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PMBC - Shown not to be viral reservoirs
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PMBC - Shown not to be viral reservoirs

http://natap.org/2008/HCV/030508_01.htm
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114 Comments Post a Comment
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148588_tn?1412862268
I'm not seing in the article where the PBMCs that were tested were obtained. Were they extracted from blood, from the lymph system, or from some other compartmentalized system?
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315094_tn?1201393650
finally some good news...
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Avatar_n_tn
Thanks for the link to this study.  If these results are the real thing, as  supported by using more sensitive testing, as they claimed to have used, then we should be very happy with these findings.  This is a study that goes against the recent trend of claiming to find reservoirs of active low level HCV in aviremic groups (SVR's and spontaneous clearers).

  It looks like they were very rigorous, and double-tested the individuals, using highly sensitive TMA tests.  I will be the first to applaud if this becomes the accepted status for post-tx, persistent virus theory.  That is, that the virus is just NOT there.  BUT, I think we need to also be cautious.  This is one study, that contradicts numerous recent studies that claimed to have FOUND active HCV in the PBMC's.

I am willing to take the 'leap of faith' on this article, and would LOVE for this to be the real thing....but I now want to see more validation of these results, through follow up, larger scale testing.  Also, they surmise some things about LIVER related clearance, and try to connect the dots...but I also think there needs to be definitive studies on biopsied samples from the livers of SVR's ,and long term spontaneous clearers, using these sensitive tests, and even newer, amplified testing.  I would really like to find out what remains in the liver, years after serum clearance.  I really hope the answer is, NO virus replicating.

Here is one quote from the study that raised my eyebrows. Note, this is reproduced from the study:

"Sixty of 67 initially aviremic seropositive donors therefore remained aviremic over an average of 2.5 years, and of the 7 donors that became viremic, only 1 donor had a viral load > 100 RNA copies/mL. These 7 seropositive subjects may reflect low-level plasma viral load fluctuations near the limit of detection or, in the case of the high viral load follow-up sample, possible reinfection with another HCV strain.[31]"

How can we interpret the fact that the 'aviremic' group that they chose, that is those who have ZERO HCV on the PCR testing in serum, had seven individuals who went back and forth from aviremic to viremic during the study?????  Or from non-detectable to detectable, in other words. Only ONE was deemed a reinfection.  He had a higher viremic load.  The other six swung back and forth from undetected, to low level detected!!!   Doesn't this, in and of itself , seem to contradict the whole definition of SVR or Cleared, in our population???  I don't get it, that they threw this little carpet bomb in there, and made so little of it, in the discussion.  What the heck do we make of THAT sort of viral behavior, on lab testing?

Overall, a very uplifting study, very heartening, but with further reinforcement needed, and some clarification of what these low level 'viremic/ aviremic' cases are all about.  These are the little exceptions that raise the red flags for me, and cast question on our accepted notions of SVR!  Don't you agree?

DoubleDose
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Avatar_m_tn
i think what they want to say is, well, there is something like low-level viremia, and yes, if viremia is present in plasma, then it is also present in PBMCs, BUT the PBMCs themselves are not "responsible" for the low level viremia that some people still maintain. And, if somebody gets rid of (high and low level) plasma viremia, then they will stay so almost certainly.

nevertheless, i think studies like this need independent evaluation, simply to rule out clergical error. I also find it strange that they talk about re-infection without telling if that would be consistent with patients history or not. So, they "chicken out" a bit here, which can surely not be appreciated.

`´´´Our results indicate that PBMC are unlikely to serve as a long-lived reservoir of HCV in aviremic subjects´´´´

so, to me the key words in their conclusion are "indicate" and "unlikely", but nevertheless, its encouraging work, that will in the long run, for sure, cement the notion of HCV being curable.

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Avatar_m_tn
Studies like this -- and I believe there have been similar in the past -- are why many liver specialists don't buy into the "occult/persistent" theory, at least not in the sense of clinically viable virus that threatens our health, or the health in others, in any way.

On the other hand, didn't  the studies that found HCV in PBMC's use less conventional more sentive (and more controversial) centrifugal-type tests then appear to being used here which are more conventional TMAs? If so, this could account for the reason why one study finds something and another doesn't?

The other reason given by the authors is that they used sensitive TMA screening to determine who was "cleared" and who wasn't. The implication being that previous studies may have found virus in PBMC's because of less sensitive screening, i.e. they were finding virus in PBMC's of some who were actually had not cleared the virus in plasma had a more sensitive test been use. Not sure if the authors were simply speculating here or if they knew the sensitivity of the screening tests used by previous studies.




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Avatar_n_tn
it's an interesting addition to the topic, but for the reasons below, I don't think it does much to tip the prevailing view that hcv persists in most patients post-SVR. First, I think their results (which by the way were published in Hepatology last December) report a result contrary to one found  (in repeated publications)  by Pham, Radkowski, and Carreno among others. This doesn't invalidate them of course, but makes them the outlier and thus more questionable.  For example, the following German study, also from last year, dected virus in SVR sera using a standard commercial test:

http://www.ncbi.nlm.nih.gov/pubmed/17625963

"An HCV-RNA of less than 12 IU/ml was found in nine of the 50 SVR patients"

(Jim, I believe the ultracentrifugation technique you are referring to is
http://www.ncbi.nlm.nih.gov/pubmed/17475654
but note that they were going after "occult" ie HCV antibody negative patients, presumably ones with a much lower anount of virus than ordinary SVRs since the amount of virus was insufficient to even trigger antibody production)

The second reason is the study only considered PBMCs. This focus may be reasonable given that the authors work for  a blood lab, howver the Carreno, Pham, Radkowski findings suggest liver cells are the most likely source of  post-SVR replication as they were before tx.

The third reason is a technical one. The Pham/Michalak lab has made it clear that mitogen stimulation is an important part of the protocol of low-level VL detection :

"In previous studies, it is reported that ex vivo treatment of lymphocytes from persons who achieved SVR with nonspecific mitogens led to an upregulation of viral replication, allowing detection of the virus in the cells which were apparently nonreactive [5,6]. It became evident that such an approach facilitates a more accurate detection of HCV than by testing sera or naive PBMC. This finding also reaffirmed the notion that lymphotropism is an intrinsic property of HCV."

from http://www.ncbi.nlm.nih.gov/pubmed/17650287

However, the Bernardin study made no use of this, which I think places their result in the category of now-you-see-it-now-you-don't data based on a dated protocol.

The fact that many clinicians are dismissive of post-SVR viremia doesn't contradict any of the results in this area, it merely emphasizes that the health consequences, as far as we know, are mild to none. At this point, post-SVR virus seems a well-established result:

"In the current study, by employing the assays of superior sensitivity [5,6], it was found that more than 80% of the individuals who had been deemed free of HCV by standard detection methods in fact carried small amounts of viral RNA in sera (≤102 vge/mL) and 50% of them were also positive for HCV RNA in naive lymphoid cells at the levels ranging between estimated 5 × 100 to 7 × 103 vge/μg total RNA. Importantly, HCV RNA replicative intermediate was identified in approximately 65% of the lymphoid cell samples positive for the HCV negative strand. Heterogeneity in viral sequences detected in serum and PBMC samples, collected at the same or at two different occasions from the same individuals, provided additional evidence for persistently progressing viral replication in lymphoid cells."

from the same Pham'07 paper.

However, I continue to think these results are much more relevant to relapsers (why was the residual virus able to rebound?) than to SVRs in whom the minimal residual virus  seems to do little damage (and, on the plus side, some SVRs do seem to eventually lose their HCV antibodies..)
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Avatar_m_tn
" prevailing view that hcv persists in most patients post-SVR"

This is hardly the prevailing view. In fact, it is the view of just a few that have not so far, been able to scientifically support their claims.

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Avatar_n_tn
Judging by your comments on Willing's post, you apparently did not read the studies he listed, nor the findings on active HCV in the great majority of recent research papers investigating 'persistent HCV' after SVR.  Just because the mainstream doctors are not yet running around saying that HCV persists after SVR does NOT mean:  A. that this is not the prevailing view,   B. That the overwhelming research evidence does not support this view.  and C. That the mainstream medical community is not 'quietly' aware of these findings, and just not publicizing or acknowledging this information.

You can 'say' that the concept of 'persistent HCV after clearance' is not scientifically supported, but I think that is very hollow, in and of itself.  The research that Willing provided above, alone, is enough scientific proof to support the concept....not to speak of the many other recent research studies finding similar viral behaviors.  

I think you are issuing statements with little or no visible support, scientifically.  The lone research article highlighted, finding no HCV in PBMC's is just one nice example.  There are more than ten that produced hard evidence to the contrary.  How do you discount all of those studies, to then only believe the results of the study that you like?

  Let's search for TRUTH here, not try to trump up a case to support what you want to believe, and shout down everybody who points out contrary evidence.  Just how scientific do you want us to be?  Thirty studies to your one?  And, will you adhere to the same demands?

I sure don't have the answers yet, but I'll bet for darn sure, that you don't either!

DoubleDose
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Avatar_f_tn
DoubleDose:  Let's search for TRUTH here, not try to trump up a case to support what you want to believe, and shout down everybody who points out contrary evidence.  
----------------------------------------------------------------------------------------------------------------------------------

Cough.
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Avatar_m_tn
My guess is that what "Mr. Liver" meant by "prevailing view" is the view expressed by many leading hepatologists (including those I've consulted) who have no doubt looked at the same data you and Willing have presented, but came to different conclusions. That doesn't mean that they are right and you are wrong, but "Willing's" original statement potentially left the impression that the  majority of the professional Hep C community agreed, and this is far from the case as Mr. Liver stated. If you want to question their judgment, that's another issue, but again, the point debated was "prevailing" view.

-- Jim
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Avatar_n_tn
I understand what you are saying, but the question does, as you say, boil down to 'prevailing view', and more specifically, who's prevailing view/  That of doctors who are not generally doing intensive, laboratory research on the virus and its behaviors in the body, and often times even if they do review the research, may not have the background or tools to validate or dispute what they have just read...or, is 'prevailing view' the findings presented by the overall research community?  I guess it ends up being what definition you choose to use, in defining what 'prevailing view' really means.  

Trish....  If I am 'trumping up a case' myself  (cough), please call me on it!  I am trying to merely point out the position that most, or at least MANY researchers have taken in the past five years or so, regarding the existence of HCV after SVR in certain cells, or organs.  If I am mis-stating, please do criticize my statements, point out whatever is fallacious, and I will be happy to correct my comments or position.

I am really not trying to be heavy-handed, but I just get the feeling that some of our members ofter jump on any information that supports 'total eradication', even when contradictory studies are clearly in the majority.  I would personally LOVE for their ideas to be true.  But I have a hard time dismissing a basket full of thorough research studies that seem to document, scientifically, the existence of low level viremia, after SVR.  I get the feeling that some of us just do not want that to be a possibility, and hence, go into total denial over studies that support 'persistent virus'.    Those studies are always 'wrong', or not supported by hepatologists..(why not????), or are just plain 'questionable, when there is no other reason to dispute them...etc.  

I will believe either side, just show me the money!  Where are an equal number of highly precise and thorough studies that find NO evidence of this 'persistent virus' after SVR?  If they are available, I would really LOVE to know that.  Because I am worrying about this issue all for nothing, in that case.  I just can't seem to find all of THAT research.  

Hey, I know that I can sometimes beat the drum hard, and go overboard on a theme, but I see a similar, knee-jerk reactionary behavior in others on the forum whenever uncomfortable issues come up.  Usually these controversial issues are dismissed quickly without much evidence, and with statements like..nobody really believes that , or its not generally accepted.  DUH!!!  I realize that!  That's why much of this is still controversial.  Few people are studying it, and fewer still want to believe it!  For VARIOUS reasons.

I respect all of your opinions.  But let's also look closely and critically at ALL of the research...please.

DoubleDose
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Avatar_m_tn

  "Few people are studying it, and fewer still want to believe it!"

Is this your definition of a prevailing view ?
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Avatar_n_tn
face it folks-we are screwed!..and didn't even get a kiss.
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Avatar_n_tn
making claims about any "prevailing view" is indeed highly questioniable;  it depends on who you ask, what you ask them, etc. etc. However the statement that researchers reporting  post-SVR virus have not been able to "scientifically support their claims" is patently false.

Here's a sampling of excerpts from recent peer-reviewed publications:

1) "In conclusion, our results suggest that in patients with SVR after therapy, small quantities of HCV RNA may persist in liver or macrophages and lymphocytes for up to 9 years. This continuous viral presence could result in persistence of humoral and cellular immunity for many years after therapy and could present a potential risk for infection reactivation."

Persistence of hepatitis C virus in patients successfully treated for chronic hepatitis C.
Hepatology. 2005 Jan;41(1):106-14.
PMID: 15619235

2) "In conclusion, occult HCV infection must now be accepted as much an entity as occult HBV infection, and we should no longer loosely refer to prolonged SVR as a cure (Hepatology 2005;41:23–25), especially because this term is still being used today (Ann Intern Med 2005;142:105–114, Hepatology 2005;41:275–279). As clinicians, we may need to revise our clinical attitude to the outcome of SVR following successful treatment of HCV with more careful follow up, and we must be aware of the possibility of occult HCV infection in patients with liver disease of unknown cause."

Occult viral hepatitis: What is the significance?
Gastroenterology
Volume 128, Issue 7, June 2005, Pages 2168-2170

3) "The samples obtained from 16 randomly selected patients (5 with spontaneous and 11 with treatment-induced resolution), monitored for up to 5 years,...importantly, traces of the HCV RNA negative strand, suggesting progressing virus replication, were detected in the majority of mitogen-stimulated PBMC, including four samples collected 5 years after recovery."
(note again the use of mitogen stimulation of PBMCs)

Hepatitis C virus persistence after spontaneous or treatment-induced resolution of hepatitis C.
J Virol. 2004 Jun;78(11):5867-74.
PMID: 15140984

4) "Genomic HCV RNA was detected in liver biopsy specimens obtained from 10 (83%) of 12 patients, and the antigenomic strand was detected in 10 (100%) of 10 liver biopsy specimens in which genomic HCV RNA was detected....CONCLUSION: HCV may persist and replicate in the liver and PBMCs of healthy, anti-HCV antibody-positive, serum HCV RNA-negative patients who have persistently normal ALT levels. These patients should be followed up, because they have an ongoing viral infection."

