Occult Hep C Study and Other Posts

Just found this online and wanted to pass it along. Seems to further confirm the occurrence of persistent occult Hep C along with the potential negative consequences of having it (i.e. - the 10 occult Hep C patients studied here all had elevated ALT's and liver damage):

<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16611276&query_hl=1&itool=pubmed_DocSum">Effect of anti-viral therapy for occult hepatitis C virus infection.</a>



On a side note, for those who may be suffering long-term sx's post-tx I'll pass along my anecdotal experience of being one of the estimated 5% who remained anemic (defined as >1.0 below baseline Hg) many months after tx.

I finished a 48 week tx in Jan. of 2005 (geno 1a - now SVR, thank God) with a Hg reading of 9.6 (baseline was around 15.5). Post-tx blood work showed it mostly hovering in the 12's, never going above the low 13's. My last CBC - taken about a month ago - showed it now at 14.7. Additionally, my white count had been at the low end of normal post-tx and that, too, is now moving up a bit.


I wouldn't say that I'm all the way "back" just yet, but a slow and steady recovery can seem to take place even over a very long period of time. Hopefully that will be the case for all post-tx'ers in need.



May God's blessings and mercy be upon us all.


TnHepGuy

[mikesimon]

I saw that ealier and, frankly, I don't know what it is that the article says. I hope I'm not being racist or prejudiced but when I see studies from Spain or the Middle East I get a little suspicious and don't give them the weight that I would if the study was at one of our more prestigious centers. But given that disclaimer, I don't understand the study. Of course, it's just a short synopsis but I don't think it is clear and I am not going to get alarmed until you explain it to me. I'm glad you're Hmg is improving. Mine is as well and it's been a long time coming. Now my renal function is getting a tad out of whack but I think that's a result of immunosuppressive drugs which are being reduced. I wish you the best. Mike

[DoubleDose]

Remember that there is a major distinction between 'Occult HCV', and Persistent HCV after SVR.  Occult HCV seems to be a rare occurance, where individuals become infected with the virus, but somehow do not show any level of activity in the blood, and test undetectable for any RNA in the blood.  They may or may not be antibody negative, but do seem to carry the virus actively in their livers.  I do not believe that the researchers are yet sure how this comes about.  Maybe some people become infected, with transfusion, or IVDU, and later clear the virus from their blood spontaneously, only to have the virus remain in a replicating form in their livers.  Maybe there is some other unknown route for the virus to enter the liver, but I can't imagine how, other than some very remote chance of a gastrointestinal route to the liver.  The former scenario seems more likely.  The only scary aspect to occult HCV is that it implies that the virus can be alive and well in one organ (liver in this case), but not present in the blood.  This presents a case for ongoing, compartmentalized infection, in rare cases of those that have cleared on their own, or in current days, may mean that a very small number of SVR's who have had successful treatment, may continue with ongoing liver infection, even though RNA negative on blood testing.  The tip off would probably be elevated LFT's in both cases....but not absolutely so.  Some might be in the 'normal LFT category', even with a liver infection.  The numbers would probably be miniscule.

'Persistent HCV', after SVR (which was NOT the subject of this article) merely refers to the 'controversial' finding ( by some researchers) that small amounts of 'possibly replicating' HCV may remain in the PBMC, liver, lymphatic system, and other organs, long after the supposed SVR has been obtained, and in spite of testing undetected on long term  blood PCR follow up testing.  The researchers still seem at great odds on this issue, and its significance, and I have not seen any further attempts at clarification recently.  Does it really exist?  Can it cause down-road problems, if it does exist?  Could it cause a late relapse for someone who is compromised by immune system inhibitors, or diseases???  All good questions that are still out to jury.  One day we will know the answers, but probably not for awhile.

I hope that both of you are doing well, and enjoying your SVR status.  Post-tx problems are an issue to be addressed, and seem to be widely varied.  Anemia, autoimmunity, eye problems, tinnitus, joint problems, mouth sores, fatigue, ED, etc. are all on the list of issues that many are dealing with.  Hopefully they will all mitigate over time, as your anemia seems to be doing.

I still view the forum periodically, but am trying to get back to more normal living (and working) without a daily dependence on the ongoing commentary ( and my own internal questions and commentary!).  I am ready to take the training wheels off and ride for awhile.  

Best wishes!

