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"Occult Hep C in family members" - paper from Castillo et al
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"Occult Hep C in family members" - paper from Castillo et al

"Hepatitis C virus infection in the family setting of patients with occult hepatitis C."

Family members of patients with chronic hepatitis C virus (HCV) infection are at increased risk of HCV infection but the prevalence of HCV among family members of patients with occult HCV infection is not known. Anti-HCV, serum HCV RNA and levels of liver enzymes were determined in 102 family members of 50 index patients with occult HCV infection and in 118 family members of 59 chronic hepatitis C index patients. HCV RNA and/or anti-HCV were detected in 10/102 (9.8%) relatives of patients with occult HCV infection and in 4/118 (3.4%) of patients with chronic hepatitis C. Fourteen additional family members (seven were relatives of index patients with occult HCV infection) had abnormal values of liver enzymes without serological markers of HCV infection. Two of these patients (who were relatives of two index patients with occult HCV infection) underwent a liver biopsy and were diagnosed with an occult HCV infection because HCV RNA was detected in the liver cells in the absence of serological HCV markers. In conclusion, the prevalence of HCV infection among family members of patients with occult HCV infection was similar to that found among family members of patients with chronic hepatitis C. This stresses the need to adopt strategies to prevent the transmission of HCV in the family setting of patients with occult HCV infection.

http://www.ncbi.nlm.nih.gov/pubmed/19475603?ordinalpos=2&itool=Email.EmailReport.Pubmed_ReportSelector.Pubmed_RVDocSum


The same group has another paper listed ahead of publication:

"Hepatitis C virus replication in patients with occult hepatitis C virus infection."

http://www.ncbi.nlm.nih.gov/pubmed/19475689?ordinalpos=1&itool=Email.EmailReport.Pubmed_ReportSelector.Pubmed_RVDocSum


TnHepGuy
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Avatar_m_tn
I saw that article this morning and all I could think about was DD and his reaction. He's been singing this song for quite a while. I assume he's seen it but for all of us - thanks, I think. It is thought provoking, to say the least.
Mike
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Yes guys, I have seen the article.  It just reinforces my opinion that there is more going on with HCV, from a standpoint of infectivity, than is commonly assumed.  I suspect that blood to blood transmission, while the chief culprit in typical full blown chronic infections, is not really the mode of infection in many of the 'family member' and 'occult' type infections referenced in the article.  We need to start thinking about other ROUTES of infection, AND other TYPES of infection.  Possibly, cellular immunity to HCV, which HAS shown up in a good number of studies, within family members of infected persons...may indicate that there is something going on in these family members...and maybe not the typical full blown blood infection that we are familiar with, but also MAYBE not just some benign marker of past contact either.

I think the researchers are 'onto something' in these inquiries and studies, but that they just do not have a good handle yet on what they are witnessing.  Until they challenge their own assumptions of 'blood to blood' infection only, they will not easily see beyond the commonly held beliefs, and may not look very hard to find another sort of potential infection.  How do we know that the virus is not "setting up shop" in various tissues, or nervous system cells, just from low level fluid related exposures.  Maybe this sort of exposure does NOT have the power, or magnitude, to trigger a full blown 'blood/liver' infection, but MAYBE it creates a chronic infection of its own, in a different class or category.  Sure, this is speculation on my part, but borne out of direct observations over the years.  The new research on both Occult HCV, and on family member infections, leads me to think that there is more hidden beneath the current 'iceburg of knowledge' than we realize.  

I would never have ventured any of these 'radical' opinions over the years, had I not been seeing very suspicious symptoms and reactions in direct contacts and family members, myself.  All of this has caused me to look much closer at the behavior of the virus, and to question EVERYTHING about it.  Although I would really love to ultimately be completely wrong on this issue, I continue to feel more concerned and convinced every year.  

Maybe sometime down the road I will author another thread, with the survey format that everyone has hated in the past...but asking the HCV community about their own observations over the years regarding close contacts, sexual partners, family members, etc.  I would really like to receive some honest, non-reactionary, objective comments about what people are seeing, from a symptom and behavior standpoint, in these close relations.  I can handle the eggshells, so let them heave away!!!