Detection of hepatitis C virus (HCV) RNA in the liver of healthy, anti-HCV antibody-positive, serum HCV RNA-negative patients with normal alanine aminotransferase levels.
J Infect Dis. 2006 Jul 1;194(1):53-60. Epub 2006 May 16.
PMID: 16741882

5) "We conclude that the absence of HCV in the serum of patients with chronic hepatitis C by the end of treatment does not mean that there is no circulating virus. HCV in mononuclear cells may be an indicator of the persisting infection."

Detection of HCV by PCR in serum and PBMC of patients with hepatitis C after treatment.
Braz J Infect Dis. 2007 Oct;11(5):471-4.
PMID: 17962872

6) "An HCV-RNA of less than 12 IU/ml was found in nine of the 50 SVR patients. Two patients had a viral load of 34 IU/ml and 84 IU/ml, respectively, one of those showed persistently elevated ALT levels over a period of 5 years after the end of antiviral treatment."

Frequency of very low HCV viremia detected by a highly sensitive HCV-RNA assay.
J Clin Virol. 2007 Aug;39(4):308-11. Epub 2007 Jul 12.
PMID: 17625963

7) "The results showed that treatment of peripheral lymphoid cells with mitogens stimulating T- and B-cell proliferation and with cytokines supporting their growth significantly increased HCV RNA detection in patients with both CHC and SVR."

Mitogen-induced upregulation of hepatitis C virus expression in human lymphoid cells.
J Gen Virol. 2005 Mar;86(Pt 3):657-66.
PMID: 15722526

8) "We studied the presence of both positive- and negative-strand HCV RNA in the livers of 20 sustained responders with chronic hepatitis C whose response persisted for a mean (+/- standard deviation [SD]) of 47.4+/-32.8 months after treatment....CONCLUSIONS: HCV persisted and replicated in the livers and peripheral blood mononuclear cells of most sustained responders. Thus, these patients did not experience HCV infection clearance, despite apparent clinical disease resolution."

Hepatitis C virus replicates in the liver of patients who have a sustained response to antiviral treatment.
Clin Infect Dis. 2006 Nov 15;43(10):1277-83. Epub 2006 Oct 5.
PMID: 17051492

that's not an exhaustive list, but I'm getting exhausted. I've been following this topic fairly closely since the original reports in '04 and as best I can tell, absence of supporting data is  a charge that can be fairly leveled at those arguing for post-SVR virus eradication. All of the studies above, except (2) which is an editorial, base their findings on original data.

If anyone can find an equivalent list in support of "complete eradication", and I mean PUBMED-cited,  peer-reviewed, publications, not editorial opinion-pieces or "my dr told me X" anectodes, please post it!

It's interesting that that recent JAMA HCV overview by Scott and Gretch,
http://jama.ama-assn.org/cgi/content/full/297/7/724?ck=nck
in their discussion of occult/persistent HCV only came up with 1 reference, and that one dating back to '97, in support of the "eradication" view.

Finally, note that even the Bernardin study that started this thread, acknowledges they hadn't quite done all their homework :

"Increased levels of cell-associated HCV RNA have also been reported following nonspecific in vitro stimulation and culture of PBMC.[20][21][36] The PBMC tested here were purified directly from blood without external stimulation. It therefore remains formally possible that nonspecific PBMC stimulation could have increased residual PBMC-associated HCV RNA to detectable levels."

so, if this is "formally possible", why didn't they check?

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Avatar_m_tn
Thanks. Mike
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Avatar_n_tn
Thanks for your, as always, precise and detailed response.  You brought into sharp focus what I was trying to say in my last post above.  

DoubleDose
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Avatar_m_tn
Arguments not withstanding, I think what you're saying is that this *should* be the prevailing view, not that it is  the prevailing view. And that's all Mr. Liver was bringing to your attention, as I read it. Say what you want about "my doctor told me so", but if the majority of top docs are telling people that it's not like that, then it's not the prevailing view as I see it. Maybe it should be or will be in your opinion, but it's not. And not sure how much more we can slice and dice that point.
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Avatar_m_tn
What? Could you clarify that please? Mike
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Avatar_m_tn
http://tinyurl.com/2zzc7u
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Avatar_n_tn
I find your comments very interesting.  Its like looking at the statistics for the economy, and having the technical experts determine that we are in the early stages of recession, and then turning on CNBC and hearing the moderators and hosts scream that "We are NOT IN RECESSION, the Chicken Littles are screaming that the sky is falling!!!"   etc, etc.  Jim Cramer and the Mad Money crowd are waving the flag!!!

Now I guess we could accept the CNBC point of view, that they don't THINK we really are in recession, and the heck with what all those gloomy numbers say, and on and on...so just keep buying those stocks, and keep a smile on your face...etc.  And I guess, if you buy into that way of reasoning then the CNBC guys ARE the prevailing view.
Who cares what the analysts say, who cares what the statistics say, who really cares what the truth is???  The CNBC crew said it, so we must go with their point of view.  

So if that is analogous to how you want to determine 'prevailing view' then you are right on the money, and I can't argue with you.  I prefer to listen to the subject matter experts, and look at the hard facts.  But yes, you are probably right, prevailing view has not caught up with the facts yet, and for the media world, cure still has a capital "C"!

DoubleDose
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Avatar_m_tn
I wish you had told me this before I bought some stocks earlier. So Jim Cramer is not the prevailing point of view then :)

-- Jim
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Avatar_f_tn
It's like this, to me, in simplistic terms.  At one time, the prevailing view is that the world was flat.  They were dead wrong, however, they were absolutely convinced.  Then.. as more evidence came into being, irrefutable evidence, that prevailing view changed.

At one time, what SOC was considered to be .. whatever it was...certainly not what it is now...was the prevailing view.  That has changed.

Your viewpoint, DD, may indeed be correct.  I'm open to that, interested and want to read up more and you DO spur me to do research on things.  However.  I would say, at this point in time, that it is not the PREVAILING view.  No matter how much you think it should be, want it to be and believe it to be.  It simply isn't.  It may get to that .. but it isn't.

The first thing I thought when I read Willing's comments were... "prevailing view? I don't think so...." and then Mr. Liver posted the same thought I was having.  

So...perhaps we agree to disagree.  You think it's the prevailing view.  Some of us don't.  Does it really matter?  What happens here is that an opinion is stated, people agree or disagree with that opinion...and life goes on.  I have no idea why it upset you so much to have Mr. Liver make such a very simple statement indicating he doesn't think this is the prevailing view.  It certainly evoked a very strong reaction from you.  (I know how that happens.. I backed off posting for awhile because I was getting alarmed at the timbre of my posts...)

What REALLY matters... as you've said yourself... is what the truth of the matter is.  So ... let's keep posting articles and debating the finer points of them and allow all of us to have differing points of view and debate them back and forth but not take it personally when we all want the same thing, hopefully.  The truth.

And...expect me to challenge you when you call something truth and I don't see it that way and I'll explain why.  I don't think you'd want it any other way .. would you? :)

Trish
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Avatar_f_tn
Interesting thread.

My brain is to tired to engage, most of you know where I stand on this. Because I know it to be true.

Deb
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Avatar_n_tn
I couldn't agree with you more.  Let's find the truth, and everything else will just follow along.  That is what I am trying to aim for, and I want to stimulate conversation on new findings that may often contradict 'accepted' views.  If we just stay with what's comfortable or accepted, we will never learn anything new.

I think Willing's list of rigorous research papers are indeed a great starting point for conversation, and to generate  more research (to either finally confirm all these findings, or to refute them with even more rigorous testing , which the initial study in the thread did NOT do) and to gain a better understanding of what MIGHT be going on with this virus beyond current medical practice knowledge.

I just want to stimulate people to think, question, and have the courage to look for real, honest, answers...not just comforting, shallow maxims.  I am sure that some of my more far-reaching conjectures, and theories probably tick some people off, or really threaten some others, but you know what?  If I don't pose some of these 'possibilities' someone else will.  And if there is some truth to any of my theories, then eventually that will come to the surface anyway...no matter whether people like the news or not.
Science will eventually find the answers, for sure.

But, I will say, I do not often 'call something the truth', but usually try to preface my comments and conjectures with 'my opinion, my thoughts, my speculation, etc."
As you have probably seen, theorizing with one's opinion on the forum, or asking scary questions, often provokes a furious response here.  I have no real problems with that, and I have a pretty thick skin.  I don't recklessly make comments, but put forward my theories based on something rational, or concrete that I see or have noticed.  Doesn't mean that I am right, but I will absolutely continue to ask painful questions, and look for explanations that go deeper than today's understandings.

But again, I agree with you, let's do keep debating the finer points, and searching for the truth.  That should be the main goal of all of us on the forum.  And 'debating' is a good watchword.  NOT just saying 'no one believes that, my doctors don't buy that stuff, its not what everyone else thinks, etc.  This is not debate, but just following the lemmings.
Let's look for facts, research, and data.  We need lots more than we have.

DoubleDose
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Avatar_m_tn
DD:NOT just saying 'no one believes that, my doctors don't buy that stuff, its not what everyone else thinks, etc.  
-------------------------------------------------------
C'mon. It's not like you haven't been challenged on the "facts", as per previous discussions on "reactivation" where the studies you yourself posted don't necesarily lead to your theories. As to members reporting what their doctors are saying, it would be responsible if they did not. ALL imput is important, including input from top hepatologists whom you seem to dismiss a little too easily, as if they are lemmings and you have some greater knowledge. My liver consultants are not TV docs like in your Jim Cramer analogy. I don't mind you posting your articles and theories for debate. Why do you take such offense and characterize those that post the opinions of top docs who also have read the same articles. People interested will read the entire threads and I'm sure will take everything into consideration.

-- Jim
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Avatar_m_tn
Willing asked: "If anyone can find an equivalent list in support of "complete eradication", and I mean PUBMED-cited,  peer-reviewed, publications, not editorial opinion-pieces or "my dr told me X" anectodes, please post it!"

Jim replied: "My liver consultants are not TV docs like in your Jim Cramer analogy."

So when it comes to a "list in support of complete eradication" we have the article which was the subject of this thread along with the extremely articulate, persuasive and very well vetted Jim"s "liver consultants".  
Can there be any doubt about what the truth is in the face of such conclusive evidence? Well.......maybe so!

Mike
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Avatar_n_tn
Thanks!  You beat me to the reply!

DD
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Avatar_n_tn
And, please take note, I am not trying to say that "I" have any greater knowledge than leading doctors, hepatologists, etc. as you stated, but that maybe, just maybe, a basket full of well run, reputable, very sophisticated research studies, all published by highly regarded organizations, might just carry some weight in forming a scientific opinion on the subject of 'persistent virus'.  Maybe!

When you can't come up with more objective proof for dismissing these studies than saying that some docs who have read them don't agree with them, then I just can't put much validity around their point of view.  I want to see WHY they believe none of these studies are valid, and I also want to see THEIR studies showing a different result.  Not just their opinions.  Opinion is just that: opinion.  Not fact.

Now, you are right, I do have lots of opinions myself, but that's how I characterize them...as my opinions.  That is quite a bit different than laboratory research with tons of data, and state of art technologies employed to elicit a concrete result.

And, of course you have a right to your opinions just as well.  But remember that opinions are opinions, and we were talking about facts and studies above.  Two different things.

DoubleDose
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Avatar_m_tn
Maybe you can point me where I've stated I believe in what you term "complete eradication". Your quote is out of context. What I've stated is part is that many of the studies themselves don't claim clinical significance, which is actually close to what "Willing" himself recently stated stating, at least in regard to SVRs. The diaglogue between DD and myself regarding viral "reactivation" has nothing to do with "complete eradication" but with DD's hypothesis that alcohol, for example, can trigger HCV in someone with something akin to "occult" HCV where the individual is both antibody and serum negative. My comment here re my doc's opinion was directed toward the idea of "prevailing" point of view, which DD seems to acknowledge above, is not prevailing throughout the HCV community. I believe you've given your doc's opinion before on other topics, or am I missing something?
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148588_tn?1412862268
Not going to argue semantics about 'prevailing view' or 'majority opinion' -  enough studies have been done on SVRs and those who cleared on their own and have come back with the same resuts. 85-90% of those who have become undetected in their bloodstreams still show recognizable + and - strand HCV RNA in their spinal fluid, lymph nodes, livers, etc. It's a matter of practical indifference to me, since I'm not about to get a spinal biopsy just to find out if I'm part of the lucky 10-15% who are totally undetectable everywhere in their body.
Serum undetectable works for me.

What interests me is if there has been a study that has found complete HCV RNA in a compartmentalized system. That means over 9,000 nucleotides all in their proper order - not just frags. If all they're finding is fragments, apparently that's enough of a cure for most of us. My late virus's distantly related great grand nephew is welcome to share this body with me.
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Perhaps it would be a bit more even-handed to say .. "if anyone else who has been researching this closely since '04 can post an equivalent list ... ".  Like...come on.  Take the global warming debate for example.  Scientists on both sides of the fence.  All authoritative and considered experts in their field.  So...who's right?  Yes. You have the edge here.  You can cite more studies than anyone else.  I'd like to keep reading before I bow to the one who can post more studies because they've devoted more time than anyone else to the subject.  

There are plenty of thinktanks and researchers out there.  The first thing that any thinking person needs to consider is.. what is the particular bias of the organization putting out the data.  Who commanded the study?  