DoubleDose

[jmjm530]

I just did a quick google on the ocult virus. As you suggest, these are folks who are both PCR negative AND antibody negative. In other words, these people have never treated for Hep C. Do you know if any studies suggest occult virus was found in SVR's? Because it not, then the occult virus issue is somewhat mute for those who treated.

I'm also a bit confused on this one study:
http://tinyurl.com/2jkvp

If these folks were antibody neg and pcr neg, where did they find them? I can't believe that 57% of all people with elevated liver enzymes who are PCR negative have occult virus???? There are many causes for elevated enzymes including medications, exercise and fatty liver. Maybe I'm just not reading this study right, hopefully you can help here.

-- Jim

[jmjm530]

On second re-read, that appears to be 48%. In other words, 48 out of a hundred people with elevated enzymes have occult virus???? BTW are they treating it? According to the study occult virus is associated with liver damage.

[Forseegood]

hi, thanks so much for your thorough response...yes, Henley's doc did tell him there are cases of co-infected people who present this way...perhaps youre right about the HIV theory...like I said, if you knew Henley, and how important it was for him to be well, that he lives alone with no partner (therefore, no way he could of contracted it by razors, etc), didn't do any medical procedure except take meds and get blood draws (with new needles every time) it just doesn't seem likely that he could of re-infected himself,

or else a flip scenario would take be more likely - that this disease is easier to contract then previously thought...and seeing all the married and live-in couples where one person in the couple is infected and the other isn't (and they are legion) this disease does not seem that easy a disease to contract...with everything I've read, the evidence points more and more to it being a truly blood borne disease...

but then on God's green earth, anything is possible..

it is good to know so many SVR's and how they just go on with their lives HCV free though...

[Forseegood]

could you elaborate a little? my doc says HCV does have something to do with immune response...but I guess they are all just working this stuff out themselves with plenty of theories to throw around...

[Forseegood]

sorry, I read youre post wrong, I get the gist..seems as though our docs do have a disagreement though...

[jmjm530]

To clarify my docs point of view -- yes, the immune system plays a critical role in hep c, but that role is played either at the time one is first infected (spontaneous clearance or not) or later during treatment. It is after SVR where he thinks the immune system no longer becomes a factor. In other words, if there's no virus left, than there's nothing to relapse regardless of how weak the immune system might be.

[lilmoma]

Oh gosh!!!!!!!!!!
I feel like a "rage-aholic" right now. I am over whelmed with the feeling of extreme anger, hatred, and venom.
Ohhhh! This too shall pass.
Very BAD day at work,.............I am so sick of "inspections" and little "Corpoate Games"      
Okay, that helped a little, just being able to say it!!!!!!!Whew! (well,...kinda)
lilmoma

[can-do-man]

says....Oh gosh!!!!!!!!!!
I feel like a "rage-aholic" right now. I am over whelmed with the feeling of extreme anger, hatred, and venom.


Glad to see your having a good day lilmoma, just remember most are not this pleasent

[psychdoc]

Hey Guys,
I haven't been around for a while. I finished tx in Nov. 2003 and have been Svr since then. I have had continued problems (occult virus) since then. I had osteomyelitis and had IV antibiotics for 8 weeks. I had gallstone pancreatitis and had my gallbladder removed. I have auto immune issues,  muscle pain and fatique. I am learning to adjust. I work in the am and then take a nap and go back to work in the late afternoon. When I finished tx I could only work 3 half days a week. I recently got back from Costa Rica. It was exhausting but also beautiful. For those of you new, I am 1a/1b and did pegasys for 48 weeks. I had every side effect listed and was on a ton of meds. I took procrit for the last half of treatment. I am very slowly getting strength and endurance back but don't think that I will ever get back to where I was before. I check in periodically to see if there is anything new and I wish the best to all currently on treatment. It is a tough road but doable. Hi to Mike, Chevygal, DD, jmjim and any others I have missed. Thanks for being there for me!
Peace and love,
Barb

[beamishboy]

seems like this SX is part of the package...breathe,stifle,and YES,it will pass..Meds sux-Hang in there!! GOODLUCK-get ina tickle fest w/ the wee ones:Hugs help too!!

[Wasabi Pea]

Quick question:  How are these researchers testing for the occult virus in the liver?  Or is there a test for the virus present in the liver?  Is it just a biopsy, or is there another method?

