Prednisone and HCV

[VXman]

I am most fortunate to have an SVR for 1.5-years. I was a successful statistic in a Prove 3 telaprevir clinical trial. Recently I developed a sinus infection (no relation) and was prescribed an anitibiotic and prednisone. I just started the antibiotic, but am delaying the use of the prednisone until I have an opportunity to speak with my past hepatologist. My father-in-law is a retired MD and told me that there was a remote, but none-the-less possible relapse of HCV due to the use of prednisone. I am inclined to disbelieve this, but do not want to gamble. I'm certain that I'll clear the sinus infection with antibiotics and nasal rinsing, without the use of the prednisone: however, I wanted to see whether their was any information regarding this issue. I performed a Google search and was unsuccessful in narrowing it down to my specific concern. Any information would be most appreciated. Lastly, for each of you living with HCV, keep your spirits high. Telaprevir and other medicines will radically change the SOC in the very near future. Vertex has indicated that it expects to file for a NDA (new drug application) in early 2011. The SVR rate for HCV is significant for treatment naive and experienced patients. I was a non-responder to Peg/Ribavirn. The clinical trial MD claims that I was undetectable within the 1st 2-weeks of my 24-week trial!

[Pharaoh]

You either have the virus or you don't.  It's a mutually exclusive proposition and a collectively exhaustive list.  HCV can relapse only if you still have the virus. You have a 1.5 year SVR, so the likelihood that you still have the virus is minuscule.  If you do relapse, then you were never SVR.  Those are the facts.

I would recommend that you not take the prednisone OR the antibiotic.  It's just a sinus infection, for goodness sake.  Unless your immune system is highly compromised, it is sufficient to deal with the sinus infection on its own.

My doctor proudly proclaims that he has the cure for the common cold.  Drink a glass of water every day for ten days and your cold will be gone.  100% effect.

[mikesimon]

My transplant center was not concerned with predisone post SVR... except when I asked about a bolus injection of Solu-Medrol. That is a gram (1000 mg.) of prednisone delivered intravenously in about 30 minutes. They weren't so sanguine about that scenario.
Did they know what would happen - relapse? No,they didn't. This was in 2005.
Along with the variables ML listed I think we might consider adding the amount of the dose of steroid administered. Nothing is really certain in this area, in my opinion.
Mike

[Mr Liver]

Since HBV and HCV aren't  in the same family of viruses, parallels may be impossible to predict and cause/effect on one virus does not confer the same trait to the other.  A hypothesis of immunosuppresant therapy as a cause of HCV reemergence has little evidence to support itself from what I have read. Many studies as you know have been done on this topic as it is of concern to those post-tp who plan to treat.  
ML

[Mr Liver]

can you provide the study in which someone was proven to relapse after 8 years ?
I've never seen a proven case of relapse beyond 3 yrs and even then most of the ones in reports and studies I've read who had late relapse beyond a couple of years are questionable.
ML

[Mr Liver]

marcia  - I don't think any conclusions can be based on this study.

" We report two patients that relapsed when immune suppressive therapy was given within a few weeks of achieving SVR."

The problem here is obvious. This is exactly in the time frame when the vast majority of people who relapse will do so, immune suppressants or not.

To all: Some may choose to characterize relapse after 6 mo post tx as "rare" but over a 1000 people last year in the US alone received the news that they hadn't been 'cured' as their doctors had told them. We've had a few pass through here in recent months. SVR status is not ironclad. It is not airtight. Yes, the odds are low that
relapse will happen. But it wrong to tell people that SVR at 6 mo post-tx that it is a definitive outcome, when it clearly is not.

[apache1]

While these isolated relapses are true, many mitigating factors are not included, such as the actual viral load before immune suppressant therapy. And the sensitivity of the SVR vl test used. I have seen these 2 case studies before.

As we have seen from past HCV occult debates on this forum, there are rare cases of low level HCV infections after SVR. The occult studies point this out and prove that sensitive testing is needed. Past tests with low sensitivity are not good enough to prove SVR in all cases. Don't get me wrong. I don't think very low level hcv infection is rampant, but it is a rare possibility as  McHutchison and Castillo's 'occult' studies have shown

So my question is, did these relapses come from a totally real SVR. Or did the immune suppressant therapy let the replication of an already present serologically unapparent, persistent and usually asymptomatic infection, termed occult or silent infection, now go unchecked and replicate to a full blown infection once again ?


Keep in mind there are case after case of immune suppressant therapy and chemo therapy not causing HCV relapse, and showing how durable SVR is.  I will find them to post latter.

I find this subject interesting because resolved HBV and immune suppressant therapy/chemo therapy, has regularly caused HBV relapse. The new protocol for anyone with resolved HBV,  is to go on anti viral hbv meds if  immune suppressant therapy/chemo therapy is needed.
As of now this is not the case for hcv SVR. To err on the side of caution, if immune suppressant drugs are not really needed, why take the chance. But on the other hand if they are needed, I would not hesitate in using them along with regular ALT, AST and PCR testing to monitor the chance of a remote possible relapse.

jmo
apache