So....I would like to continue with independent thought here and not engage in a "my study list is bigger than yours" kind of debate.

If it was all about the number of studies one could cite .. then we might as well all just shut up and close off debate.  The one who posts the most studies wins.  

It's not enough for me that someone with a particular viewpoint posts a bunch of studies that support their viewpoint.  Yes, I would like to see other studies posted as well by those who don't share the viewpoint of Willing, DoubleDose, et al.  However.  I don't make up my mind by counting who posts the most studies.

It's like the "my dad is bigger than your dad" thing.  Just because your dad is bigger...doesn't mean he can fight better.  It just makes it LOOK that way.





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desrt:  What interests me is if there has been a study that has found complete HCV RNA in a compartmentalized system. That means over 9,000 nucleotides all in their proper order - not just frags. If all they're finding is fragments, apparently that's enough of a cure for most of us. My late virus's distantly related great grand nephew is welcome to share this body with me.
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To me, that is currently the crux of the matter.  What I want....is studies that show that the same HCV RNA that exists in our blood, that tx is meant to eradicate, exist and replicate in these bodily fluids and cause chronic HCV.  OR....that these fragments, mutants, strains... of a type of HCV in these bodily fluids and pockets such as the brain... are capable of replicating and causing the same chronic condition that the HCV RNA in our blood does.

I accept that these fragments exist.  What I don't accept, until definitive proof otherwise...is that these fragments mean that there is no such thing as SVR.  

What DOES it mean?  If it means that they are breakaways from the HCV RNA that used to exist in my blood and they are evidence that chronic HCV was once my condition...that is possible and I can live with that.  For example ... despite the fact that I'm a runner .. I haven't been at it long enough to eradicate the ravages of the years of NOT being a runner.  My love handles and choice of abdominal injection sites for tx are the fallout from that.  Perhaps....the HCV mutant strains in my bodily fluids are the same sort of thing.  Evidence that I had chronic HCV.  Not that I still HAVE chronic HCV.   (Well..once I get to SVR.  )

Still reading... still contemplating.....still drawing conclusions until I read something that poses irrefutable proof of ....whatever it ends up proving.
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I really do not think that the studies that are being cited are being done by groups or by researchers who have a particular "leaning" or bias toward any particular outcome.  It just happens that the studies cited by Willing, myself, Mike, TnHep, and others etc. are basically THE current, existing group of studies on the subject.  They were all done by different, and very reputable researchers, and I think their goal was to find out what the status of HCV is after SVR.

If there were other studies, other than the sole study at the top of the thread, which gave evidence on NO HCV remaining after SVR, I think you could be sure those studies would be cited, linked, and put forth by jmjm, Mr. Liver, and others, myself included.  Hey, I would LOVE to have MORE of the studies showing a negative HCV result!  But, all I seem to find is study after study, after study, confirming the same news....that there seems to be evidence of replicating HCV in various places after SVR.

I do not think that a few of us are 'biased' on the subject, nor are the various researchers 'biased' on the findings.  They are scientists, conducting studies and reporting the findings.  I do not know why their findings seem to generate so much anxiety, denial, and accusations, as if they were a bunch of politicians trying to use 'global warming' as a platform to get votes, as you liken them to.  I don't buy that analogy one bit.  

All I want to see is some, any, just a few, real and thorough studies showing an absence of HCV replicating in the body after SVR.  
I am not asking for the world, just a little proof.  Even a tiny bit.  Not just people trying to negate all the research by saying that the researchers are 'biased'.  WHY?  How do you know?  What on earth would be the motivation there?  Wouldn't you think that if their findings were NOT valid, that the drug companies would have sponsored many research studies to prove them wrong, and show the opposite, by now?  Or that some medical research group, hospital research center, or private group would be finding evidence to the contrary, at some point?  How much proof WILL you need in order to accept the findings of the many and different research studies?

I am still open minded on this, but at the moment I have to say the evidence swings very far to the position that HCV, replicating HCV, exists long after SVR.  I am looking for something to latch onto to demonstrate otherwise.

We are not politicians here on the forum, but we just are trying to study the latest information to understand what is and what is not true about the virus.  None of us are trying to make anyone think or believe in anything that they don't wish to believe.  I don't want to coerce anyone to my point of view.  But I will express my point of view freely.  

DoubleDose
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PS.    I also think that the fact that we appear to have replicating HCV at low levels after SVR does NOT mean that there is no such thing as SVR, as you seem to fear.  SVR exists now, and will continue to exist, even WITH the understanding that there is a small replicating HCV load being held in-check by the immune system.  The same term will continue to be used, "SVR", because it means SUSTAINED viral response.  Having low level, persistent virus does not negate the SVR, because in almost all cases, the remaining virus will never overcome the immune system barriers, and thus will not emerge again as a chronic, active,high viral load blood/liver infection.   Now, on the other hand, we may have to say that using the terms Total Eradication, or Total Cure are no longer appropriate.  Maybe the term "a working cure", or just a 'cure' with asterisk, or with the understanding that the virus is not completely GONE from the body.  It has just been rendered 'inactive' on a permanent (we hope) basis.

DD
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You've completely misinterpreted my post.  I don't have any issues with the studies you've posted, or anyone else for that matter.  We're all able to see where the source is and read them for ourselves and come to conclusions.  What I take exception to is the suggestion that the number of studies posted merits more points given to the position taken by the poster. It simply supports the position of the poster better..but that doesn't make the poster's position accurate.  It just indicates an absence of data being posted .. not that there is an absence of data. That is why I said it would be more even-handed to say "if anyone else who has been researching this closely since '04 can post an equivalent list ... "  That's apples and apples.  
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I grow weary of this. I have nothing further to add here... not that I had anything of value to add in the first place, that is.  When I have time.. I'm very interested to read the articles that have been posted in this thread and to seek out more on this subject.  At least these debates stir my curiosity and prod my thought processes in different directions.
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PS.    I also think that the fact that we appear to have replicating HCV at low levels after SVR does NOT mean that there is no such thing as SVR, as you seem to fear.
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Sigh. I do not FEAR this.  I do not accept this.  Big difference.  Twist, twist, twist.
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Sigh...I take that "twist" comment back as unfair and I apologize.  You DID say "as you seem to fear" not  do fear, obviously fear, or anything quite as definitive.   The rest of the comment stands.  I wanted to be done with this but I couldn't let that comment go.
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   Research and studies... everyone is doing them that gets a grant from a drug company and is asked to prove ours is best and more studies will follow( money)if you favor this.
   So... many people saying this and that and proving this and that. I got reading a study by a well known university that wrote one of thousands  that conclude  Urine drinking is the cure all, the panecea of all that is disease! the life extender, the fountain of youth!!!
   But the urine must be collected at 3 am no earlier or later and mid stream flow only please.It is said to be full of bacteria, fungi and underwear fluff in the first part of the stream, and the last part usaully will contain noxious gases. All that is excreted is actually important to the bodies well being. You must only drink your own following the above standardized method and consumed before it cools, similar to the mornings tea or coffee.
  Now this must be true because how many like a cool cup of tea or joe first thing.

  Anyway they say it is full of vitamines and minerals that have all ready been metabolized so this is excellent for the weekened liver.No strain all gain.
  But they note that a slight complication occurs with 87% that have taken part in the 50 million particapant study that began 3000 thousand years ago in India, the problem is a FOUL smell to there breath and yellow stained teeth. And due to Government over throughs every decade or so  the particapants can't verify their said three hundred plus  ages.
  On conclusion the participants look 300 plus.  Gandi is said to be one of the advocates of urine drinking and practices it often.

  Google urine therapy studies, and be shocked why haven't the states adopted this practice yet?


Harry
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great discourse.....

but 60 out of 67 is the hand they hold,...not exactly a royal flush.

so bottom line, I'd like to click my ruby heels together 3 times and go back to Kansas but for now

I'll just have to call, and raise you....take credit cards???
...better yet, take my organ donor card......no D   goes back on the plastic any time soon here.

It's not so much the possibility of always carrying a remnant, or of not being a donor that's the real issue in my mind as much as just getting something more definitive answers about whether we are spreading it even by saliva and after HR's last discourse there......eek.

well SSMMMMMMAAAACCCKKKKKK  there's a big wet one for ya Beamish.....at least I won't be puttin' the hurt on you..!!.  : )))))))))))))))))))))))))))))))))))
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can someone please explain what is the study sayin in very simple laymans terms so when i go see my hep doc wed. he can answer the question that is sited here?
i asked the nurse pract. the very same question the other day and she could not give me an answer so she will have my doc there for my 3 mth post vl results

thanks
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Ask your doc if the fact you can still find recognizable bits of the virus in places like your spinal fluid and lymph nodes after your cured is meaningful.
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thanks.  i will try to let you know what he says.
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I do not think that a few of us are 'biased' on the subject, nor are the various researchers 'biased' on the findings.  They are scientists, conducting studies and reporting the findings.  I do not know why their findings seem to generate so much anxiety, denial, and accusations, as if they were a bunch of politicians trying to use 'global warming' as a platform to get votes, as you liken them to.  I don't buy that analogy one bit.  
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Are you kidding me that you're not biased?  Everybody has a bias and yours is blatantly obvious.  When you post, it's usually not a surprise what position you're taking.  And that's okay.  You've got a reason for your bias.  But you DO have a bias.  Most of us do in one way or another and as much as I try to stay objective, my own views are coloured by my experiences, perspectives and individuality.

I NEVER...not ONCE...likened the persons doing these studies to politicians trying to get votes in the global warming debate.  Holy stretch it out of context, Batman!!  What I was SAYING is that there are very credible scientists involved in the global warming debate who have the same data available to them and yet they take very different positions.  Man.....where do you get Al Gore out of that??  All those scientists have the same data available to them.. yet they interpret it very differently.  Who is right?  Who is wrong?  So.....even though someone can post alot of studies...it doesn't make one an authority nor correct... nor NOT an authority nor incorrect.  It is simply data and the many people reading it are still free to study for themselves and draw their OWN conclusions.
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to err is human, to Bias is divine....; ))))))))))))))))))))))))))))

but seriously, don't you think it is naturally an emotional issue.

my son for instance, has had 2 pos. and 2 maybe neg. PCRs
I can see how, and especially for the young/unmarried/hopeful to not be eternally alone that this would be a very big issue and one bound to elicit a lot of hope and our all too human biases.

Maybe the whole question ought to be pondered differently.
Example: we still carry chicken pox virus our whole life, if we ever had it, and yet as of yet no one is worrying (or maybe they are and I am unaware) about whether a child given a transfusion will contract that virus from donated blood.    And why not??

Maybe the bigger picture is what viruses can't be passes, maybe they all can be, and that's why we are all thankful we have an immune system...to deal with stuff as it presents.
I know I don't lse any sleep about when chicken pox will come back and get me...
so my point is....until more is nown, maybe SVR should be a chance for us to at least own or buy into a little bit of peaceful gratitude.

In the end, there are not going to be any definitive answers any time soon. It's like, how do we know that almost every cancer doesn't have a viral or bacterial trigger???  We don't know....and maybe we will know far better in another 30 years, but all this research takes a long time to sort out.  

Meanwhile, I guess we all just need to let our concious be our guide, as well as research, as to how "careful" we need  to be for our own sakes and that of others.

For me, and this will sound phobic, but HCV has super heightened my own awareness of bodily fluids points of contact, and also made me redouble my efforts in public areas, not only because of the small risk I may pose, but much more because I believe that carriers of HAV and HBV may be less aware of their disease and it's potential to spread.  
But, for the sake of all the young and lonely hearted.....or haters of Damacles sword, as the case may be, here's hoping the good news will one day prove to be the truest!
maryB
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desrt: I'm not really clear on the difficulties involved in sequencing the whole 9600 nucleotides - but they must be considerable because there doesn't seem to be much full-length sequence data out there (though genbank does have some full-length depositions). Part of the problem is the virus is so variable : once you get past the conserved 5' utr used for our vl tests you're not talking about amplifying one sequence but a family of quite different ones. Anyway, re the full-length vs truncated question, the following, (written by the same guys strangely enough) is on point:
http://www.ncbi.nlm.nih.gov/pubmed/17493654
Looks like as long as  a few full-length virions remain in an infected  cell, it can happily turn out large quantities of severely truncated variants (reminiscent of "swarm intelligence" ?) .  Also, as far as spinal fluid, looks like we're OK:
http://www.ncbi.nlm.nih.gov/pubmed/17935188

Trish : the point of listing those studies was simply to refute the claim that post-svr viral persistence  is a view held by  "a few that have not so far, been able to scientifically support their claims. ". One of the things I love about science is that it requires so little faith - show me convincing new data and I'll change my mind pretty quickly!
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http://www.natap.org/2002/AASLD/day15.htm

The pubmed article you quoted re: spinal fluid speaks of a negative finding in the disc of a single patient, whereas the link posted here shows fairly compelling evidence going back 6 years that spinal fluid is a reservoir for HCV RNA.
The other article is interesting but seems to refer mainly to the HIV co-infected and how absence of immune pressure can create truncated HCV RNA. Interesting stuff.
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I appreciate your comments above, and I do think that you hit the nail right on the head.  The emotional issues associated with comprehending and accepting the research that has been bombarding us about HCV persistence after SVR are extremely powerful.  In my gut I believe that this is the major reason that we have such an outpouring of refutation whenever this subject comes up.  Often the claims of denial are far out of proportion to the evidence presented that 'persistent virus' might not be real, and out of synch with the many objective, scientific studies supporting persistence that are listed for review.

I agree, that probably many people are very shaken by this possibility, and like all of us, would prefer to believe the more palatable possibility, and refute the more ominous one.  I am probably in a smaller minority, because even though I hate the prospect of this stuff being true, I still think we must face it directly, and push hard for more continued, and rigorous studies to really and finally provide firm answers, and explain the long term consequences.  