Best to all of you!

DoubleDose
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Avatar_m_tn
and to think of the bashing I took here about 2 weeks ago for saying sharing tooth brushes was a very possible way of transmission. My point was they really don't know the extent of how this "resilant" disease is transmitted.
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Avatar_n_tn
I understand your feelings!  It is not unusual to receive very defensive and angry reactions from some forum readers, when one questions the commonly held beliefs.  I am not sure if the more extreme reactions are more motivated by personal fears that there might be more to the HCV threat than one would like to believe, or just a reaction to someone questioning the current medical establishment views.

My feeling is that it never hurts to ask uncomfortable or unpopular questions, and that it also never hurts to look for variations and quirks that were previously overlooked or assumed to be very benign.  Don't let the bashing bother you....those that scream the loudest usually don't want to discover or understand the real truth anyway.  

Some of my theories and views are very unpopular (to many here), but I am yet to be convinced that these opinions are invalid...so I really could care less if some don't want to hear them.  Just show me definitive proof that I am wrong...and I will be happy to say I was wrong...and will actually be very glad to BE wrong, if it turns out so.  In the meantime, I say, ask lots of questions, and tough controversial questions as well.

DoubleDose
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626749_tn?1256519302
Same old from the same groups, that always post incomplete studies, never peer reviewed, and always with questionable play on wording, and questionable choice of methods, imo.
Oh ya, they also always assume there is diffidently occult hcv. This is still a debated topic among the experts. Many of the top hepatologist do not agree what they have found is actually occult at all. And everything they have in their study is based on that.
My Hepatologist (M.D.,P.H.D.,M.A.C.P.,F.R.C.P.,M.A.C.G.,A.G.A.F.)says the only occult hepatitis is HBV. Oh ya he's also done a bit of research himself.

How does this have any thing to do with transmitting HCV with a toothbrush. Are you hinting at HCv might be more easily transmitted than we now beleive? That is certantly a possibility.
But, its all speculative, unless you have any type of proof, maybe a study that suggest hcv is more contagious than previously though, and blood to blood might not be the only mode of transmission. Maybe saliva, or even a cough ? maybe just rubbing up on someone, maybe a hard long deep stare ...who knows...
What exactly are you guys thinking for other methods of transmission ?

Don't believe everything you read, even if its in a study, from professionals. Peer review and large organized studies by outside researchers are the only ones that really should be taken as actual proof, imo.
IMHO, these studies by these occult groups are just interesting experiments that deserve more research (by outside of their group microbiologist peers) and data to get real proof.

You guys are killing me. lol

;)
apache
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626749_tn?1256519302
In my first sentence was not referring to you guys, or any forum members,  but to the studies authors.
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Avatar_n_tn
I hate to burst your bubble, but Occult HCV is a generally accepted, mainstream medical community acknowledged form of HCV where the virus is found in the liver, without any signs of it in the blood.  Often the blood PCR is negative, and sometimes the blood antibody tests are negative as well, but the virus is alive and chronically reproducing in the liver.  Tell your Phd, and multi-initialled doctor that he has been asleep at the switch.  HBV is not the only Hepatitis virus that has an Occult form.
Again, this has been documented and studied, AND acknowledged by almost all the major Hepatologists, researchers, and top liver treating hospitals.  

Occult is a little different than "persistent" HCV, but may or may not be related in its behavior.  That part is currently more gray at present.  I would suggest that you get your
FACTS straight before launching into a tirade.  The statistics in the family transmission article were also factual, and objective..so you figure out why and how the infections are happening.  We are searching for answers...you seem to want to mock that approach.

DoubleDose
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well I feel better already. Not because I like the news, but because all the precautions I've been taking are making more sense with every new study.

Honestly, other than the obvious bad news aspect we can all releate to I really don't see what's so surprising about all this. Other viruses regularly transmit between family members, why would be think HCV would be the one exception. At some point, we need to be testing our families and treating them carefully rather than risk giving them this disease.

If I weigh my fun smooching and shagging against the grief giving this to a loved one would bring, I want to err on the side of caution until ALL Occult anomalies are proven wrong...which probably won't happen.