Also, is this something we can request of our doctors?  If it's a simple test, why don't they monitor viral activity present within the liver as well as activity or RNA presence in the bloodstream?

One more:  How accurate is an ultrasound in diagnosing a fatty liver?  I was dx'd two years ago, but I was also 30+ pounds heavier.  I'd like to find out if a combination of the tx and weight loss helped reduce the fat infiltration of my liver cells.

Thanks.  Hope everyone's doing well.  I'm just chugging along to that final day.  Tomorrow's technically my last shot, although I may just go ahead and finish the box (one more shot, more more chance to kill any roving virus) next week...especially since I'll be on riba until 5/20 anyway.  Otherwise, doing pretty good.

Happy Wednesday.

[OnAPrettyPoison]

LilMomma, I agree with the Beamish - deep breaths, hug children, nice supper, oh and maybe a bubble bath!  Work sux sometimes, even when you are not treating!  People play games...just do your job and go home and love your family!

This article is somewhat over my head, however, I choose to believe that if the virus is gone, it is gone.  If I do get to SVR, I will not waste energy or fight a dragon I don't even know exists!  That's my story and I'm sticking to it!

[dyce]

Ha lilmoma, I know where your coming from there girl. When I get this kind of feelings I tell myself it will pass and it usually goes away after awhile. The riba seems to wire me up and drinkin some water seems to help mellow me out. Some days are worse than others , so for me , it's 1 day at a time and at times 1 step at a time. Hope your feelin better soon!

Dyce

[lilmoma]

Thanks guys!!
Can-do: you my friend,...I just love.....I cant seem to help.
You have a quality that brings out my"cybil" yet makes me want to hug you too. I think they call that schziziod (sp?)

pretty, dyce, and Beamish: thank you too!
I just took my Lunesta (Looney) so I better go to bed. I begin to babble on this stuff, and no memory of it the next day.

So, good-nite all,........
love ya, lilmoma

nygirl? where you getting all the fugdesickles?
gosh those have always been my very ffavorite, but now all I find is the Ice-milk aarrgggg. I want the REAL THING.
No and that not a Coke (Im so mad at the Coke salesman)
We did battle today. I won.
good night again,,,lilmoma

[DoubleDose]

Jim,

The people with true occult HCV have been recommended to undergo the same sort of tx that we have done.  Those that appear to have abnormal liver function, and on biopsy appear to be progressing would be the target audience for our good old tx.  The numbers that see resolution of the liver virus seem to be similar to the percentages that one sees with the typical blood borne virus, from what I have read.

Wasabi,

I think the way to track the liver damage AND the viral load in occult HCV would be standard liver biopsy.  Other than that, only the FibroSure, and similar blood tests would give a clue to progressing damage, but would be less accurate.  The biopsy would allow for PCR type testing, and possibly some sort of test of viral 'load', or density within the liver cells.  They don't do these tests on the typical HCV patient (with HCV in the blood and liver), because the research has shown that eradicating the virus from the blood is usually equivalent to eradicating it in the liver, long term.  So they just monitor blood PCR results, and extend long enough to make sure both the blood and liver remain negative.

PsychDoc

I finished up in Oct. 2003 about the same as you.  I have also been plagued with post-tx problems, including lots of spinal joint problems (neck, back, ribcage, shoulders), eye inflammation and dryness, fatigue, some flaring depression, mouth sores, sun sensitivity, lupus-like autoimmunity, thyroid damage, ED, and some others that I am sure I am forgetting.  Still, I am working harder, doing more outdoor activity, and feeling healthier in other ways (if that seems like it makes sense!).  I fear that some of these issues are here to stay, but who knows?  I will keep trying to recover, and push myself to new levels of functioning.  I still run a business, have a high demand family, attend lots of outside activities, and travel as much as possible.  I think I have learned to live fully in spite of pain and misery!  Still, I would prefer to be minus the pain and misery.  Good luck to you, and hopes for continuing recuperation!  I think things will improve more, over time.  And, I do not think your problems are due to 'occult virus'.  That is a different thing altogether.  I think most of your sx are from one thing:  Interferon....in high doses, over a long period of time.  It has a way of re-training our systems to 'raise hell' ...on ourself.  That is my read, and I hope that slowly the effects will unwind.