This is the only way that we can move forward on the medical front, and understand what else might be happening in our bodies as a result of this persistent infection.  We can either ignore it, and pretend that it is all just 'bad research' , or inaccurate findings, thus lulling ourselves into a false sense of security, OR we can confront the issue, demand further research, and try to find out what the ramifications are.

But, I really DO understand the emotional thinking that attaches to this subject, and I have no negative feelings toward anyone who just does not want to deal with this subject.  It certainly is scary and threatening!

Willing / desrt:    The article you linked on CerebroSpinal fluid infection, and all the issues raised about differing variants in serum and CSF, and even different GENOTYPES!!!  make you raise your eyebrows and think...YIKES!  This stuff can do some really frightening things, and we have so little deep understanding at this point as to what it might mean!  The CNS infectivity to me is a theme that deserves tremendous research, and discussion in the medical community.  Maybe the liver issues are more dangerous in an immediate sense, but the possibility of this other form of infection might be a long, draining, and life sapping issue as well.  And might it also relate to the higher incidence of Cerebral Hemorrhage in many with long term HCV?  Anita Roddick is a good recent example.

Everyone:   This thread seemed to open up a pretty powerful, and disturbing set of conversations about the HCV infection and therapy.  I hope that we can all continue to agreeably discuss and debate these kinds of issues, and help each other broaden our scope of understanding, and also to push the HCV viral research and HCV medical community to find more clear and definite answers to these 'gray' areas!

DoubleDose
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I concur with DD 100%  

it is emotional and people do not want to hear  the negative, that it COULD happen.

I know it has happened, I would be more than willing to be a part of study to find out why.

Till research is done and done accurately looking at all    factors,  without emotion, scientifically and unbiasedly.  

This is going to be a touchy subject, but for someone like me, a VERY IMPORTANT one.

I appreciate so much the knowledge of Willing and his accurate  keeping the facts straight, Mike Simon,  you DD Guys with teeth who get what they are chewing.

Deb
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who us??????  afraid of a wittle gray area. or two.....you must be thinking of some other forum wascally wabbit!!

let the games begin!!

I've got 13 big blobs, they can't say infection or what, in the grey matter now, and we haven't even touched on HR's saliva info.....next it'll be in my ear wax (rolleyes).

maybe we should have a special section for research discussions, with a skull and cross bones to warn away the faint of heart.  : ))))))))))))))))))

these are informative and needful threads that need to continue, but I am concerned as to the degrees of discouragement that it could create in newbies.

anyone want to vote on whether to ask for a "Hep Research Only thread where the nerds can play and the timid may go or stay???
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maybe we should have a special section for research discussions, with a skull and cross bones to warn away the faint of heart. LOL! and I'm sure they would allow a picture.

Hey! here is an idea? Why not use the “NEW” Health Page and put it under “Research”!

All, very interesting discussion and any thing is possible. I for one believe there floaters in our system per the discussion with hr and still think that lipids are the preservatives of the virus itself and or the cleaved fragments, but this is just me with no back up to prove or disapprove of my assumptions but maybe if I had and extra billion I would be able to shed more light on the assumption.

jasper
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to lipid or not to lip it.....that is the question....
that's always going to be a dilemna in my mind....she says as she downs another PPC...  

yes to research section....I've been thinking about starting it..
but I really hope JIM     JMJM

JMJM        has the entire HR files I think...he'd be a good one to add them.

no reason others shouldn't as well...but I think we need to shorten the titles of research papers maybe...

I've been thinking of starting a page on depression.....

maybe Whose and doubledose etc have things in the works...it would be great to get a current fact pages in here up and running...now that it's finally available...
(that was my suggestion by the way...so I should shut up now and go contribute)

good t see you Jasper, how goes the dog walks?????
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these are informative and needful threads that need to continue, but I am concerned as to the degrees of discouragement that it could create in newbies.
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Funny you mention that, MerryBe.  I was thinking that today ... that there are people here just finding out that they have HCV and others just starting treatment and various stages.  So I wonder what it's like for them to read things that may leave the impression that they'll NEVER get rid of this thing if it's not put into proper context.  

I'm frustrated with the ongoing insinuation that any objection to comments is based on "fear".  It's more with the lack of context and clarity that goes along with the research.  There just isn't enough information to back up some of the assumptions being posted and to me, that is reckless.  That's just how I see it.   I'm tired of my words being twisted out of context and emotions read into them that don't exist.

And.. MerryBe.. I concede to your earlier comment.  This discussion is naturally an emotional issue or certainly can easily become that way.  One little comment one way or another and we're off on a wild emotional tangent again.  And so it goes.

Anyway.  I don't think we need to shut ourselves away and discuss in private.  Don't know what the answer is.. perhaps an uncomfortable debate at times is something we need to deal with .. certainly I don't want censorship of what topics get discussed.  One of the things I value here is that people are free to ask whatever they feel they need to.  And sometimes it's great entertainment value.  :)  

Thanks for your post. :)

Trish


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I’m sure when a consensus is reached it will be the way to go but not out of fear but to narrow the scope of the topics being discussed in its richest context but not to isolate per say because anyone can excess it by clicking on the Health Page as one would do on the two forums. To lip or not to lip, lol. Dog walks are getting longer, got to hold myself back some times, hehehe. Hope all is well with you as well.

Take care!

jasper
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Free and open rational discussion is the name of the game.  I think we are all adult enough to digest information and make prudent personal decisions.  Newbies have always had to deal with the current issues, information. and statistics.  Not too long ago they were facing about a 20% SVR rate if they were a GT 1.  Today their odds are much, much better.  I give everyone credit for being capable of dealing with reality, and doing what makes sense.

But I don't think anyone needs to be 'kept away' from current topics and research findings.  For goodness sake most of this stuff is available and published on all the HCV related sites, including the HIV and Hepatitis site, Hepatology, etc. Its not like this stuff is a secret, or is only discussed on the Forum.

   And once again, just for the record, as Willing demonstrated with a list of published scientific studies, we are NOT posting 'assumptions' here, but excerpts from, and links to scientific research studies that have been published in all the most prestigious medical journals.  If these articles and studies are not worthy of discussion, than I am not sure just what is!  

So, my two cents says let's keep the forum open to, and acceptant of , all new information, scientific studies, and research, relating to HCV.  And let's keep encouraging a healthy dialogue about what the studies mean, and how they may or may not affect us.  That's just my opinion.

DoubleDose
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A question that got lost in the debate over persistent HCV.  

In the initial article linked at the top of the thread, by Mr. Liver, indicating an absence of HCV in the PBMB's, there was one other issue that the researchers discussed.

Seven of the participants, who were all SVR and undetected, seemed to have intermittent test results showing undetectable HCV and then detectable HCV, at low viral loads, and vice-versa.  Only one of the seven appeared to be a reinfection, and this person's viral load was much higher than the other six.  My question again is this:

Given how we define SVR today, and that someone who is shown to be 'undetectable' on PCR testing beyond six months after tx ends....how can six of these SVR's now show intermittent viral loads???????   When this happens after the end of tx, with a low PCR load level, and later going back to undetectable, don't we usually just say it was a false positive???  Well, these are a group of SVR's who seem to periodically go "non-SVR", and then back again.

To me, this contradicts the very nature of what we call SVR today.  Once you obtain the SVR, either the virus is GONE, and you will have no viral load showing on future PCR tests,  OR......if you really have the virus, and relapse, it will pretty quickly go up to typical levels, and show many thousands (and higher) in PCR testing for viral load copies/IU.  

So, why do these six go from undetected to very low viral loads????  Could this indeed be the 'persistent virus' after SVR, showing a little bit of its little fin above the ocean surface???  That would be the first question I would ask, as a scientist.  Either that would be an explanation, or what else????  Everyone just keeps having periodic false positives???  or, people who have been SVR for a long time are allowed to just 'show a little fake HCV virus' on PCR out of sympathy for the former infection??? (joke, joke)

I am at a loss as to how it makes sense.  I mean, we are told either you have the chronic infection or you don't.  Either there is a solid viral load, or no viral load.  So, what is the blinking light viral load?  Especially in someone who has been tested over time, and is considered to be fully SVR?

Just a question.  I would love to hear some good explanations.

DoubleDose
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The 'mutated great grand nephew' model might be one explanation for intermittent positive PCRs.
HCV is a liver lovin' creature that may have to make some minor changes to get over into the 'compartmentalized' systems of the body, hang out there for periods of time, and replicate. RNA lifeforms mutate like crazy (hence my interest in Replicative Homeostasis). Every so often the lymph lovin' variation makes whatever change is necessary to migrate back over into the blood and occasionally creates enough copies of itself to be recognized by a PCR before the immune system - or whatever mechanism helps maintain genotype stability (RH) causes its numbers to implode back to UND.

Maybe HR could be asked to give us an explanation of how a PCR exactly works. Could be the 'amplification' in a TMA or the 'chain reaction' in a PCR doesn't always recognize what is or isn't "HCV".
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I'm a 'newbie,' and though I am far from understanding all the discussions -- these debates and dialogues are invaluable (if sometimes, yes, scary, and yes, uncomfortable) -- for they are demonstrating to me how important it is to 'question' the research, and in so many ways, it is the true value of this forum and the variety of individuals within it.  I get a chance to get 2nd... and 3rd... an infinite number of "opinions" and "interpretations", if you will, and more importantly, honest, unabashed discourse.  

It's truly healthy here in this forum :).  Don't ever let the virus of censorship ever take hold.
Push on, folks. :)
  

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good points!!   I think that's why I asked the 60 out of 67 question.

all that is really proven by that is that either the answer is not definitive or that the tests are still nt sensitive enough to ever reach a conclusion. A 14% variance doesn't resolve the issue does it.

although your theory as to why may have it's own merit and is logical.
In theory that "recognition factor" may be why people can carry it for years before becoming noticable sick, it keeps getting knocked back when the VL load triggers response.

(on the other hand, if we are talking mutated grand nephews, who can't be making love on the kitchen table while lassoing the cow outside (or whatever that wonderful analogy of HR's was a while back, wish I'd saved it) ...but if we are talking ineffective crippled mutants....then the question become how long after all this were they testing?
Because days or weeks could make a difference in the entire outcomes I'd guess.

but then the question becomes for how long would mutants unable to reproduce be able to stay in the circulation anyway. It doesn't make much sense to me that that type would not be filtered out over time by the immune system....it's not heavy metal metal right?
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DD:  To me, this contradicts the very nature of what we call SVR today.  Once you obtain the SVR, either the virus is GONE, and you will have no viral load showing on future PCR tests,  OR......if you really have the virus, and relapse, it will pretty quickly go up to typical levels, and show many thousands (and higher) in PCR testing for viral load copies/IU.  
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Consider tuberculosis.  My father is from an area of Cape Breton where coal mining was very prevalent and my grandfather was a coal miner until they moved to Ontario when my father was 7.  Some many years later, my father tested positive for tuberculosis like alot of people have done around here.  We had a discussion about that.  And we discussed the possibility that, while he had the presence of tuberculosis strains, not enough or not the right ones to give him full blown tuberculosis.  He never did develop it and never will and is not considered "positive" for tuberculosis, just that the test indicated a positive presence.  No treatment was ever required.

Since we're all conjecturing a theory here with no hard scientific evidence as yet to support it, I'll conjecture my own ponderance on a theory.

I conjecture that a person with HCV also possibly has mutated strains of HCV that make it's way into bodily fluids, compartments and even the brain, as posted in other studies.  However...that doesn't mean these mutants replicate or are contagious or transmissible to anyone and at this point, I don't accept that they are...simply that they exist.  Frankly...  knowing that HCV RNA mutates in the first place... which is why a vaccine for HCV has been so elusive to date... and when people can have VL's higher or lower than mine which is at 2.1 mil IU/ml .. it's not beyond the realm of reason to think that when you're carrying that many critters in your blood, they'll have babies and grandbabies that aren't the same as the parents but are offshoots, mutants.. but not the same properties as where they came from.. and VERY distant cousins many times removed even and may end up in other body compartments but not able to replicate as they do in the blood.  

That's my conjectured thought.



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I haven't been online for a bit and was quite surprised to see this discussion still drawing some attention.


I expect to be back in a few days and would like to respond to some of the posts in a more detailed fashion than I presently have time for.



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I look forward to it.  I would indeed like to get your take on many of the comments and replies that have been put forward in this thread.  It has been a good thread, and has crossed the desert, covered the oceans, and come back to a more agreeable, or maybe just plain worn out forum.  We sure could benefit from having some expert commentary periodically from top Hepatologists and HCV researchers also, on these sorts of long, involved, and contentious threads.  I would love to see some dialogue with the professionals, even if indirect, or sporadic!

DoubleDose
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It is funny how the word “assumption” can invoke an emotional response. DD, you may want to go back to mid December 07 and scan post going forward to the first of March in the mirage of replies by our very own Professional that is away at the moment.

jasper
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Sorry, I do not think it is right for anyone to decide what I am capable of reading or not.  
Smells to me of censorship.
People will read what they wish and what they have an interest in. There already are two sides, on for this very thing and and one for sociolization.

I mean no disrespect to anyone,   but this is patronizing.

Deb
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Your comment above:  
"Since we're all conjecturing a theory here with no hard scientific evidence as yet to support it, I'll conjecture my own ponderance on a theory. "


My reply:

I am not sure why you keep going back to the same idea, that we are all 'conjecturing', and this is all opinions, and assumptions.  You continue to ignore the list of scientific studies presented, and hard, clinical evidence already demonstrated by HCV researchers.  Why do you choose not to hear what is being said, and read what has been posted?  Its hard to reason with someone who ignores what they want to, and then labels everything as 'conjecture' that they do not wish to understand.  I really can't discuss anything on this level.  The 'proof' regarding 'persistent virus' has been posted, published, disseminated widely, and discussed thoroughly on the forum over the past few years.  Its your choice to ignore it, but please stop calling scientific data and results 'conjecture'.