What concerns me, is if I pass on, and then my children or husband would have to go through their own treatment later, and alone....alone would be horrible....this worries me, and makes me sure we should be paying attention to this research even if we don't like it, or it's not what we were originally led to believe.

mb
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233616_tn?1312790796
YOU took a bashing?!!  Well join the club!!
mb
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Avatar_f_tn
I don't know whether occult HCV is a potential problem or not. I can see possibilities to both sides. I normally do not like anecdotal information but DD, I would be very interested in a survey if you decide to go that route.

Here's my anecdotal experience with HCV, which in my case is the farthest thing from occult (never even close to undetected). I had this virus since 1966 (heavy dose through transfusion). I learned about it in 1991, Therefore, never taking any precautions. Got married in 1965, had first daughter in 1967, second daughter in 1970. My girls used to aggravate me because no matter how many times I told then to use their own razors, they liked mine better. We've all used the wrong toothbrush upon occaision and little girls love to play manicure which we often did. My family is clear. I am not saying you can't get it the ways I've described, just that I did not transmit it to my family. I do not believe it is that easy to transmit in a family setting.

And if it's occult, not in the bloodstream, how would it be transmitted anyway? I am curious how that would happen.
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I appreciate your comments on the subject, and I also know how much of a relief it is to see the antibody tests turn out negative for our spouses and children.  My family has tested negative as well.  That's where the questions begin.  Of course Occult HCV may not show up in the blood, and may have no markers, other than sometimes elevated LFT's which then may lead to liver biopsy and findings of HCV.  They do not know yet how it gets into the liver, without showing up in the blood.

But I am suggesting a possibility of something maybe even more inconspicuous.  Possibly a fluid transfer of the virus (sexual fluids, salivary, etc. ) that might have the potential to develop a 'chronic infection' in other tissues, if not the blood.  Possibly a transmission of the salivary virions, that could cause chronic "Sjrogen's - style" symptoms, as HCV is already known to also cause.  If the virus reproduced in salivary cells, it could also infect the gastric mucosa, causing digestive disorders, as typical HCV is known to often provoke.  The sexual organs and tissues could become a chronic reservoir as well....all without triggering a full blown blood/liver infection.  These are some of my concerns.  Why do I think that this is possible?

1.  I have seen many specific symptoms in past years that seem chronic, mimic my decades-long extrahepatic sx, and they have occurred in past partners,  and children, some time specifically after initial contact.  I won't go into all the details, but I could write a book.
None of these symptoms seem to respond to medications, etc...and they are chronic.

2.  Researchers, and many HCV doctors are finding patterns of tissue and organ "cellular immunity to HCV" in  family members and partners of HCV infected persons.  These family members do not appear to have the blood antibodies, and show up as being 'negative' for HCV, yet still test 'positive' for cellular immunity to HCV, in various tissue tests.  The blood tests show "Humoral" (or blood) antibodies, thus show a HCV infection.  Tissue tests show what is called "Cellular Immunity" or being positive for HCV in the tissue, or cell.

3.  It has been documented that HCV virions are often shed in fluids, including sexual, salivary, gastric, etc. but they have not been considered a threat unless they directly enter the bloodstream of another person.  I believe that part of this assumption is true, but that there may be more to the story.  The virions may well set up a chronic infection in the tissues of the other person. (Thus the positive cellular immunity results that show up in family members) This could lead to chronic salivary, lymphatic, gastric, sexual tissue infections.  Again, to all that read this, please note:  THIS IS MY HYPOTHESIS ONLY.  I am not claiming to have any proof, or stating any FACT.  
Just a very strong, and observation based belief.

