get goin; out of the door and down to the street all alone")
tn/dd: good review and a shot across the bow at the "it's just contamination in your gel" orthodoxy. Carreno does seem primarily interested in occult ( vs post-tx residual) which almost seems like a new addition to the existing active/chronic infection classification. It'll be interesting to see what repercussions this has on plasma testing...
I don't know much about AIH - had a sister-in-law that had it and it sure deteriorated her liver fast. If yours has receded, that is great. I don't know what it means either as I though a year of steroid treatment was the only way to beat it.
I am fine - still dealing, I guess. Got the name of a good liverhead in Dallas I will consult with - probably next May. I guess I am fated to get deeper in the game. (by that I mean I really need to start researching and advocating)
Just to bring my earlier comment up to this thread from the earlier 'occult' thread below: I think it still applies, after reading the paper linked, and here is what I said:
I also want to make a distinction between 'Occult' virus, and 'Residual' virus. I think the easiest way is to describe the general circumstance for each:
Residual Virus is that virus found in those who have treated and achieved SVR, and also potentially in those who spontaneously cleared the virus. The residual virus is most commonly found in very minute quantities in PCMB's, lymphatic tissue, and sometimes in minute quantities in the liver. It may also be in other cells, and organs, but not enough research has been done at this point. This 'residual' virus is controversial, and so far has not shown itself to be a serious threat to the tissues, or cells that it resides in. The liver is generally not inflamed, and the LFT's are almost always normal. There is no sign of ongoing liver disease. It appears 'benign'.
Occult Virus, on the other hand, is usually referred to in cases where there are abnormal LFT's, and a lack of antibodies in the serum, and no trace of the virus by PCR in the blood. These are chiefly people who have not treated, and are not considered to be spontaneous clearers either, since there is no HCV antibody in the blood. They come to the attention of their doctors because of their abnormal LFT's. The virus residing in their livers is active, as in the typical HCV blood/liver infection, and it is chronic. Generally there is ongoing damage being done, and obvious inflammation, as evidenced by the LFT's.
A good percentage of Occult HCV infected persons are those with a history of intravenous drug use.
This is my understanding of residual vs. occult.
One is a 'benign' viral infection in somewhat of a dormant stage. The other is active, destructive, chiefly in the liver, and often needs to be treated. On the other hand, Residual viral infection, by its very definition, shows no sign of going away, regardless of treatment length.
But we can have both, right.
A chronic active HepC, and simultaneously an occult Hepc that we never knew about. When we become SVR, we can have residual virus, plus the occult virus.
The residual doesn't respond well to re-treatment, nor does the occult virus.
We may have two different things going on at the same time.
My read of this article is that the "occult" virus is not so much a distinct virus but a distinct "expression" of the virus. I may be off base as this is techie stuff, but if you are introduced to the virus (hello I'm scre!ed, nice to meet you!) you can be left with (1) HCV antibodies but no serum RNA normal enzymes and no liver damage; (2) No HCV antibodies, no serum RNA and high enzymes and liver damage; (3) No HCV antibodies and no serum RNA and no damage. My understanding of occult is that it is used to explain condition (2) where there is nothing in the blood but the liver is being damaged.
In these cases they have determined (Castillo) that the virus can replicate in areas other than serum and cause damage. Therefore, those of us who have antibodies and RNA and some or much liver damage have a different expression of the virus and do not have, by definition, the occult variety. The problem they are seeking to resolve is in people who cannot be identified as HCV positive but are having liver damage. That particular circumstance leads to the definition of occult.
I guess it is possible that occult is a distinctive illness that you could have right alongside the HCV or that it is PRIMARILY the mechanism that dmages the liver. I did not see in the paper however that both things could be happening at the same time? I did not see nor did I search for papers on SVRs with high ALTs which are explained as occult virus. Guess its possible. The scary thing to me is that people with occult virus can be carriers of the virus and not know it and we can be reinfected by contact with them. Or we can go to all this trouble to clear the virus and only clear the blood and be left with the occult variety continuing to wreak havok. "My name is Occult. You killed my father prepare to die"
confusing to me as well and the more I think about it the more confused I get - but it appears that if occult could exist in someone who cleared the virus spontaneously and shows no virus remnants in their blood then it is equally possible that if you clear the virus with the help of combo tx, that you could be left with no virus in the blood but some virus in other areas, including the liver. The occult version damages your liver etc and causes other side effects but is not the full blown HCV. Kind of depressing if you ask me.
It is a very strange manifestation of the virus, the 'Occult' virus. It seems to NOT provoke the antibodies in the serum, NOR develop a viral load there, BUT it was able to get into the liver, and become a chronic infection! That is the real issue the researchers have to figure out. The fact that many 'Occults' seem to have a history of IVDU or Transfusion, leads me to believe that maybe some people have a resistance to the virus in the serum?????, but maybe, since it traveled in the serum during the blood contamination, they develop the infection in their liver only, which may NOT be immune to the virus. MAYBE these people could be very valuable to HCV research, in that they may have some natural resistance factor in the blood, which could be developed into a vaccine, or used as a model for new drug treatments. On the other hand, maybe these people once DID have a blood infection, but it cleared spontaneously, and they also cleared the antibodies, leaving only a smoldering liver infection??????
Science just does not have any answers to this one yet.
I think we all want to keep in mind that the 'Residual' virus (or persistent virus after SVR) on the other hand, is a very different animal, and seems to be the 'dormant' or 'remission phase' of the active HCV infection. It may be that this 'residual' virus exists to some degree in ALL SVR's, and spontaneous clearers. We are getting close to finding these answers, and the medical community is quickly altering its concept of SVR = CURE = Eradication.
The E word, and the C word are not heard nearly as frequently these days. SVR though, is still a very viable description. It seems to be "as good as it gets" at this point in the world of medicine. It may indeed even allow most of us to continue right along with our lives, and hopefully have a normal lifespan...which will make it 'about' as good as a true CURE.
Now if we can come up with some replacement therapies for the heavy blasts of interferon that are in current usage. More user- friendly drugs will certainly change the entire landscape for HCV, and for life after!!!!
I still find DD's deferentiation of occult v residual to the point. And still encouraged by the fact that hcv was not found in 100% of the pts. A high number seemed to harbor it, but since the study had such a small sample, I would like to see a more comprehensive research on a large number of SVRs, and grouped by length of tx. Since only 24 wks was used to "treat" the occult virus, would longer tx eradicate it completely? it seemed that 24 was enough for at least two of the patients, maybe longer therapy could eliminate the residual virus?
more, and more encompassing research is needed. Show me pts that underwent tx for 72 and longer weeks, are SVR and showed hcv+ on biopsy, then I will panic, I promise.
PBMC does not show the occult hcv in almost 50%, another positive reason for a biopsy in some folks. don't think the fibroscan can pick up occult hcv.
the youngest. still looking through hundreds of dead trees printed with college information. I had to email one of them to stop sending stuff already!
thanks for asking. I am worrying about more pressing things nowadays, no need to add occult hcv to it until it starts acting up. Many people would trade places with some of us SVRs, so I am not complaining or worrying more than needed, just keeping my eyes open is enough for now.
I hope you get some direction for you and your son, on the next path to take with hcv. Clever little bug, isn't it? Almost puts you in awe to have been harboring such a master of disguise and deceit!
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