DoubleDose
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Hm.  Out of the few studies I have had time, to read .. I didn't think I'd read anything about HOW the HCV mutants got to where they got to and definitive proof on that.. only that they exist.  Did I miss something?  And I'm not being facetious when I ask that question.  

From the bit I've read, it seemed to me that the only scientifically proven conclusion so far... is that existence of strains of HCV RNA in some form exist in body compartments and fluids other than the brain.  Nothing scientifically proven about how it got there nor what the implications are .. just that it has been found.  

If I missed that part ... I'm open to being pointed to it.  I just haven't had time to delve into it more than what I have to date.  

So..
HAS it been scientifically PROVEN how these strains got to these other body compartments and fluids?
HAS it been scientifically proven what the implications of this are?
IS there concrete data to support the two questions I have just asked?

If not... we are still at the conjecture stage on those two questions.  

If yes...then I am open to correcting my viewpoint once I've read the data that makes enough sense to me to do that.

Frankly, I'm getting a little tired of all your accusations.  

I'm not "choosing" to ignore what has been read.  
I'm not ignoring what I wish to and choosing to label it as conjecture.
I'm not making active choices about what I choose to understand and what I don't.

This is simply as far as I've gotten on what I have read already.  It would be reckless for me to call my own viewpoint anything BUT conjecture and unless I see that there is definitive data supporting the two questions I've asked above....it all remains conjecture to me on THOSE questions - A) how it gets there (does it mutate off? Is it independent from the HCV RNA in the blood?  etc etc) .. and B) what the implications are.  I accept that it exists.

Your ongoing accusations anger and insult me.  I would appreciate it if you would quit painting me as a close-minded fearful ignorant person who is not interested in the truth and would prefer to hide her head in the sand.  I would appreciate it .. but I'm not holding my breath that you will stop.

Trish
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Trish:  From the bit I've read, it seemed to me that the only scientifically proven conclusion so far... is that existence of strains of HCV RNA in some form exist in body compartments and fluids other than the brain.  
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If not obvious...I meant, "other than the BLOOD."
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I am not in any way trying to insult you or accuse you of anything, but am trying to point out why I hold a particular viewpoint, ..a viewpoint which was developed in response to reading the list of studies that Willing linked.  I have looked for something that would invalidate these studies, or contradict them, and have been disappointed to find little or nothing. So, in other words, I did not have a particular point of view first, and then look for research studies to support that point of view, but the opposite is true;  I have read all the research available over the past five years, and have formed some conclusions based on the weight of these findings.  Here is what YOU said, way up near the top of this thread:

your comments were:

"It's not enough for me that someone with a particular viewpoint posts a bunch of studies that support their viewpoint.  Yes, I would like to see other studies posted as well by those who don't share the viewpoint of Willing, DoubleDose, et al.  However.  I don't make up my mind by counting who posts the most studies. "

My reply is that I don't make up my mind by counting who posts the most studies, but I do pay attention to what the preponderance of the available research results conclude.  The studies LEAD ME to my point of view, and I remain open to seeing something that might prove them wrong.  I honestly believe that this is a pretty typical, and rational way to form an opinion, or to draw a conclusion.

I think that all we are saying, in the end, is that almost all available studies conducted in recent years demonstrate the finding of ongoing, replicating HCV in various organs, fluids, or compartments, but at very low levels.  I think the studies are also saying that these are not 'remnants' or 'mutants' but actual replicating HCV virions...again, at a very low level.  They are not an uncontrolled, chronic, active HCV infection.  No one has intimated this at all.

How to INTERPRET this or what it all means is, of course open to further research, discussion, etc.  I don't think any of us have tried to say exactly what these findings might imply, or what the impact might be.  I do not see anything above that implies that.  

I regret that you are offended by my comments about why I believe this subject may create emotional responses, or why I believe that the studies listed are the most valid information currently at our disposal, or if my reaction to your "characterization of what I am saying" did not resonate with you, etc.  But I am just answering your comments that were directed toward me.

Now,  I may have some 'other' theories, that I sometimes submit as possible scenarios, etc. and when I do I always state them as my opinion.  But this thread is a different one, and the information is all based on scientific studies, the only ones available on the subject, and are NOT MY opinion in any way, but stand on their own, as research studies and conclusions drawn by those teams of medical professionals.  I may form some opinions as a result of studying these papers, but they were not MY original opinions.  

DoubleDose
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About this time ..... I could use a scotch straight up.  Followed right after by another one.

Of course, I won't.  But right about now I'm sure wishing I could.
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Ok, if in fact as proven by the research to date and presented here how dose/do the virus or virions, cleaved, fragmented or whatever exist in the extracellular fluids in and around the organs for extended periods of time after treatment? What is the mechanism or body chemicals that allow them to exist long after treatment?

The research listed suggest that they do, but is there any research as to how?

jasper
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If there was such a thing as a PCR test that went down to <0, and someone on tx became <0 and was still <0 EOT but then relapsed, I would imagine that everyone would have to agree that mutants or residual virons within compartments replicated and made their way back into the blood.

If a test like will or can be possible someday,, that would help answer some questions cause if nothing was in the blood, how did the person relapse 2 months later or whenever. Right now, many people assume that relapse is from left over virons floating in the blood and the immune system was not able to control/suppress them and yes I would say that is one way to look at it... But maybe they aren't left over in the blood in every situation and are in fact in the tissue/ lymp nodes etc and then make their way back out. Granted it is the immune system that is not able to suppress them if relapse happens,,,,but why do we or some I should say, automatically assume these left overs were in the blood and not left over in compartments that caused relapse? I'll answer that -its because we always say, well the test only goes down to <10 or <2.

MO
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Before the lipid connection is totally dismissed as off topic, is it really?

To: geter
The "floaters' are explained by the lipids that the virus attracts to its outer, partially lipohilic virion coat sections, that make it possible for HCV to protect itself from neutralization by antibodies . This coating is variable for two reasons:

1. Because of the quasispecies/genetic variability of the individual virions, some might have an even better ability than the majority to bind those extra lipids .
2. Due to the stochastic process that underlies the lipoid coating there is some variability - a "distribution" - of lipid coating even with genetically identivcal virions.

The ultracentrifugation steps tries to oversome the floaters by reducing the specific gravity of the serum in which the virions are suspended at the time of centrifugation, thus making them heavier relative to the medium in which they are centrifuged, sending them to the bottom after almost 3 hours of ultracentrifugation.

Geter - It is not so much as the liver protecting it self as it is with the “virus cell” floating around and hitching a ride on the plaque in the veins and in some instances being coated additionally by the tumbling lipids and sticking to the plaque and eventually being encapsulated in it over time which brings me back to the virus cell and the thickness of the cell envelopes which is not soluble and floats at various degrees with in the blood stream in which the cells act as balloons because of the chemical make up of the inner membrane and outer coating and the varying buoyancy of each cell given that make up and coating.

Geter - Hope HR is lurking because I doubt if I’ll remember this scenario, in which all probability is totally wrong but here goes.

Using hr’s example of the ten vials of 1ml of infected blood serum all from the same draw and using ten centrifugal mixers (lack of better word) and set at different speeds among the ten vials what would be the viral content at the various speeds and the viral buoyancy of the virus cell at each speed. Now if going by the different centrifugal speeds and all ten vials show different concentration of virus cells and virion at those different levels what would cause those virus cells and virions to stay buoyant at that given speed, and of that, what would be the thickness of the envelopes in each virus group? In looking at it this way the newly created virus cells and virions would be lighter and would sink to the bottom at the slower speed because they have not had the time to mature and flow through the blood stream and pick up additional protein coatings of its outer cell envelope and in contrast; the maximum centrifugal speed would yield the most hardy of the virus cells and virions because of the length of time floating in the blood system (years) and picking up the additional proteins of insoluble coatings of the outer envelope along the way in which it makes them more buoyant in our water based blood system and would it not make more sense that the newer virus cells and virions get eradicated faster in the beginning of treatment because of this lack of additional protection of each? Sounds far out but to the layman sounds logical for a hepc 101 class minus all the sifi wording.

So, say out of the ten vials centrifuged, vial one has 500k virus cells and virions at the lowest rpm and viral 10 has 5000 of the virus cells and virions at the maximum rpm would it be safe to say that what in the virus cell has made it so resistant to the downward pressure of the spinning centrifuge.

By differentially spinning the virions containing samples one could indeed separate them by their varying density due to the variability in the lipid coating. Why would we do this, however? To possibly "identify" the ones with the thickest lipid coat?
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Obviously the ultracentrifuge uses the highest possible speed and additionally means to reduce the buoyancy of the suspension medium to get the vast majority down.
By the way, once the density of a particular virion is less than the suspending medium, no centrifugal speed in the world will bring them down. They will go to the top, in fact.

Geter - To:

////////  To possibly "identify" the ones with the thickest lipid coat?  /////////

Yes, because these virus cell have learned through the past encodings of previous generations of virions on how to adapt to its changing environment and use any means of survival including learned host dna of the virion strands through the replication cycle process over time in which more of the bodies defensive strategies are learned to combat the virus cell but the evasive maneuvers of the virus has figured out that the more lipid coating protecting it form the opposing forces of the bodies natural inf production and adapting to the treatment drugs over time has made it to what I call, a super virion.

It was interesting when St. George brought up the subject about statins and in the one abstract where (?statin name) was used that there was a VL drop but only temporarily but none the less there was a drop. My thought would be that the initial intake of the statins thinned the lipid coating of the virus cell in which the natural INF was able to penetrate the envelope and eradicate the process of the progression of the evolution of the virus. Just a wag on my part.

But if this did hold true and these virus cell had evolved to this state to where they defy the centrifugal forces of a centrifuge and these are the ones I would be looking at for the reasons of the margin of error and possible the reason for relapse because of the opposing external forces are no longer there and the virus cell by its own internal mechanism would start to shed it harden shell back to a point where the host liver cell becomes attractive again. Also another wag on my part, I think?

The 30% chance was only referring to the 1ml of serum investigated in the test. You could still have 3000 viruses in the non tested other part of the blood and also there will some be located  in the interstitial fluid - outside of blood vessels but also out side of the bodys tissues. that is at least 10 more liters of fluid where a virus can be, although the concentrations in this interstitial space should be less than in the circulation, since the virus is at least partly confined/blocked off  by the endothelium lining of blood vesels.

Note however that in the liver this otherwise fairly tight endothelial lining has numerous large holes (fenestrations)  - to allow better access of plasma components to the liver cells, that actually for this reason  come in direct contact with the plasma alongside the sinusoids, this way there is no barrier for viruses  in the liver capillaries at all.

Geter - So the INF is injected into the body’s intercellular fluid (or makes its way into) and to combat the virus in these fluids and also be absorbed into the blood stream which is why it takes time to build up the INF concentration with in the body. The Riba on the other hand is ingested and absorbed through the intestines and works in reverse by being absorbed into the body. So the virus works in the same way to some extent because some virions make their way through the blood vessel wall in to the body through various channels of the blood vessel which makes it harder for the INF and the Riba to find and explains for the long duration of the treatments.
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Geter - So what has changed is, is in the initial up dosing of the combo it has or should have eradicated all most all of the virions in the first 12 weeks of TX for (responders speaking) as UND, and for the remainder of TX is for the remaining TX time is for the body compartments and or organ components in which the virus may or may not find their way back into the blood stream and this is why the post PCR are needed to see if any remaining virions have reentered the blood stream which leads us back to the taper down Theory, at least for me anyway.

*** have interrupted inserted meaning of my understanding of medical terminology used***

Surprisingly, the circulating or otherwise existing in the extracellular fluid virions are only of relevance insofar as they can reinfect new, uninfected hepatocytes , from the blood passing though the liver .

Geter right
All virions that do not reinfect are of importance only insofar as they (or better their processed remnants, taken up by macrophages and dendritic cells.) act as a trigger to the peripheral immune system to produce cognate CTLs and helper T lymphocytes.
Attacking as a foreign invader and eat up any unused and decaying virus cells
The immune system and IFN or riba does not have any direct effect on circulating virions ( with the minor exemption in the case of HCVs minor neutralizing antibodies  ) Killer Cells, nor would such an effect be of any importance in the fight against the infection , unless it would reduce the number of circulating virions to such numbers that reinfections could not occur anymore, (which is a very small number). Reduced viral load by eradicating the number of virions being produced in the liver which is where the cleaving mutilation occurs.

There is really no "virus killing' going on outside of the liver  (because of their lipid coats) in the sense of an active, therapy induced destruction. Because of their RNA make up, Circulating virions have a short life and die by themself in huge numbers, a small number only makes it back  Stronger RNA life cycle and lipid coats, to the liver and finds a fresh hepatocyte to infect and to start a new virus producing intracellular machinery.

The therapy is directed against and works by:

1. Eliminating  Infected hepatocytes by CTL mediated killing / Eating the now dead hepatocytes pads
2. Noncytolytic elimination of the intracellular virus machinery by induction via CTL produced gamma IFN or therapeutically induced IFN alpha . Neutralizing of the central nerve system of the virion
3. Killing of hepatocytes, infected or not, by unspecific "bystander" inflammatory mechanisms caused by the unspecific proinflammatory capable of promoting inflammation, intrahepatic with in the liver, infiltrate and there the diffusion there of, ( In the biopsies seen as portal infiltrates and "necroinflammatory fibrosis and bridging " activity).