So, let me ask you the hypothetical survey question, for your anecdotal response.  Have YOU ever observed any chronic symptoms in your children or partner, that seem to mimic symptoms that you believe are HCV related in yourself.  Some people have symptoms with HCV, others don't.  Some might include...chronic excessive fatigue, without explanation, autoimmune rashes and skin reactions, chronic gastric and digestive problems, dry eye and chronic salivary issues, joint pain, neck and back problems, that have no sensible explanation, depression, brain fog, memory issues.  Most of these sx are rare in healthy children, or have some specific detectable cause.  This is the sort of self-examination type question that I would pose to forum members, in order to gain a better understanding of their intra-familial experiences with unexplained symptoms in the family.  And maybe I am way off the mark here, and nobody else has ever observed this phenomenon. And maybe some have never really connected the dots, either. Whatever the input, I would love to hear it.  Thanks for your comments above.

DoubleDose
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===========================================================
quote from DD
I hate to burst your bubble, but Occult HCV is a generally accepted, mainstream medical community acknowledged form of HCV where the virus is found in the liver, ***without any signs of it in the blood***.
Often the blood PCR is negative, and sometimes the blood antibody tests are negative as well, but the virus is alive and chronically reproducing in the liver.  Tell your Phd, and multi-initialled doctor that he has been asleep at the switch.  HBV is not the only Hepatitis virus that has an Occult form.
Again, this has been documented and studied, AND acknowledged by almost all the major Hepatologists, researchers, and top liver treating hospitals.  

I would suggest that you get your
FACTS straight before launching into a tirade.
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Hmmm,  think you should check your facts Double Dose.
The last study we debated here on occult HCV, from the occult group, found all their patients had HCV blood Viral Load of 8-400 vge/ml... IN BLOOD. Easily found by available to us, sensitive PCR or TMA vl testing.
And the above study even mentions they found
"serum HCV RNA"

Although I do understand your confusion because of the jump around methodology and varying different protocols your occult study groups use.

Please define exactly what occult HCV virus is. It seems very wishy washy and whatever fits the bill for the study they are doing at the time.
Is occult HCV viral load in serum, like HBV occult is, and as the last study showed.
Is it a Viral load of < 2000,  like most HBV occult ?
Or is HCV occult viral load now .5 copies/ml ?
Or was the previous study that found occult to be 8-400 vge/ml in serum just plain wrong ?
I mean what is occult HCV, exactly what defines occult HCV ?

It was explained to me like this.
We can find many sunken war ships from previous wars. They are war ships. But are not actively participating in any ongoing battles, nor could they in there current state.
Is it possible to resurrect these sunken ships and make them viable again? Sure, probably is.
Just as in a laboratory petri dish, researchers can nourish and get HCV remnant has beens to flourish again.

DD, please list any PEER REVIEWED studies you have showing your,
"documented and studied, AND acknowledged by almost all the major Hepatologists, researchers, and top liver treating hospitals."


Not mocking anyone DD, just want some facts,
not hocus pocous petri dish occult, non peer reviewed, questionable medical research.

apache
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We, our families - every human on this planet, in fact - are full of virus, truncated gene strands of virus, 'junk' DNA/RNA, antibodies,etc. Some may have hysterical reactions to these discussions because they imagine their blood and bodies pristine, except for HCV or an occasional flu virus.
One of the theories why the current H1N1 strain of flu is more devastating to younger people is that they haven't the prior exposure/antibodies that we older folks have.
Don't get me wrong - I've always kept my toothbrush and razor out of reach of my younger kids, even post-SVR. I just don't feel non-serological HCV is a huge danger. Perhaps, my casual attitude is due to the fact that I never experienced "extra-hepatitic" symptoms. I co-existed pretty well with my virus for almost 30 years with little damage. If you or your family are genetically predisposed to quick disease progression, I could understand why it would be a concern.
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Here are a few studies and analyses regarding Occult that might answer some of your questions:

http://www.natap.org/2005/HCV/090505_20.htm

DoubleDose
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Here is a copied article on the subject:

Hepatitis C: Occult Infection
Liz Highleyman

There remains much we don't know about chronic hepatitis C. One such mystery is occult HCV. Usually the virus betrays itself by the presence of antibodies or viral genetic material (RNA) in the blood serum or plasma (the clear, fluid portion of whole blood). But some people who have no detectable HCV antibodies and no evidence of HCV in their serum nevertheless harbor hidden virus elsewhere in their bodies. (HCV is not the only virus that can take an occult form; HIV, for example, can hide in "reservoir" sites such as the brain and lymph nodes even if blood viral load is undetectable.)