Forseegood,

I feel for your friend, and it does indeed sound like a legitimate case of very late relapse, in his case.  We can't know for sure, but other similar cases have been reported...which leads you to believe that they may be genuine cases of relapse, or reactivation of the virus.  If one case is true, then I think it proves a point: that the virus may indeed be sitting somewhere in our bodies, in an inactive state.  Note the national HCV ads that now mention 'keeping the virus at undetectable levels long term' after successful therapy.  They have dropped the 'cure' word...and I think that means something.
Anyway, I am happy to be SVR, and take it for what it is...a lifesaver!  We will all hope to maintain this state!!!!!

Good Night All

DoubleDose

[jmjm530]

I posted a link to an "occult" virus study earlier in the thread. It should answer a few of your questions. As to why don't doctors request, it -- probably because no one would know what to do with the results. From what DD said, and my quick read, "occult" virus is only relevant to those who have negative antibodies and negative PCRs and therefore have never treated. That excludes just about everyone here. Regarding fatty liver and ultrasound -- yes, ultrasound can give an *indication* of fatty liver but only needle biopsy is definitive. Hope this finds you well.

-- Jim

[OnAPrettyPoison]

We sit here on this forum and debate and discuss all of these issues we encounter with having HCV - our treatments, our outcomes, and how we feel (and how badly we feel) while we treat.  We for the most part have healthy discussions where different points of view and opinions that are researched, discussed and debated.  Other than our lack of medical backgrounds for the most part, how different is this from how the medical community is researching HCV.  We are very aware of our disease, blood panels, odds, treatment options - sometimes more so than alot of the medical community.

We all found this forum, so I wonder if pharmaceutical developers/researchers ever watch or monitor our discussions?  It would almost be like they can watch the guinea pigs discuss the experiment.  Just a thought...

[Forseegood]

hi, you seem to be so knowledgable about this, and you bring up a good point..one of my best friends is co-infected with HIV-HCv and did a year of peg-intron two years ago, he had been SVR these whole two years...with 6 months pcr's the whole time...this last one shows a high viral load, he is infected again...course, we thought about him re-infecting himself, but it just seems unlikely, he's adamant that he couldn't of...he's clean and sober, a real neat-clean freak that always is very cautious about germs, his environment, etc...has had no sexual partners...you brought up a point about protease inhibitors (I understand the kind you take for HCV are different then the ones you take for HIV)could you elaborate?

his doc said it prob has something to do with him being co-infected and taking the meds he has to take for his HIV as nebulous as that sounds...

the good news is that on his first go around with peg=intron he cleared at 4 weeks, so maybe on this next go around with pegysus he'll have the same good fortune...and as we all know, it's pretty crucial that he clear the HCV from his system...what is your take on this, of course we are just speculating..I just hope he clears again and remains clear...if anything, I hope the treatment helped his liver...course if you'd rather not comment that's completely okay...

[jmjm530]

I agree with those that can't make heads or tails out of the abstract. This is not uncommon and often you have to go to the full-text document. I did ask my hepatologist about occult virus once and he said that as long as the virus is non-replicating it doesn't present a threat. That's one opinion, I'm sure they're many more. One thing is certain, at this point, no one really knows the significance of occult (non-replicating virus). My personal opinion  -- being the optimist I am -- is that it's a non issue and just viral "debris" left over from the battle.

-- Jim

[DoubleDose]

Your friend may have relapsed DUE TO his HIV status, rather than from the treatment drugs.  If HCV is an immune-system inhibitor, and causes the immune system to be much more ineffective, then the HIV may have caused that controversial 'persistent, remaining HCV' to re-emerge, well after SVR.  This would mean that a real 'cure' did not happen, and that the virus remains 'armed and dangerous' in those that achieve SVR.  So, the real issue is whether your friend really RELAPSED, or was re-infected.  Recently, and article was published, stating that an eight year HCV SVR had relapsed with HCV after therapy with immuno-suppressant drugs.

Again, we do not know for sure whether any of the late relapses were really re-infected, or have honestly relapsed.  If they have relapsed, after years of follow up, with highly sensitive PCR's showing continuing undectability for the virus, then we are looking at a scenario of HCV being more 'in remission' than cured.  We would have to be very wary of any potential 'triggers' that could cause the virus to re-emerge.

I really hope that there is another explanation for your friend's apparent relapse...and the other late relapse reports out there.