4. The prevention of reinfection by anti HCV antibodies binding to circulating virions is not of major importance in the dynamical fight of the immune system against HCV. For that reason hyperimmunserum hyper active immune response in the blood, "HCIG" CD4 binding ability, does not effectively prevent reinfection after transplantation. Currently, two companies are trying to develop a pair of strongly binding anti HCV monoclonals, alfa antibodies in the hope to improve upon this mechanism to prevent reinfection after transplantation. Transplantation BTW is the one moment in which the  extrahepatic out side of the liver virons DO come into play, becuse they reinfect the new, vrgin liver .
your killing me here, I gots a headache
Right, the circulating virions in the blood serum and extracellular fluids can only infect the uninfected hepatocyte pad of the liver. Yet, the floating virions circulating in the serum and extrecellular fluids are either dieing or dead on their own and triggers the “natural INF” response of CTL’s and helper T cells or killer cells that attacks the invader virions and or decaying virus cells, which is over come after the initial infection process begins and ongoing process. Thus reducing the viral load of the virions with in the liver caused by the induced therapy of the combo treatment but there are few who survive either because of their stronger (DNA) for lack of words, and or because of their thicker lipid coats makes and its way back to the liver through the serum to a virgin hepatocytes pads.

Through combo treatment, the infected hepatocytes pad or pads are helped eliminated by CTL target killing of the pad cells and sometimes neighboring cells accentually, eating the cell or cells which may be in the process of inflammation or the possibility of promoting inflammation with in the liver cell pads as seen by the biopsies in the various stages of fibrosis and or bridging.
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oh I know, the games must go on!!!   Just musing I guess cause when I first arrived some of these type studies and discourses had me reeling. Time brings perspective.

the plethra of new studies are impossible to keep up with, and I'm lazy, I've begun to rely of this group to bring anything REALLY promising to the group....otherwise I'd be in pubmed and clinical trials all day and my head would spin Linda Blair style by every evening!!!!!!

So let us continue.......funny thing is, my first day in here (in June) someone was chewing people out for giving links and/OR posting long studies.....and yesterday I got chewed for NOT doing it  (although the person above me had just posted the study so why would I)   but still.......it's funny how things change over time isn't it.
stay well, love your posts whether we agree or not...   MB
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Can’t add much more than that to the thread but more speculation than already exist.

jasper
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For anyone with an interest in this area, I just started a 'Health Pages' page on 'Occult Hep C' - for direct links to studies and papers related to the subject. Feel free to add any relevant materials and help edit and organize it, please.


TnHepGuy
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Sure wished you had posted this about 2 hours ago, would have saved a lot of cut and past, LOL!

Nice to see the Health Page being used on a host of topics.

jasper
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I just spent about an hour trying to rearrange the papers in chronological order on the 'Occult' Health Page. It appears as if the software has some serious bugs over there. After putting things in order I saved it - and the mess that is now there is what the program put up. And, I don't seem to be able to edit any of what is there ...... double whammy. I tried to delete the mess and replace it by C&P'ing a previous 'good' revision. No go. I just keeps putting the same mess back up again.

No time to try and fix it now. I'll see if there's anything more that can be done tomorrow.


TnHepGuy
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Thanks for the Health Pages compendium of articles and studies regarding 'occulr HCV, persistent HCV after SVR, and related topics.  I did not even realize just how many papers had been published documenting and explaining this phenomenon.  For anyone who really wants to understand where we are today with this issue, and what exactly seems to be happening in our bodies after SVR, this listing of studies is the most comprehensive that I have come across.  Thanks for taking the time and trouble to compile all this information, and to make it readily available to all of us.  Great reading for a rainy day!

Reading these studies also makes you realize how much more there is to learn about the virus, and why we can't stop with the current treatment regimes thinking we have solved the riddles, and provided the total cure.  We need lots of follow up to determine what this form of residual infection does to us, what its level of infectivity and transmission might or might not look like, and to also understand more about what the general population really looks like vis-a-vis HCV infection, in all its forms.  

Questions like, does occult HCV occur only in those who have treated...is occult exactly the same entity as 'persistent HCV after SVR, are their many people out there with undetected, antibody-negative HCV occult infections???  Where does this infection originate from in cases where it seems ideopathic?  Does this 'little, compartmentalized infection cause any of the familiar extra-hepatic symptoms///  Does our immune system begin to create auto-immune illnesses or disorders as a result of occult or persistent HCV??? The list of things we need to understand goes on and on.  

I think we are really just at the threshold of understanding regarding the life and behavior of HCV.  The researchers will have a field day exploring all the peripheral issues.

Thanks again for the great resource.

DoubleDose
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The following does not speak to any position I have about post-SVR viral persistence, the role, if any, of PBMC,or the inhabitation of any other cell suspected of a role in the HCV lifecycle. I will get to that pretty soon I hope, as many have raised some very interesting points, and I do have some studies to share that may (or may not)  illuminate some areas of this topic. I would rather wait for now until I can be assured of some continuity on my part--otherwise I'll get lost. Lately my ability to remain focused has been off somewhat.

The following is some science along with a sprinkling of conjecture, and a dash of what  hopefully will appear to be logic. I usually don’t stray too far from the scientific path when it comes to HCV, but speculation can be thought provoking at times and fun to share.

" RNA lifeforms mutate like crazy"-- DD

This is a very good reason why it wouldn’t be necessary for HCV to convalesce or 'hibernate', go dormant,etc, as a means to ensure it’s continued existence. HCV is the fastest mutating virus ever discovered to this point in history. Its apparent survival strategy is quite simple--mutate so fast that the immune system is overwhelmed. A plan of diversion on a grand scale---from thousands to millions of mutations (quasi-species) per lifecycle by each infective virion. And every one of them is unique.( It is through this process that new genotypes/subtypes will rise. )

HCV seeks its lowest state of free energy. Don't we all ? ;) Another way of stating this is to say that through phylogenesis it has become as efficient as possible . To illustrate this phenomenon consider the following: HCV in its past history has shed replication mechanisms that were at one time needed for its survival. As we all know HCV cannot replicate by itself. It relies on its innate ability to manipulate the host cell’s replication processes to produce viral copies for it. This leads many evolutionary biologists to surmise that at one time in the  history of HCV  it must have had the ability to replicate using its own viral properties.Once the virus eventually unlocked the ‘code’ of a host cells replicating mechanisms it no longer needed to expend any energy on replication---a process which it previously had needed for survival. The ‘parts’ of the viral assembly that allowed the virus to self-replicate were eventually eliminated (devolution) or shed, in the never ending goal towards maximum efficiency (lowest energy state).  For HCV to develop and/or keep another mechanism for survival when it already possesses one that requires almost zero energy (extremely efficient) while at the same time being unbelievably prodigious (an almost perfect machine), would be an expenditure of energy that would appear to be antithetical to the goal of reaching its lowest state of energy (becoming most efficient). It would serve the virus absolutely no purpose to develop (or keep) another process for survival, such as entering cells to 'hide', especially since doing so has never been shown to result in a release,delayed or otherwise of infective HCV back into the sera where it could be available for an opportunity to infect a new host.  If HCV is to succeed in its drive to remain in existence it  is absolutely imperative that infective forms of the virus are readily available whenever a transmission vector presents itself.  Being blood borne necessarily limits HCV in the opportunities it will have to ensure its perpetuity. Passing infection via blood to blood contact is one of the most inefficient means of transference known.  (Let’s pray it stays this way so that HCV, as well as a host of other viruses, never mutate to ‘aerosol’ form).  Since these events of exposure are rare and cannot be predicted, the virus can ill afford the luxury of ‘hiding’, going dormant, or convalescing for very long if it wants to continue to be.
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  And again....all I pull up when I copy/paste that sight (as others I try here) it brings up this post, not the article. What am I doing wrong? Want to read that!

LL
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First, this is NOT my quote, so I do not know where the "DD" came from:

" RNA lifeforms mutate like crazy"-- DD  < (not my DD, or comment)
Someone else must have posted the above comment.

Secondly, I think your above description and explanation is interesting, but assumes that the virus must be trying to 'hide', and therefore you proceed to negate that possibility.  I do not think it is 'hiding', or anything like that.  I believe, from what I am reading in the various studies, that the virus has been placed under immune system 'control' and is not likely to be doing anything at all of its own accord, but is just being kept at extremely low levels by the immune system.  Maybe the immune system cannot fully exterminate the virus in these circumstances, and maybe in some people it eventually does.  Hence the 10% or so that show up as having no persistent virus in PBMC, Lymph Nodes, Hepatocytes, etc.  I think the virus may still be alive and well in the serum also, after the SVR, but at extremely low levels, under the limits of standard detection.  It could be randomly at 1 copy / 20 IU of serum for instance, and would NEVER be detected on the most sensitive PCR tests.  This would explain the six people who continued to go from undetected to very low level detected.  Maybe the immune system varies in its ability to keep the virus at extremely low levels in the blood, and sometimes allows little detectable fluctuations to occur.  

Finally, what you described is interesting to ponder, but is contradicted by the cold hard facts in every one of the linked research studies, but one, the initial linked study at the top of the thread. (and the study you linked did not use the most powerful amplified testing to look for the virus, either).

  If the virus is showing up, and is detected by special amplified testing, and is replicating, then explaining why theoretically it cannot really happen becomes an exercise in futility, and an academic construct.  If its there, then its there, and whether we theorize that it should not behave that way, or not, is a moot point. Its there.  We need to figure out HOW it remains at low levels, and what the significance of this residual infection might be.  Thats my take anyway.   Let's also place DD notations on things that DD has said.  Thanks.

DoubleDose
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The next logical step to deconstructing the evolution of the virus is that at one time it may have been an useful symbiote rather than a parasite (see mikesimon's recent posting about post transplant patients who beome totally virus free).  A virus that only causes fatal complications in 20% of the population, and that generally not till later in life, wouldn't have any deselection pressures on it in a country like Afghanistan where the average lifespan is under 50. Even less so in Northern Europe 1000 years ago where the lifespan was even lower.
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I just re-did the Health Page on occult. I decided it would be much easier to do if I started again from scratch. Along the way I figured out how to do direct linking (i.e. - the article title is also the link) - thus cutting in half the amount of screen usage and scroll time. I've titled the newest page "Occult Hepatitis C (1)" and asked MedHelp to please remove the first page - after which I will then re-title the new version.

Please add to and update it with any any-and-all relevant materials. If you are not comfortable yet with posting, just send or show me the link and I will add it.

Thanks.


TnHepGuy
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In my case as far as virons and relapse, I think I am in a Th2 mode and might be stuck there. I thought of the parasites as a distraction to my immune system (kept my immune system from fighting the left over virons) - didn't know how else to word it to my doctors, being I am not from a scientific backround, but as I look a bit deeper and try to grasp things, I might have been on that money about that cause it seems (if I interpreted it correctly) that the paras trick the immune system into thinking the Th1 is present and helping but its not and you wind up just having the Th2 thing going on which if you think about it, at the end of treatment you would need a balance of Th1/Th2 after tx stops in order to suppress any lingering virons.

The reason I concern myself about being stuck in a Th2 mode - not due to paras - they are gone, but it seems that there are other reasons where a person can become Th2 dominant - even past Chronic Fatigue and FM and also chronic stress can make you Th2 dominant. Don't take my word, look it up if you want to make sure my interpretation was correct, but I think it was. Too tired to go thru my bookmarks to paste - so I added the disclaimer so I don't hear feedback,,"where's the studies etc."

So anyhow, I have to talk to my doctor about the Th2 mode and possibility of me being stuck in it. I'm sure he'll want to throw me out the window, but I have to ask.

MO

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This sure has been one heck of a thread!  Pro or con, good, bad, or ugly I have really appreciated all the participation and commentary.  TnHepGuy...thanks for the useful Health Pages resource!  Willing....thanks for always being willing!  Mr. Liver, thanks for kicking this thing off!    jmjm, as always, appreciate the voice of moderation, and the contrarian point of view.  I have not given this subject so much thought and consideration in a long time (a good or bad thing, I am not really sure).

DoubleDose
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Well DD, I guess your thread is now officially closed. Take a bow! Applause!

gee
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DD: (thanks) always, appreciate the voice of moderation, and the contrarian point of view.
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Well, thanks, but I'm not about to concede that it's my point of view that is "contrarian" ;)
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And well you shouldn't!    I got word recently that you were a messenger from that new show, The Prevailing View!  Now I've watched the show, and I am just waiting around for the credits to roll.  I just know we are all going to see some really 'meaty' studies to support the theme of this new show.  And when I do, you will have convinced me, and I will have to become a regular cast member too.  For now I guess I'll just stay in the back of the bus, and throw peanuts!  Oh well, we can't all be stars.

DoubleDose

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tn: EXCELLENT WORK! there is something endearing and therapeutic about the endless repetition and rediscovery that goes on around here, but, ultimately, it's both tiresome and conterproductive. Thisi is the perfect remedy and I hope it will serve as a model for gathering research findings on other ever-popular topics like anti-fibrotics, mj/alcohol consumption, extended tx etc.

LadyL : maybe try using tn's links to go to the study you want and compare that with the URL in the cut/paste text?

Desrt/DD:
In that truncated genomes paper :
http://www.ncbi.nlm.nih.gov/pubmed/17935188
only one of the three patients was hiv con-infected. This was a very rare set of patients indeed : no antibodies and plenty  of serum VL ( in the millions) unlike Castillo's group where "occult" was defined as no serum and no abs, but hcv rna in hepatocytes. I read through the paper in more detail and from their references it seems that truncated/defective genomes of this sort are common in other contexts but have not been reported previously in HCV. Though this is very much a corner case, it represents a dramatic example of the virus evading basic immunological mechanism.

Their PCRs strategy divided the genome in half, 5K being apparently a practical upper bound on length of a PCR extension.  By assembly, they were able to extract full sequences which are deposited with genbank accession numbers DQ430811-DQ430820.

The practical question in all this, at least from my point of view, is determinants of relapse. If it's not absence of virus that separates SVRs from relapsers it seems important to understand whether   host or viral factors play the major role in outcome. I may be jumping to conclusions a bit here, but I tend to see this as supporting a re-tx approach that relies on using SOC in the earlier part of therapy and the hcv-targeted, precision ammo like r-1626 and vx/bocepravir later. Why count on long-term stimulation of  an immune response that can be so blatantly evaded?