Occult HCV may be suspected if a person has persistently elevated liver enzyme levels or extrahepatic (outside the liver) conditions commonly associated with hepatitis C. About one-third of people with chronic HCV have persistently normal levels of one such enzyme, alanine aminotransferase (ALT). Although many people with normal ALT do not progress to serious liver disease, some do develop fibrosis. A recent large study showed that patients with normal ALT can benefit from therapy with pegylated interferon plus ribavirin, suggesting that HCV-infected people with normal ALT should be treated based on the same guidelines as those with elevated ALT.

Unfortunately, an estimated 10% of people with persistently abnormal liver enzymes have no readily identifiable cause of liver damage using standard tests. There is concern that such patients may be missed and therefore not offered therapy due to false negative antibody or serum viral load tests. While occult HCV appears to be relatively mild in comparison with its more obvious counterpart, some patients with hidden virus may still progress to serious liver injury. Another concern is that HCV in donated blood and tissue may elude current screening tests.

At the annual meeting of the American Association for the Study of Liver Diseases this past October, and again in the January 1, 2004 issue of the Journal of Infectious Diseases, researchers reported that patients with persistently elevated liver enzymes may harbor HCV even if they have no serological evidence of the virus. Immaculado Castillo and colleagues from Madrid studied 100 patients who had abnormally high ALT, aspartate aminotransferase (AST), or gamma glutamyl transpeptidase (GGT) levels for at least 12 months. All readily apparent causes of liver disease were ruled out. The group had no evidence of HCV antibodies or serum HCV RNA (using a viral load test with a limit of detection of 10 IU/mL). Thirty patients with liver damage due to non-viral causes were studied as controls.

The researchers used two different types of test to detect occult HCV. First, they analyzed the presence of HCV RNA in liver biopsy samples using the reverse transcription-polymerase chain reaction (PCR) assay, the most commonly used viral load test. Using a PCR test that identifies the 5' NC region of the HCV genome, they found evidence of HCV genetic material in the liver samples of more than half (57%) of the 100 patients with unexplained elevated liver enzymes, but in none of the samples from the controls. Using a PCR test that detects the core region of the HCV genome, they detected RNA in 70% of the samples from the 57 patients previously found to have occult virus.

Second, using a test called in situ hybridization, the researchers found positive-strand HCV RNA in the liver biopsy samples from all of the 57 patients with occult HCV and none of the controls. Negative-strand RNA was detected in 84% of these 57 subjects. (Positive-strand RNA can be used to directly manufacture viral proteins within an infected cell. Negative-strand RNA, in contrast, is used as a "template" to produce a complementary positive strand. Thus, the presence of negative-strand RNA indicates that the virus is actively replicating.)

In addition to the liver biopsy samples, the researchers also detected HCV RNA in the peripheral blood mononuclear cells (PBMC, a type of immune system white blood cell) in 70% of the 57 patients with occult HCV in their livers.

Patients harboring HCV genetic material in their livers were more likely to have liver inflammation and fibrosis than those with no evidence of hidden HCV. About one-third (35%) of patients with occult HCV had METAVIR inflammation scores of A1 or higher, versus 14% of those without evidence of HCV. Likewise, just over 17% of patients with occult HCV had stage F1 or higher fibrosis, versus about 2% of those with no detectable HCV in their livers.

In an editorial in the same issue of the Journal of Infectious Diseases, Hervé Lerat, MD, and F. Blaine Hollinger, MD, of Baylor College of Medicine suggested that doctors should measure both ALT and GGT to identify patients with suspected occult HCV. The study results suggest that testing of peripheral blood cells may be as informative as invasive liver biopsies. The authors noted that several mysteries remain, including whether hidden HCV genetic material is infectious that is, whether people with occult hepatitis C can spread the disease.

