Q about passing on hep C

My partner has hep C type 1, I have type 2 B.  Have anyone ever heard of of the type changeing once transmitted another person?  

I went to my first dr. appt with the hep dr.  She told me with all my other test results so far (no biopsy yet) and risk factors, that she would bet I haven't had this for that long.  She wants to do some research on sexually transmitting from one person to another to see if the hep c would mutate into a different type.  she doesn't think it's it probable, but wanted to check it out none the less.  Has anyone ever heard or read of anything like that happening?

She put in an order for a biopsy, so we will know for sure after that, but she would bet that I have a little or no damage to the liver based on what we talked about today.

[adamben101]

Do you have any other risk factors that involve blood?  IV drugs, cocaine, getting in a fight, etc?

[1oftheclub222]

My mother has had HCV since before I was born, I did some coke in the 80's (no needles, but did share straws), had my mom live with me about 2 years ago, she stayed with me for about 1.5 years,  she is full care and use to fall a lot, always hurting herself and bleeding, etc, then there is my partner who I have been with for 11 months.

My doctor said being born with it, or sharing straws is possible to transmit, but a low percentage rate of that happening.  I know it is even lower to be sexually transmitted, and my mom would have had to bleed on an open wound of mine to transmit.

Basically I could have had this for 50, 30, 5 or 1 yr.  I think she was trying to get a handle on liver damage possibility.

[nygirl7]

No genotypes dont just change themselves.  If you knew what geno your mom was it might line up but many people get hcv and never know where they got it from.  It doesn't really matter the only important part is that you know so you can treat it. The rest heck could have been a dentist a few years ago or something like that (not to pick on dentists)........

[1oftheclub222]

Yeah, don't know what type my mom is, she's had it for 50+ yrs, did the liver biopsy maybe in the 90's, but never wanted to do treatment (she hates western medicine).  She has a bit of dementia now, it's hard to know what information is accurate and what is something she imagined any more.  I did ask her, she just it's C, ha.

[orphanedhawk]

Like nygirl said, genotypes don't change.

And hep C is rarely spread sexually.

How or when you got it is moot.
Once you have the results of your biopsy, you can move forward.

  

[can-do-man]

"She wants to do some research on sexually transmitting from one person to another to see if the hep c would mutate into a different type"

Shes a Hep doctor yet doesn't know this???

[DoubleDose]

Wait...you, your wife, AND your Mom have HCV, and there seem to be no apparent risk factors....and people think there is NO CONNECTION....????

The FIRST thing I would suspect is transmission.  What are the odds of three people so closely related, without big risk factors, all having HCV.  The genotype thing doesn't really answer anything to me.  Who knows how the genotype issue really works, or if there are dominant and minor strains, that may manifest differently in one person and another.  I think its illogical to dismiss something that is so overwhelmingly a big red flag....three people together all with HCV....I wonder how many families with no risk factors have that situation, with all three being infected accidently, separately and without any relation to one another's infection???  I would explore the obvious...There is still MUCH that we don't know about this virus.  DD

[1oftheclub222]

she said she had never seen it, and didn't think it could happen, but wanted to research it to see if there were any studies out on it.  she thought I may have just gotten it, maybe because I had a normal liver ALT/AST in 2007 and she didn't see any signs of advanced liver disease so far in any of blood work or my ultra sound, or physically.

We were discussing treatment options at the time.  She had said that my viral count was high (2.4 million), which put me in a category for treatment, but all my other tests were good, and she couldn't see any physical symptoms that would suggest advanced liver damage so far.  She was thinking it was fairly new, which is what made her suspect my partner, but he has a different genotype then I do.  She said it was up to me ultimatly if I want to do treatment, which we will discuss after I get the biopsy results back.

[willbb]

You say your hep doctor? Is this a Hepatologist or a G.I who possibly may not be as informed as usually a Hepa is??
She has made some odd statements to you it seems :

she thought I may have just gotten it, maybe because I had a normal liver ALT/AST in 2007 and she didn't see any signs of advanced liver disease so far in any of blood work or my ultra sound, or physically.

Having normal  liver enzymes 4 years ago will tell her nothing about when you may have contracted HCV,and  most often the only signs of advanced liver disease she would see is when she does the biopsy. Often all the blood labs are perfectely normal (mine are after 36 years infected) Ultrasounds ,also are not at all telling about how long you have been infected or usually how fibrotic your liver is  and physically many people look just fine ,even right up to liver failure decades into the disease.

She also says??
" that my viral count was high (2.4 million), which put me in a category for treatment, but all my other tests were good, and she couldn't see any physical symptoms that would suggest advanced liver damage so far.  She was thinking it was fairly new, "

Viral count has no bearing to catagorize anyone for treatment and how you look physically ..again ..will tell her nothing about how long you have had HCV or damage to your liver.

Just mentioning this,,as you would want only a knowlegable doctor treating you thru therapy as there is a lot at stake.....

Best..
Will

[1oftheclub222]

Her specialty is Hep C and HIV.  I may have misunderstood or not translated it well it my message, but she did say she wsa going to look up about the transmitting stuff.

There were only 2 options for me to go to in my medical group (both in infectious disease) and the other guy looked old and grumpy, ha.

Maybe she said the high viral count put me in a category for liver biopsy?  she said not all 2B's need to get liver biopsies.  My head is spinning form all this, i tried to write stuff down, but very likely got some of it screwed up!