Also, that spinal disk paper, had no bearing whatsoever on spinal fluid; different tissue type, my mistake.
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For starters.....I quote you:  DD:  "Free and open rational discussion is the name of the game. "

I posted what I thought was a reasonable comment that started "Consider tuberculosis".  I was knocked on my A$$ by the vehemence of your response.  For a person who claims to want to encourage truth-seeking and open discussion and participation by all, you have a funny way of showing it.  

I wouldn't have minded a bit if you had respectfully disagreed and pointed out, with references, where my conjectures didn't add up.  I don't post in forums to be right.  I post in forums to learn by participating in discussions and to have my own as-of-today opinions tested by the knowledge of others so that I can learn more.

Instead, you reverted to what amounts to "discussion thread rage" and engaged in personally attacking me and casting aspersions on my character.  How is this supposed to encourage the search for truth and encourage others to want to participate in forums like this and to venture an opinion for others to respond to so that they too can learn, watching how you attacked me?  Should we have read a certain number of studies before we are allowed to post a thought or an opinion?  Should we only be allowed to post if we agree with YOU? It certainly seems that way.

You say this to me:  
"Why do you choose not to hear what is being said, and read what has been posted?  Its hard to reason with someone who ignores what they want to, and then labels everything as 'conjecture' that they do not wish to understand.  I really can't discuss anything on this level.  The 'proof' regarding 'persistent virus' has been posted, published, disseminated widely, and discussed thoroughly on the forum over the past few years.  Its your choice to ignore it, but please stop calling scientific data and results 'conjecture'."  

I tell you that I am angered and insulted by your accusations (particularly because you keep repeating the same accusations and any time on these forums would tell you they are baseless), you have the utter audacity to respond as follows:

"I am not in any way trying to insult you or accuse you of anything, but am trying to point out why I hold a particular viewpoint"

Huh?  How about you re-read what you wrote to me.  You accuse me of quite a bit and frankly your comments are an INCREDIBLE insult. If you were not TRYING to insult me, well you managed to insult me WITHOUT trying.

In response to your attacking post, I responded calmly explaining why I used the "conjecture" approach and perspective.  I posted very specific questions inviting a response as follows:
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Trish:  From the bit I've read, it seemed to me that the only scientifically proven conclusion so far... is that existence of strains of HCV RNA in some form exist in body compartments and fluids other than the brain.  Nothing scientifically proven about how it got there nor what the implications are .. just that it has been found.  

If I missed that part ... I'm open to being pointed to it.  I just haven't had time to delve into it more than what I have to date.  

So..
HAS it been scientifically PROVEN how these strains got to these other body compartments and fluids?
HAS it been scientifically proven what the implications of this are?
IS there concrete data to support the two questions I have just asked?

If not... we are still at the conjecture stage on those two questions.  

If yes...then I am open to correcting my viewpoint once I've read the data that makes enough sense to me to do that. "
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In the post that followed this one of mine, with this very painstaking clear explanation of my position and posing these very clearly posited questions, YOU TOTALLY COMPLETELY IGNORE THESE QUESTIONS.  

You say this:  "How to INTERPRET this or what it all means is, of course open to further research, discussion, etc.  I don't think any of us have tried to say exactly what these findings might imply, or what the impact might be.  I do not see anything above that implies that.  "

Well......isn't that what CONJECTURE is?????   The INTERPRETATION of these studies, and what they mean?  And isn't that pretty much what I said only different?  

If, to quote you again, ""How to INTERPRET this or what it all means is, of course open to further research, discussion, etc."  I submit that IS conjecture, to venture an opinion on the interpretation, and that is ALL I was doing in my "Consider tuberculosis" post and by saying that we are ALL conjecturing because we are ALL interpreting and deciding what these studies mean.  







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Continued and concluding......

THEN.. you don't stop there.  You go on to say THIS...

"I regret that you are offended by my comments about why I believe this subject may create emotional responses, or why I believe that the studies listed are the most valid information currently at our disposal, or if my reaction to your "characterization of what I am saying" did not resonate with you, etc.  But I am just answering your comments that were directed toward me."

Uh....no.....I was clearly offended by your personal attacks on ME and SAID SO.  Yet you ignore that completely and instead make the unfounded and baseless comment that I am offended by your comments on your beliefs on this subject. That has no resemblance whatsoever to what I said.  That is not ethical on your part and you sidestep the responsibility for your comments by further maligning me with misrepresentation of my words.  If anyone is choosing to ignore the truth, you are choosing to ignore my clearly stated issues with your personal attacks on me!!!

Incredulously, in conclusion you state:  

"Now,  I may have some 'other' theories, that I sometimes submit as possible scenarios, etc. and when I do I always state them as my opinion.  But this thread is a different one, and the information is all based on scientific studies, the only ones available on the subject, and are NOT MY opinion in any way, but stand on their own, as research studies and conclusions drawn by those teams of medical professionals.  I may form some opinions as a result of studying these papers, but they were not MY original opinions.   "

Yes, this thread is based on a scientific study.  Yet....our interpretation of those studies, in your own words.. are our own individual opinions.  It seems you are free to have yours but anyone who differs from you is not accorded the same privilege without being subjected to tirades and personal insults and attacks from you.

Frankly, I was looking forward to taking some time this weekend to read up on some of the studies posted here.. and become better acquainted with the subject matter and participate in ongoing discussions and having my horizons expanded by having the benefit of having further discussion in this thread.  

Your responses are hypocritical of a person who claims that, and I quote you again:

"Free and open rational discussion is the name of the game. "  

In the immortal words of Inigo Montoya...." I do not tink that means what you tink that means" ... perhaps paraphrased, but that's the basic gist of it.

Trish
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I am not quite sure how to respond to your long diatribe at me.  I think you are greatly over-reacting to my comments, and reading a lot of personal stuff into them.  Please, let's get back to the facts in the research.  I have become weary of trying to answer you in a sensible manner.  I don't think that I am the one engaging in 'tirades' and personal attacks.  I think you are reading way, way more into my comments than what was intended.  And, I have a right to respond to your criticisms and 'rants' just as well as you do. Believe me, no one is 'maligning you!  You seem to be screeching the insults and accusations,judging  from your post above.  Let's move on!

DoubleDose
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I also just went back ane rer-ead all your posts to me, and my replies, and for the life of me I can find NO personal attacks at all from my end.  But I do find you saying some pretty inflammatory things directed toward me, early on in the conversation.  (which I let roll right off my back).  I am concerned that you give yourself the latitude to make all sorts of comments to me, and misinterpret what I am trying to say, and then act as if my responses, detailing my position on this subject, are in some way insulting!  I really am offended myself right now, and do not appreciate your interpretation of my intentions.  If you want to get into a debate on a subject, then at least have a thick enough skin to deal with the replies to what you have said.  Look at the things you said to ME!  I should be very offended.

I am not amused by your attitude and do not agree one bit with your characterization.

DoubleDose
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DD:  I don't think that I am the one engaging in 'tirades' and personal attacks.  I think you are reading way, way more into my comments than what was intended.  And, I have a right to respond to your criticisms and 'rants' just as well as you do. Believe me, no one is 'maligning you!  You seem to be screeching the insults and accusations,judging  from your post above.  Let's move on!
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Back atcha.


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DD:  But I do find you saying some pretty inflammatory things directed toward me, early on in the conversation.  (which I let roll right off my back). ........ Look at the things you said to ME!  I should be very offended.
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I recall nothing of the sort in this thread, however, quote them like I quoted you.  THEN I will make my apologies if required.  
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Tho at the end of tx and barely a brain left... and with my eyeballs hurting, taking close to  3 hrs to read this thread- you all done good! very, very interesting!!!  bookmarked it, as well as when feeling better (lol) will read the TnHepGuy Healthpage w/links.  just too much to take in now.  anyone saying this scares newbies or people tx'g is full of malarky (sorry but that's my humble opnion).  this is interesting, fascinating reading and hoping more and more research is done, and hopefully find a 'real' cure someday.. but until then this is the best we've got. frankly I'm one of the ones liking to know ... 'cause don't think all stones have been turned and really when feeling better will be watching this!!!  I WANT to know and really interested in this research!!  ah... DD- I imagine your inbox is full of many commending your 'patience' ...God Bless You!  All-in-all just a fricken great thread!!  THANKS... to all providing links!!!!!!!  Libby
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Not only are you educating, but also entertaining me at the same time.  Such a wonderful group of creative people you are!!!!! THANKS  Leah  
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Whoops... didn't mention 'entertaining', but actually I didn't see that as much as I found part of the thread annoying and sad that interested parties such as ourselves have to wade through such opposition when 'studies' and 'papers relating to occult hep c' are being discussed in a reasonable manner - with DIRECT LINKS to same, I might add.  If a person feels uncomfortable reading such discussion or do not want to see what research is out there, why must they attack the messengers and those having open minds wanting to discuss same?  I mean.. for chripes-sakes... if opposing parties have STUDIES, PAPERS, LINKS from RESEARCHERS (DUH) showing that what is attempting to be discussed here then by all means I wish they would show it.  I'm tired and sick and really have discovered with this thread what members I can skip,  and not miss, since my eyeballs feel like their turning inside out - just my take.... lol  Yeah.. I'm just one hoping for continued discussions in this very interesting subject. Sheesh... just my humble opinion!
Again, thanks MrLiver, DD, Jmjm, Willing, TnhepGuy and others parties discussing this in a mature manner.  THIS IS SO INTERESTING.   Sure it be a lot easier to put my head in sand (lol) or hands over ears.. lol ... just hoping this has not stopped anyone from these interesting discussion - - Please don't let nonsense bother you -doesn't take a course in rocket science to see what is going on here and none of the personal attacks are reflected on those sincere in these discussion... just my humble opinionn.. and take for what its worth  Be well
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Here we go again.  I don't oppose this.  I'm learning about this.  I posted what I thought was a reasonable thought on this.  I asked what I thought were reasonable questions.  And I got no direct answers, instead I got told what kind of person I was thought to be.  If you go back and read, despite my first "cough" post, every post of mine to DD was reasonable and calm.  He attacked me anyway.  Now YOU are attacking me using the same sort of reasoning.

I do not oppose this.  Neither do I support this.  I am simply learning about it.  I have even said that my position is based on what I personally have read to date, that I have not had time to read further studies, that I am open to changing my position once I read those further studies.  That does not mean that I will AGREE with DD, Willing, MS, or whomever, once I DO read those studies.  IS that allowed in this forum?  Disagreement?  It does not appear so.

If you go back up and read... the very FIRST attack in this thread was by DD himself.  I suppose if it's a crony, that is allowed?

I even posted calmly back to DD and stated why I used the word conjecture.  And he uses the same frame of reference as me and I asked him very direct questions about that, that he did not answer.  And the attacks continue.

I am learning here.  And it appears you are only allowed to learn if you follow like a sheep and follow the crowd with no independent thought allowed.  As a point of reference, to calm DD down, I used the global warming situation to illustrate a situation where there are very credible people with the same data yet who interpret that data very differently.....really as a plea to allow differing points of view into this discussion without it devolving into attacking people who have different points of view so that discussion can be had.  Instead... I got the accusation thrown at me that I am suggesting that the scientists who are responsible for the studies that Willing posted and DD references are simply trying to score political points.

Frankly ...every time I've posted what I thought was a reasonable post .. I've had it twisted and I've been attacked for what it was interpreted to be.  THEN the attacks became on me as a person....saying that basically I choose to be ignorant, I choose to be biased, I choose not to learn and that I choose to believe whatever is convenient.
ANYONE who truly knows ME ... would fall on their a$$e$ laughing...and I suppose, knowing the nugget of who I am .. I find such accusations incredibly hurtful and offensive.

This has all started from the assumption that I am here to oppose and attack.  

I resent your subtle accusations, EspritLibre.  I tried to set things aside .. and I tried to get back to the discussion at hand by posting the comment that started.. "Consider Tuberculosis" .. .and yet the attacks continued.  The response to that post was incredible.  And it only got worse.

And now... here you are.  Continuing this.  And yet .. I still do not have the answers to my questions.. that I felt were fair, reasonable, open-minded, demonstrated the desire to seek knowledge and truth .. and yet the only response.. is sidestepping and more attacks.  So ... I will post them yet again....and if I do not get a fair and reasonable response to those questions.. without attacks.. I will know that it is not ME who is the one with blinders on.  Why would someone.. who isn't interested in seeking knowledge.. ask such questions.  I shake my head at your comments.  I truly do.
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To: DD
Hm.  Out of the few studies I have had time, to read .. I didn't think I'd read anything about HOW the HCV mutants got to where they got to and definitive proof on that.. only that they exist.  Did I miss something?  And I'm not being facetious when I ask that question.  

From the bit I've read, it seemed to me that the only scientifically proven conclusion so far... is that existence of strains of HCV RNA in some form exist in body compartments and fluids other than the brain.  Nothing scientifically proven about how it got there nor what the implications are .. just that it has been found.  

If I missed that part ... I'm open to being pointed to it.  I just haven't had time to delve into it more than what I have to date.  

So..
HAS it been scientifically PROVEN how these strains got to these other body compartments and fluids?
HAS it been scientifically proven what the implications of this are?
IS there concrete data to support the two questions I have just asked?

If not... we are still at the conjecture stage on those two questions.  

If yes...then I am open to correcting my viewpoint once I've read the data that makes enough sense to me to do that.

Frankly, I'm getting a little tired of all your accusations.  

I'm not "choosing" to ignore what has been read.  
I'm not ignoring what I wish to and choosing to label it as conjecture.
I'm not making active choices about what I choose to understand and what I don't.

This is simply as far as I've gotten on what I have read already.  It would be reckless for me to call my own viewpoint anything BUT conjecture and unless I see that there is definitive data supporting the two questions I've asked above....it all remains conjecture to me on THOSE questions - A) how it gets there (does it mutate off? Is it independent from the HCV RNA in the blood?  etc etc) .. and B) what the implications are.  I accept that it exists.