Along with persistently elevated liver enzymes, extrahepatic conditions often associated with HCV infection may also suggest that occult virus is present. These include thyroid dysfunction, low platelet levels (which can lead to impaired blood clotting), lichen planus (an inflammatory condition of the skin and mucous membranes), vasculitis (blood vessel inflammation), and cryoglobulinemia (a condition in which abnormal proteins form in the blood and clump together, thus restricting blood flow). In the November 2003 edition of the Journal of Viral Hepatitis, for example, Milvia Casato, MD, and colleagues from Rome reported results from a study of three cryoglobulinemia patients with no evidence of HCV antibodies or serum HCV RNA. Two of them were nevertheless treated with interferon and demonstrated good clinical response, but their cryoglobulinemia relapsed after interferon was stopped, suggesting that HCV was indeed the likely culprit. At the time of relapse, HCV genetic material was detected in blood protein clusters (cryoprecipitates) of both patients for the first time. In the third patient, HCV RNA was detected for the first time during a cryoglobulinemia "flare" associated with a herpes virus infection. The authors concluded that some cases of so-called "essential" (that is, unknown cause) cryoglobulinemia are in fact due to occult HCV infection.

People with immune dysfunction may be especially likely to harbor hidden HCV, since their immune systems are less able to produce antibodies against the virus. Studies have shown that people with HIV (especially those with CD4 cell counts below 200) and transplant recipients taking immune-suppressing drugs often have HCV infection but no HCV antibodies. Marcel Beld and colleagues of the University of Amsterdam reported in the August 15, 1999 issue of Blood that injection drug users (IDUs) sometimes had a prolonged period of being HCV antibody negative after infection (as long as eight years), and that some also had intermittently undetectable serum HCV RNA. The authors suggested that IDUs may have impaired immune function independent of their HIV status. Research to date suggests that IDUs, people with HIV, and others whose immune function may be compromised should be tested carefully for HCV (possibly using PBMC or liver biopsy tests) if they have elevated liver enzymes or other signs that may indicate hidden HCV infection.

With more sensitive testing, occult HCV may prove to be the culprit behind many previously mysterious cases of liver disease. Like all people with hepatitis C, these patients should be considered for treatment since hidden HCV, like its more apparent counterpart, can lead to severe, long-term liver damage.

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also note the paragraph from the above article regarding 'extrahepatic conditions' without evidence of HCV infection:

Along with persistently elevated liver enzymes, extrahepatic conditions often associated with HCV infection may also suggest that occult virus is present. These include thyroid dysfunction, low platelet levels (which can lead to impaired blood clotting), lichen planus (an inflammatory condition of the skin and mucous membranes), vasculitis (blood vessel inflammation), and cryoglobulinemia (a condition in which abnormal proteins form in the blood and clump together, thus restricting blood flow). In the November 2003 edition of the Journal of Viral Hepatitis, for example, Milvia Casato, MD, and colleagues from Rome reported results from a study of three cryoglobulinemia patients with no evidence of HCV antibodies or serum HCV RNA. Two of them were nevertheless treated with interferon and demonstrated good clinical response, but their cryoglobulinemia relapsed after interferon was stopped, suggesting that HCV was indeed the likely culprit. At the time of relapse, HCV genetic material was detected in blood protein clusters (cryoprecipitates) of both patients for the first time. In the third patient, HCV RNA was detected for the first time during a cryoglobulinemia "flare" associated with a herpes virus infection. The authors concluded that some cases of so-called "essential" (that is, unknown cause) cryoglobulinemia are in fact due to occult HCV infection"
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388154_tn?1306365291
There was a study posted here some months ago, both jennypenny and willy posted it I think and willy changed the headline because it scared the shiit of many here treating.

That study was only dealing with people who had spontaneously cleared we found out after the shock has settled somewhat
.
Well the study said that among those who hade reach UND by spontaneously clearing some of (quite a few if I remember correct) them had ongoing liverfibroses although UND and had been UND for many years.

Then during the debating about this study other studies were  presented that showed
quite the opposit regarding  people how have reached and maintained UND(SVR) thx to soc tx namely ongoing fibros reduction instead even among stage 4s.

What I find interesting among others issues  is the correlation between elevated alt  and this occult stuff.