The whole issue makes me cringe.  One pretty high profile HCV doctor that I spoke with, who previously was pretty much in the cure camp, said recently that ...well...maybe the virus could act a little bit like Shingles, or Herpes..and under extreme circumstances could be re-activated...but that by and large for most out there, they can 'consider themselves cured'.....

I guess, as long as their virus does not re-emerge!

I wish I could offer something more definitive...but the answers are scarce at this time.

DoubleDose

[jmjm530]

DD says f HCV is an immune-system inhibitor, and causes the immune system to be much more ineffective, then the HIV may have caused that controversial 'persistent, remaining HCV' to re-emerge,
------------------------------------------------------------

Hey DD, long time no speak. Hope things find you well.

Regarding the above, I asked my hepatologist about the role the immune system plays in SVR and he unequicoally said it plays no role. What he means is that if the virus is gone, it's gone, and no immune drop can bring it back.

This makes a lot of sense to me if you study post SVR figures.
At six-months post tx, 98-99% chance of SVR being durable. At one year post, close to 100%. I would imagine that if we all were relying on the strength of our immune system to keep the virus down, we would see a MUCH higher relapse rate post 1 year. In fact, the odds of relapse are so low at 1-year that the odds of accidental reinfection are probably greater. Another thing is testing sensitivity. If initial SVR staus is based on less sensitive tests, then it's a false SVR with virus under the radar. This then can be picked up later with a more sensitive TMA. Also the possiblity of a false negative first time around.

Lastly, hoperully anyone who tests positive after testing negative will immediately re-test to make sure they didn't get a false positive. I imagine this happens more than people realize.

-- Jim

[mikesimon]

Just a note: I've been clear since 2003 and stopped TX in June 2004. As you may recall I wrecked my bike in 2005 and, for some reason, while I was hospitalized the transplant team increased my immunosuppressive dose by 50%. It's been backed down a lot since then but I was on an increased dose for 8 months and I am still SVR as of last month and I do take immunosuppressive drugs. So what do you make of that? Mike

[DoubleDose]

I did mean 'if HIV is an immune system inhibitor, not HCV.  In, other words, the 'relapse' may have been due to the HIV causing a weakened immune system, thus allowing minute amounts of 'in-check' HCV to multiply, and re-infect the entire system.  This would be what must have happened, IF this person indeed RELAPSED.

Good to hear from you as well!!!  I hope you are feeling well!

DD

[DoubleDose]

Your case gives us all lots of hope....that there is no such thing as a true 'late relapse'.  I really hope that your scenario is the 'valid' one, and that the few cases of so called 'late relapse' are proven to be from some other cause.  It does make you a bit concerned though. I doubt that many long term SVR's are going to do anything to knowingly potentially cause a reinfection.  You have to wonder WHY the late relapse...especially after frequent PCR's showing no virus.

Again, I am not taking a position that actual relapse is occurring, BUT that IF IT IS relapse, then we have some things to be concerned about.

I hope you are doing well also!  Great to hear from you, and continued best wishes!!!!  

DD

[DoubleDose]

Just another note on the 'Occult Virus' comments.  Remember, that the "Occult Virus' is actually a replicating infection in the liver, with abnormal ALT's and ongoing liver damage.  Its just not found in the blood.

Now the other thing, 'persistent residual virus'(after SVR) is what your doctor is referring to.  Most doctors do not believe that this is replicating virus at all, and do not think that it can reignite an infection, whatever it is.  It may just be inert fragments of a once living virus.  This is not Occult HCV virus.

But the occult virus is another matter.  It is rare, but documented in various studies, and is not something pertaining to people who have tx'ed, or who are SVR.  It is merely HCV infection in the liver, causing damage, and replicating, without any traces of infection in the blood.  No one can really explain how it exists, but it does...in rare cases.

DD

[jmjm530]

Gues our post crossed. But unless I'm missing something, still don't see the relevancy of "occult virus" to anyone here who is treating, treated or intends to treat based on a positve PCR -- and thatg includes all of us, I think.

My understanding is that "occult virus" only pertains to those who have never been PCR or antibody positive yet have raised enzymes. Maybe I'm reading it wrong....