Your ongoing accusations anger and insult me.  I would appreciate it if you would quit painting me as a close-minded fearful ignorant person who is not interested in the truth and would prefer to hide her head in the sand.  I would appreciate it .. but I'm not holding my breath that you will stop.

*Footnote.  I think it is a very good thing that I did not hold my breath, especially since it appears that the pack is growing.
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Sheesh!!!!  Well, now I guess you can see how I feel.  I am just not responding to the stuff above anymore!  Its a waste ot time and energy.  Glad to have you on the Forum.  I hope you continue to enjoy the discussions!

DoubleDose
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EspritLibre:  Whoops... didn't mention 'entertaining', but actually I didn't see that as much as I found part of the thread annoying and sad that interested parties such as ourselves have to wade through such opposition when 'studies' and 'papers relating to occult hep c' are being discussed in a reasonable manner - with DIRECT LINKS to same, I might add.  If a person feels uncomfortable reading such discussion or do not want to see what research is out there, why must they attack the messengers and those having open minds wanting to discuss same?  I mean.. for chripes-sakes... if opposing parties have STUDIES, PAPERS, LINKS from RESEARCHERS (DUH) showing that what is attempting to be discussed here then by all means I wish they would show it.
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Perhaps you could use some independent thought of your own, or wait until your eyeballs have recovered and read what I actually posted, rather than only DD's tirades and incorrect assumptions about my posts that I CONSTANTLY have to go back and correct because he has quite the knack for reading into everything I say.



I thought it was a discussion about strains of HCV RNA getting into various other compartments of the body besides blood and what the implications are.  

In DD's own words:  "How to INTERPRET this or what it all means is, of course open to further research, discussion, etc.  I don't think any of us have tried to say exactly what these findings might imply, or what the impact might be.  I do not see anything above that implies that.  "

IS it?  IS it open to interpretation?  Further research?  Further discussion?  

Then why am I being attacked for choosing to read the studies, then ask questions about my own interpretations to date, posting my opinions on same?  

Despite DD's comments, it seems that the interpretation has already been decided, the research to date is already conclusive and no further discussion is required other than for everyone to simply agree with the conclusions of those who feel they are right.

There is nothing wrong with feeling secure in what you have come to believe.  But do not state something like "How to INTERPRET this or what it all means is, of course open to further research, discussion, etc.  I don't think any of us have tried to say exactly what these findings might imply, or what the impact might be.  I do not see anything above that implies that.  "  if you are not willing to allow others the same right to do the same investigation, ask the same questions and come to their own personal conclusions.

I am not a sheep.  Have never been a sheep.  Last time I looked this is not a cult and any who are not true followers and don't toe the party line get ex-communicated..however, I am beginning to wonder on the "cult" thing because this discussion has taken on overtones of that sort of thing.

How about...instead of you continuing false accusations against me..... you actually answer my earnestly posted questions as I would REALLY like answers to those.  
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I was hoping to leave this thread for good, but you being a new member here, who just started treatment –  I wanted to add that while these threads no longer raise my hair as they did when I treating – I do share your frustration at how DD mischarterizes and personally attacks those who disagree.

He often insinuates that this topic gets people emotional and defensive, but it’s obvious to anyone reading this thread that he’s the one who gets emotional and defensive, as soon as anyone disagrees or calls him to task.

This is not a topic I’ve researched thoroughly, so have limited my comments mostly to what I consider DD’s incorrect conclusions (or however many ways he qualifies his statements)`from the study data he himself presents. And I do mention on occasion – thought it pertinent this time since  we got into this whole “prevailing view” nonsense -- what some of my doctors have said.

Instead of DD simply saying that that in his opinion the study data doesn’t support my doctor’s opinions – he chooses to attack and mock both me and the doctors. This is par for the course.

Trish, you’re on treatment now, the drugs can be rough, and really should garner your energy to that end. My only suggestion is to eiher ignore threads like these, or simply post your opinions and ignore what invariably will be a personally directed, ad hominem response.

Speaking of ad hominem, I'm of course doing the same right now   (talking about the person and not the topic) and for that I’m not at all happy, but felt it should be said, at least for your sake as someone both new here, and obviously someone very bright who has picked up many of these topics quite well in a relatively short period of time.

And taking my advice, I’m leaving this thread and going to enjoy the weekend. No need to respond.

All the best,

-- Jim
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Jim,  I am sorry you feel that I 'mocked you', but a little bit of light hearted humor should not get anyone that bent out of shape.  For someone who comes on as the resident 'know it all' ,and has been called to task on that behavior by other members in the past, you least of all should be calling the kettle black!  I am disappointed that you take my disagreement with your interpretation of this viral persistence issue so personally.  And I do think there may be more going on than many doctors realize, but I am not mocking them or you!  I am just saying that research may be ahead of their current views.

And for you to give a 'free pass' to the person you addressed above, for all the twisted misinterpretations she has been spewing out, I am really disappointed in you.  I thought you were more rational and objective than to do that.  You sound like someone who's ego has been offended, and you are lashing out to feel better.  I mean really!  Read all of her responses.

I always gave you credit for trying to look a both sides of an issue, and 'trying' to remain above the garbage, but today you just took a big swan dive right into it.  People can disagree with me all they want to, and they do frequently, but it does not bother me in the slightest, contrary to what you seem to think about my attitudes and behaviors.  

You strike me as the guy who can't handle it when someone contradicts your 'authoritative pronouncements', and today you just made it perfectly clear.  

So if you feel entitled to define me in your above post, then here is my synopsis for you.  It goes both ways Jim.

DoubleDose
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DD:  or all the twisted misinterpretations she has been spewing out,
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Qualify that, for you are surely speaking of me.  Quote my twisted misinterpretations.  I have surely quoted yours.  Quote mine.    

You insinuate that I am purposely twisting and misinterpreting.  I am doing nothing of the sort.  I am asking questions, conjecturing, forming opinions.....and you attack me each time.  You have consistently twisted MY words and I have been forced to come back to you each time and correct what you have said so that nobody will think that what I meant is how YOU have interpreted it.  It is beyond me how you can read into my posts each and every time I post them something that has nothing to do with what I was intending to convey.  All I can conclude is that the glasses you are wearing are so tainted that you are not capable of clear thinking any longer.

On that note....and with constant evidence to support that thought....I will read the studies posted as I said I was interested in doing, I will then read the comments posted here including your own because I am interested in various takes on those studies and I will continue to seek and learn.  What I will NOT do .. .is discuss it further with you.  I have been part of discussions on this topic with you before and they all devolve to the same point.  As they say.. the definition of insanity is to do the same thing expecting different results.  It is clear that it is insanity expecting to have a fair and open discussion with you on THIS topic.  Perhaps other topics it would be possible.  But not THIS one.  Whatever your personal investment in this topic is....you are too threatened by other points of view to engage in rational discussion.

Regards.

Trish

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You've gotta be kidding, right?

I am done responding to you, so read and research and enjoy.  Bud do not engage me any further, in any way.  Thanks you.

DD
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Avatar_m_tn
Hey trish, don't let him get to ya. He did the same thing to me back when I was treating. I spent from 05 thru 07 on this forum ( I didn't read all of the 100 posts above, but I hope someone has explained to you that this is a pattern with DD) treating and spent lots of time on this forum while I was on tx since I was in bed 90% of the time! Im SVR now (HOORAY) and don't visit often now that I feel good again! My POV:

In a nutshell, he thinks in spite of the fact he cleared the virus, that somehow it is responsible for his ( and his families' believe it or not!?) current ills. He has blamed almost every common human ailment under the sun on HCV and he uses these " persistent/occult" studies to try to shore up his theory. Needless to say, this current study isn't helping his argument.
Honestly, I came to the conclusion after reading his exhaustive posts for years that he and his family might be suffering from some enviormental pollution or allergies given the symptoms he described but he was not receptive to the idea it was anything other than HCV had come to attack he AND his family in some hidden way in spite of being SVR and in spite of his family never having had HCV.
I say this so you don't waste your energy trying to have a discussion with him on this subject. First, all the info on both sides of the aisle are theory at this point, there is no defined "truth" but thousands and thousands of SVR patients showing not one scintilla of evidence of illness from HCV speaks volumes to me. My doc is on the YOU ARE CURED WHEN YOU SVR team, and that is good enough for me. There are docs in the maybe you aren't cured camp yet they can't offer up documentation for that position, I think they say that to cover liabilities, personally.
A perponderence of evidence shows that SVR after treatment with Interferon/Riba = CURED.
You can't rationalize with irrational people, so don't waste your breath. You need it for your treatment!
I do try to read some here and try to contribute as feeble as those attempts have been lately. I am full tilt back into getting my business off the ground and busy and thanks to SVR have the energy to do so!
There are many new people here that seem like wonderful additions to the crowd including you.
I hope tx isn't being too hard on you. Someone taught me a trick here long ago that really worked for me well and it was to look BACK and be proud of all the days you have done rather than focusing on all the days ahead that can seem to stretch on forever. It helps in those discouraging moments!
Hang in there and don't forget to drink that water!
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Avatar_n_tn
Gee, thanks for the nice and supportive comments.  Maybe next time you respond to a thread you could actually read it first, as you state that you did not do.  I remember you were the one who always jumped all over me when I discussed the studies on persistent virus, and like some others, reacted angrily when I asked questions that you didn't like.

Your comments above show exactly what you are all about.  We were discussing the validity of various research studies having to do with occult HCV, early in the thread, before you barged in and started slinging mud.  No need to actually read anything though, because that has always been your style.  Willing, and TnHepGuy listed a long array of studies regarding finding persistent replicating virus after SVR.  If you want to attack that premise, go right ahead.  It just reveals your scientific approach to the subject.

Would you like to contact the research doctors in the various studies to tell them what you think?  In the meantime, instead of recklessly attacking someone without even think about the context, or without reading the posts, why not just go back to whatever...Oh never mind!
,  

You don't want to see studies, or discuss science, you just want to slam people who do not share your point of view, or who pose difficult questions.  Yes, I remember you very well.

DoubleDose
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233616_tn?1312790796
If you follow the premise of shingles virus being the reememergence of chicken pox left hiding in the spine, then it follows anything is possible. If you read of the demylinization of former polio victims in later life, you can readily conclude that things that weaken us at any time of life can also predispose us to later injury. There's even research linking the Hep A and B vaccines with a greater risk of diebetes (diabetes)....nice to know after they forced vaccinations of every child....the research not withstanding.

The thing is, you can be cured of cancer, defined as 5 years free of any sign of the disease and yet still get a reemergence of that same cancer 10 years later.
Why the same cancer becomes the question then.

that's not to say we know the reasons or will soon. Does that cancer have a genetic origin or a trigger such as a virus, or something even smaller we do not yet know of.
Something we may need more than an electron microscope t even see....it's still a possibility. One we can hpe is not true, but yet we know there are flks who will explore it...because they want to find AND kill it...i.e. cure us.....for which we all should be greatful...grateful even if, and while, it may scare us.

I'm not saying any of this to scare anyone, or defend anyone's position, just saying....
it wasn't long ago doctors thought is was an insane idea that there were even germs, or that thye should wash their hands...

we've come a long way since then, and have further to go.

Meanwhile, we are all effected with being brn into a world where we will be coated with billions of bacteria on our skin, in our throats, and thrughout our systems from birth to death...and none get by without being host to billions of critters.......we are covered in them...to the same extent our planet is covered with trees and people.....and sooner or later.....we will return to the dust we came from....irregardless.


My concern is not...will something come back in years, my cancer may, it been gone 14 years and I lose no sleep but hey, and my HCV could, assuming I ever get to SVR which I haven't...but meanwhile I try t comfort myself that those who are around me  are relatively safe, and not sick from years of my saliva etc...because otherwise I'd go bonkers...and because lives lived in fear are full of torment...because each day is a present, our only present, we just need to focus on how to best live each one out.

maryB
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Avatar_m_tn
I didn't know how you arrived at that description: "voice of moderation".
I was going to post then but I figured I'd let it go. Well, I did but as it tuned out it's clear that it wasn't even close to being accurate.
Mike
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264121_tn?1313033056
I sometimes wonder, and I'm sure this is unpopular, but I wonder if there aren't a small percentage of people, who continue to abuse substances after or during treatment - thus causing risk of reinfection.

Due to the fact that I was a social worker prior to going into sales, I realize that the first place some people find out they have HCV is in jail.  Others find out while selling their blood - or is it plasma? I can''t remember which - but at any rate, it's frequently done to help support a drug habit.  

So these people just out jail and people with substance abuse issues are at higher risk of using again either during or after their treatment.  And I don't know that they would necessarily tell researchers.  I suppose there is some monitoring of the blood to test for other substances during studies, but I'm equally certain it could be fooled if someone wanted to badly enough.

Anyway, it would explain viral loads after tx.
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Avatar_f_tn
Thank you TnHepGuy and all others participating in putting the Health Page "OCCULT HEPATITIS C" together.  http://www.medhelp.org/health_pages/Hepatitis/Occult-Hepatitis-C/show/54?cid=64
As mentioned yesterday, after giving my eyes a well needed/deserved rest, I would  return to examine thoroughly each link (Studies/Conclusions - Occult HCV) on the HEALTH PAGE.   I noticed as I read through a link, to the right there would be 'links of interest'... wow - but reading further, I would see that too would be listed - so this is an extensive AND APPRECIATED list!!!  This is very interesting research going back to 2004, as well as presently ongoing research.  I find it fascinating and have appreciated everyone's input on this.  Again... keep this info and discussion going!  We are all in a learning stage... even researchers themselves!   Although there's room to debate speculation, we certainly cannot refute what's been evidenced.  Thank you for gathering all the studies all into one easy area to access!!  
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