Is it possible that some people who have been treating hasn´t got enough meds to totally clear and maybe they need more treatment and can elevated  alt be an indication of that.

And shall those of us who managed to reach SVR aswell as those how spontaineously SVRd , when alt is elevated Rs do biopsys and fibroscans more often.
And maybe also get some medications to make alt stay down.( if there is any such available ,which I doupt there is at present time.)

DD maybe you shall ask in your studie what alt people have and have had after treatment aswell as their and their family members symptoms.
And maybe we shall ask our family members to check for liver enzymes values also and not only for HCV antibodys .

ca
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Here is a link to that thread.  The title didn't make it clear that the group was TX naive and were those who had spontaneously cleared.  Within the thread it also contains a kink to the JennyPenny thread as well.---willy

http://www.medhelp.org/posts/Hepatitis-C/Continued-damage-in-cases-of-spontaneous-clearance/show/745240?personal_page_id=7400&post_id=post_3923879
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Thanks for the link.  Here is a quote from one of the studies in the link that you provided.

"Non-viremic HCV antibody positive patients have a liver biopsy that is usually abnormal," the study authors conclude. "Fibrosis was present in most with similar inflammatory infiltrate to viremic cases."

They added that, "The presence of a CD8 rich inflammatory infiltrate suggests an ongoing immune response in the liver, supporting the view that HCV may persist in the liver in the majority of HCV RNA negative cases."

Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Pathology, University of Cambridge, Cambridge, UK; Clinical Microbiology and Public Health Laboratory, Health Protection Agency, Addenbrooke's Hospital, Cambridge, UK; Medical Research Council (MRC) Cancer Cell Unit, Hutchison/MRC Research Centre, Cambridge, UK.

Just another disturbing commentary on what happens after viral clearance.  This probably is the same in SVR as well as the spontaneous clearers studied in the article.  The "immune response" comment is noteworthy...because there is no evidence of any viral load, but still an immune response, and observable damage is taking place in the liver.

Transpose this to the familial transmission issue that we are discussing, and then you realize how family members might have "immune responses" and possible symptoms, damage, etc. while not showing evidence of any HCV viral load.  Might this same low level, contained or controlled infection that SVR's are left with, also be somehow transmissible to close contacts?  That is my real question, and ongoing concern.  Maybe there is another 'form' of HCV infection, that exists under the radar, so to speak, and is undetectable by standard testing...but might show up on cellular immunity testing.  This could be causing symptoms, and maybe even pyysiological changes over time, in close contacts...if it is happening.

DoubleDose
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apache > please list any PEER REVIEWED studies
all of the journals which have published studies on occult HCV indexed by PUBMED have peer-review acceptance policies; this is pretty much standard operating procedure. Obviously that doesn't apply to editorial summaries, like Liz Highleyman's above, but it does apply to the research publications underlying the editorials.

DD: IMHO this was an interesting paper but a bit light-weight on the methodology:

- they provided no additional biochem-based assays beyond their RT-PCRs. Discrepancies in serum VL, as evident from the difference between commercial and in-house tests in the  MacParland paper make  relying on a single source of data suspect and obviously the same limitation applies to their liver-cell tests.  Use of additional tests such as  detection of viral proteins, HCV-specific T cells , etc. would make the results more credible

- they don't report staging for the two bxs they did : was there damage? Enzyme elevation among some family members doesn't mean much.

- their whole argument for infection-by-family member rests on a phylogenetic tree of sequence from the viral core protein (Figure 1). However they provide no reference standard to assess whether the observed clustering is significant (though the shared genotype is suggestive)

"in all families examined so far the sequences isolated from the index patients and his/her relative clustered together, suggesting that in each case the index patient and the corresponding relative were infected by a common source. Furthermore, the analysis showed that all index patients with occult hepatitis C and their relatives were infected withHCV1b genotype, while the index patient with chronic hepatitis C and his relative were infected with HCV genotype 2."