[DoubleDose]

You are correct.  Occult virus is a rare phenomenon that would have no relationship to members of the forum.  We should be aware of its existence though, when we hear about people with persistently abnormal liver enzymes, who are tested for everything and find no cause, including HCV.  Those are the people who likely have occult HCV.  It will be interesting to discover how this infection comes about.  Maybe there are rare people who can eradicate the virus in the blood spontaneously, sometime after infection, but are unable to eradicate it in the liver.  Maybe their blood becomes resistant to the infection after initial clearance.  Its hard to understand how the liver can remain HCV plus for years in these people, but the blood does not become infected.  Totally counter to logic.  We all fear relapse after therapy because there might be a minute amount of virus left trapped in a few liver cells!!!  These people have an active, thriving liver infection... that does not seem to impact the blood at all!

I think the REAL controversial issue, that does relate to us...the SVR's....is the question of possible 'persistent residual virus' after SVR.  This is an issue that has totally contradictory research results everywhere you look.  About half the studies say the virus is gone...dead...eradicated...everywhere in the body after SVR.  The other half seem to find replicating strands of virus, long after SVR, all over the place...lymph system, PBMC's, nerve tissue, brain tissue, bone marrow, etc. etc.
It seems to be a hot potato, and neither side seems capable of totally proving their point, yet.  I vassilate between both opinions...sometimes feeling that there may indeed be a lurking viral remnant in various organs, that is not strong enough to re-ignite the blood and liver...but that keeps our systems in a constant state of autoimmunity....where on other days, I feel that the virus is long gone, completely wiped out, and only the after effects of the interferon and immune system battles remain.  Its somewhat a moot point though.  The real issue is recovery and rebuilding our bodies and psyches.

We are all learning and growing,,,and fighting battles together..hopefully to one day completely conquer this virus...without all the nasty drugs in use today.

DD

[Forseegood]

thanks again for your further response! anyway, hope this conversation doesn't scare anyone, that wasn't my intention, only that I try to help out my friend and see what I could come up with, though I guess his only option is to treat again, maybe that'll kill the suckers for good...and my gut feeling tells me (though no one is paying it for it's pronouncements) that it has to have something to do with his HIV status...but yeah, what's the use of even wondering too much about SVR aftermaths...if you get it, you only need to be glad as all get out...

Lilmoma: I see that youre taking Lunesta? I've taken it a few times in dire emergencies, how do you get on with it? I can't take Ambien, it makes me really weird, qaulify that, it makes me weirder, ha ha! with treatment I know you should prob rely on some type of sleeper meds, I hope that is good over the long term? some people also say, forgot the med but it's an old anti-depressent that helps with sleep...forgot what, anyway, your thoughts on it? oh and good that you calmed down, nothing more stressing then work anyway, can't imagine the added weight of treating at work, good for you that you are able to...

[jmjm530]

DD says: You are correct. Occult virus is a rare phenomenon that would have no relationship to members of the forum.
-------------------------------------
I know you know this but just wanted to clear up any confusion. It sounds very scary but whether it exists or not, doesn't directly pertain to anyone here.


DD says: We should be aware of its existence though, when we hear about people with persistently abnormal liver enzymes, who are tested for everything and find no cause, including HCV.
-----------------------------------------------------------
I have a very hard time believing over 40% of those with elevated liver enzymes who are hep c negative carry an occult virus. If so, why isn't this diagnosis more commonly made. If you google "elavated ALT" for example, you'll find a whole host of possible causes, including fatty liver.

DD say: I think the REAL controversial issue....is the question of possible 'persistent residual virus' after SVR...About half the studies say the virus is gone..dead...eradicated...everywhere in the body after SVR. The other half seem to find replicating strands of virus, long after SVR, all over the place...
--------------------------------------
I am unaware of any study that finds *replicating* virus after SVR. Strands of non-replicating virus, yes. This is a major difference. If you have any studies with replicating virus after SVR I'd be very interested.

Thanks again for the info.

-- Jim

[returntosender]

How do you explain the folks who are exposed to the virus but never develop a liver inflamation (inflammation) or other problems.  Does their immune system play a part in this?  Do they have different genetics?  Do they have smarter cells than the rest of us?  I read, I think in Dr. Cecil's site, that he considers treatment as a "training" of the immune system.  I have also been reading about SVRs having increased gamma interferon in their systems and increased "cytotoxic" (genetic I think) and other responses.  