Particularly when reporting something this remarkable I believe more data would have strengthened their case. The devil really does hide in the details. As posted earlier, after reading I don't know how many articles that take HCV PBMC infection as fact, that recent Marukian'08 article
http://www.ncbi.nlm.nih.gov/pubmed/19003912
pretty much convinced me a lot of labs have been misinterpreting adhesion as infection.
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I would like to join the discussion, although I surely don't want to add "gasoline to the fire". I would be the first to be relieved if this occult C debate were clarified once and for all.
As for now we have no definite answer, so I'd like to share my personal story and concerns about HCV and the risk posed to close contacts of an occult carrier.

Briefly, in 2006 I had a gastro-intestinal endoscopy. About 2 months after I noticed strange red dots on my skin, especially on my legs. That was the first sign. After that I had malaise, nausea, diarrhea, light stool, loss of appetite for 2 weeks. Then I started having some RUQ discomfort. I had my LFTs checked - normal range (the lowest I've had them ever since), antibodies to hep a, b, c, hiv. Everything was fine. Most of clinical symptoms improved in a couple of months except light stool (yellow), darker urine, all sorts of red dots and bruises on my limbs and the RUQ discomfort which was slowly becoming more and more painful. While my LTFs doubled they never got out the normal range. I also noticed that my sister who was living with me had an episode of digestive discomfort - nausea and vomiting which got better after a few days.
It's 4 years ever since and I've had an enormous number of blood tests, check-ups, ultrasounds - nothing ever showed up. And yet my strange skin symptoms and my RUQ discomfort are still with me. I've also noticed that a few people who lived with me developed the same strange digestive symptoms and slightly enlarged liver as my sister which they recovered from soon yet could never diagnose.

So all DD is saying strangely resonates with my experience. I've never have been able to prove that there is a viral infection going on as all the doctors I've discussed this with said it's nonsense - hep C is only transmitted through blood contact and means high LFTs, which I never had. Period.
When I read this by DD "Possibly a fluid transfer of the virus (sexual fluids, salivary, etc. ) that might have the potential to develop a 'chronic infection' in other tissues, if not the blood.  Possibly a transmission of the salivary virions, that could cause chronic "Sjrogen's - style" symptoms, as HCV is already known to also cause.  If the virus reproduced in salivary cells, it could also infect the gastric mucosa, causing digestive disorders, as typical HCV is known to often provoke" I recognized what's been going on with me. Perhaps, given that my route of catching the virus was through a digestive endoscopy, my infection site is somewhere on the digestive track. Thus I am also able to pass on the virus through saliva. I am aware that sounds a bit nuts, but not at all improbable.

Anyway, that's my story and I'd like to know what you make of it. I for one would very much want to get at least a definite diagnosis although to be honest I have no idea how. And I would also very much like to make sure that I'm not a "threat" for all the people who get close to me.
EE
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These posts scare the %&3! out of me. I have an ex wife, a 15 year old daughter, two 15 month old twins, and a girlfriend that I am very passionate with and none of them has hepatitis C. On the other hand I have cirrhosis with some of its comorbidities secondary to C and have had it for many years encompassing all of these relationships.                                                                       I have also specialized in the pain management of a Hospice population (Including those dying of end stage liver disease secondary to C) and while this is largely unscientific (I did not test the family members per se but many had communicated being tested over the years) have not heard  of any stories of casual communication. Of course a toothbrush could under certain circumstances be a vector but with common sense and discrimination such transmissions needn't occur. Thankfully all of the people in my life have been grounded and trustful.                                                                                        I already feel like I'm circling the drain half the time.  A fear induced imperviousness to reason is all I need! d
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Listen, I'm very very far from trying to scare anyone... I'm only trying to get some answers that might be not be what we usually expect while keeping a reasonably balanced attitude in light of recent research. I dont' think there's any reason to panick or make drastic lifestyle changes if whatever has worked for any of us over the years is honest and thoughtful towards all the people involved.
A few people here have pointed out that our bodies are not pristine - we carry around a lot of viruses and bacteria that cause more or less harm depending on the host. If your family get periodic check-ups and is doing fine I don't see a point in trying to dig for an occult hep C infection or anything of the sort. Unfortunately that's not my case - I have documented symptoms and a few people around me have had some of the same. That's the only reason I'm trying to get to the bottom of this...

EE
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