I read that there have been attempts at trying to recreate these enviornments, I believe the gamma interferon tx was an attempt to put more gamma in to see if this worked by itself.  It apparently did not.  Adding gamma apparently reduced the cytotoxic response etc etc.  Very careful balancing act is apparently needed. It appears that SVRs have this unique balance and combination of immune, genetic and molecular elements.

How did they get these elements?  What was happening with these elements prior to tx?  If they were there all along why didnt they work to stop it in the first place? If not, how does this combination get created?  Add some Riba, some Interferon, shake it around long enough for the body to pay attention and - viola!  Immune system from hell, designed and trained to do one thing well - kill off those friggin HVC critters.  Everything else goes to hell but if we are lucky, we become HVC killing machines.  As soon as they stick their heads out, we lop them off. No matter that the rest of the body is falling apart.  

These are just some mad ramblings of my drug addled brain. My conclusions are biased as I tend to read things in a light most favorable to me getting better. feeling better, living better and having a future. I dont want to think that the little critters are lurking somewhere waiting for me to eat too many Reeses Cups.  On the other hand, I really dont like the super HVC killing machine theory either - not if it means that I will now have just as many problems, only from different sources.  Someone, please get better and stay better and keep telling us that it is possible and permanent.  I am terrified that I will stay like this - dark, cynical, critical, sad and resentful.  I also (dont want to imply that folks cant vent) need to hear about how tx worked for people.  How good they felt afterward and how their lives are changed.  Like AA, share your strength and hope.  Maybe that is part of the soup that some of us need - hope.  Makes your heart race, chest swell, increases alertness, raises your mood - puts you in better "humour" and what is humour - the liquid parts of the body - blood, blood serum, lymph. Hmmmm, maybe we got something here.

[jmjm530]

One point I was trying to make earlier is that the immune system is critical both in fighting (or not fighting) off the inital viral onslaught and also critical in killing the virus during treatment.

A very different point is that AFTER SVR the immune system is no longer needed to keep the virus at bay, because according to many the virus is gone, dead, non-existent. Therefore something not there cannot come back no matter how weak the immune system is.

New research may prove otherwise, but this is how I've heard and read about it.

-- Jim

[Forseegood]

your handle will have me humming that tune all night...I'm a big E backer...anyway, just wanted to say...pretty lucid for mad ramblings...you kinda described menopause for me (admittedly, meno is on a smaller, more palatable scale)...can't wait for treatment!!! you bring up some interesting questions though

[OnAPrettyPoison]

Extremely well said - and I find it sadly amusing that the points being debated about occult virus is just one of many of the ongoing debates about transmission, what other damage to the body does HCV do, length of treatment, who gets cured, why they get cured, why is one persons liver damage higher, or why is it lower, or should someone treat at all if they never are going to get enough liver damage to need a transplant and ultimately die of something else. No one knows, but governments should begin doing some serious investing in research and treatment of this disease or there will be an extremely high price to be paid later.

As much as we are unhappy about having HCV and dealing with treating/not treating issues, we are the lucky ones - we know we have the dragon or those considered SVR fought the dragon and stay ever with the proverbial "one eye open" for it.  There are lots of folks that don't know and won't know till they have serious health issues because their doctors aren't screening for HCV anyway and according the the above debate, current tests may not pick it up.

[mikesimon]

Thanks for the clarification and anyway, it's always nice to see you. It appears as though you're feeling better or maybe you're just getting used to feeling badly and putting a good face on it. I truly hope it's the former and that you are feeling better. I did understand the article pretty much as you put it but I still find it muddy, to say the least. Take care of yourself and pop in when you get the feeling. Mike

[lat36]

Hey guys, just thought I'd stop in and say hi. Haven't been able to check the site for a long time, moved house, no PC set up. Finished last riba a week ago, last pegasys a week before that, so all done 48 weeks. Don't seem to be feeling much better so far, although the skin problems have cleared up a lot. Hope your tx is still going well, Dyce. I'm basically helping rebuild a house, a bit too soon after tx I think - exhausting stuff. Best of luck to you all. Cheers.

[dyce]

Ha lat, good to hear your done with this medicine. It'll take a while to get the stuff out of your sysyen, especially the riba which has a long 1/2 life. I do shot 8 tomarrow and I can feel the anemia . I just caught your post and am out the door to work , cya. It's 4 am here.

Dyce