[willbb]

It can get somewhat confusing  :)  Just take it a bit at a time possibly.
When and how you contracted HCV,as others have said really is irrelevant at this point.

You have Type 2 which is very treatable with the combo of INF/RIBA usually for 24 weeks.

Really ,it is just a matter of when  you are ready to tackle it ...

Good luck.....
Will

[1oftheclub222]

if i just got it, or got got it in the last 3 yrs or so, I wouldn't really need to tell my ex husband or worry about my kids so much.  the only reason i wonder about that really...Not looking forward to telling him

[eureka254]

My understanding is that one hcv genotype cannot mutate into another genotype in the same individual.  However, in cases where it *appears* that one person had one genotype that then "changed" to another, the cause has been determined to be not mutation, but either one of two factors:  (1) re-infection, or (2) genotype dominance.  If you're looking for a quick reference to explain it all:

Title:  "Multiple infections with different HCV genotypes: prevalence and clinical impact."
Authors:  Schroter, Matthias/Feucht, Heinz-Hubert/Zollner, Bernhard/
Citation:  Journal of Clinical Virology Jul2003, Vol. 27 Issue 2, p200  
Year:  2003  

Abstract:  Background: In a HCV genotype 3a-infected patient, viremia with a different genotype (1b) was detected after 16 weeks of ineffective therapy. Serological typing revealed that this genotype had already been present prior to therapy. Objectives: To investigate the epidemiology of multiple HCV infections and the therapeutical consequences for patients superinfected with a new HCV strain. Methods: Sera of 600 patients were screened for infection with multiple genotypes by using sequencing and a serological assay in parallel. Results: Infection with two different HCV types was detected in 13 patients. The prevailing strain was genotyped by sequencing. From two of these patients additional sera were available which had been drawn up to 24 and 28 months prior to the current sample, respectively. Those early samples showed viremia with a HCV subtype that could not be detected by PCR afterwards. Only antibodies to the initial strain were detectable in the later samples. Conclusion: In patients serially infected by different HCV strains, one strain will prevail as the viremic virus. Under antiviral therapy, the displaced strain may become viremic again and may influence the outcome of therapy. Detection of inferior strains by serological assays before antiviral therapy may be important for choosing the adequate regimen.

Hope that helps. ~eureka

[DoubleDose]

And the study you post is also one of the reasons I think the virus could potentially transmit and activate in another individual with a different genotype taking dominance...it may be a matter of individual resistance or antibodies, or who knows what!  There is still little knowledge on how the genotype, or multiplke genotype thing works, and in a cans of transmission, probably even less knowledge.  Still I say...three closely related family members, no real risk factors, and HCV in all three....if there is no transmission taking place in this scenario..then what ARE the odds of this happening under one roof???  Three different infections, with no risk factors.  There is still lots we are not fully clear on regarding transmission..   This is a very unusual and perplexing situation.

DoubleDose

[DoubleDose]

meant "multiple genotype"...and "in a case of transmission"  I need to edit more carefully.....   DD

[eureka254]

Certainly more questions than answers, but I think the odds are more likely that the spouses had separate infections... theoretically speaking the possibility does exists that one partner infected the other and individual response generated a different dominance in each, but a less likely scenario than the former.  As an hcv-negative spouse for 25 years to an hcv-positive partner who took no precautionary measures, I'm of the camp that 'household' transmission is extremely low.  

However, in regards to mom/child, until we know what genotype mom is, vertical transmission can't be ruled out considering the age of the OP. ~eureka

[eureka254]

"took no precautionary" precautions: I should explain we were unaware of his hcv infection, not because he was careless :).

[suezeeque]

You can very well drive yourself mad trying to figure out when/how you got it.  What's the point?

Move forward.

[DoubleDose]

Agreed, its enough to make one crazy....but it raises issues for researchers to look into...always learning more about how the virus acts.....  Its a real riddle in this case...but may provide more knowledge....  DD

[eureka254]

"There is still little knowledge on how the genotype, or multiple genotype thing works"

My understanding of virology isn't very good, but I do believe folks in the field have a pretty good understanding as well as appropriate nomenclature for what constitutes a genotype and subtype and what distinguishes one from the other.  The delineation of wild-type, quasi-species, and different mutations within subtypes seems to be agreed upon enough that 'origins' can be well-delineated if investigated correctly.  The riddle continues to unravel.

"NS4A protein as a marker of HCV history suggests that different HCV genotypes originally evolved from genotype 1b."
Author:  Muhammad T. Sarwar; Humera Kausar; Bushra Ijaz; Waqar Ahmad; et al  
Citation:  Virology Journal 2011, Vol. 8 Issue 1, p317-335  
Year:  2011  
Abstract:  Background: The 9.6 kb long RNA genome of Hepatitis C virus (HCV) is under the control of RNA dependent RNA polymerase, an error-prone enzyme, for its transcription and replication. A high rate of mutation has been found to be associated with RNA viruses like HCV. Based on genetic variability, HCV has been classified into 6 different major genotypes and 11 different subtypes. However this classification system does not provide significant information about the origin of the virus, primarily due to high mutation rate at nucleotide level. HCV genome codes for a single polyprotein of about 3011 amino acids which is processed into structural and non-structural proteins inside host cell by viral and cellular proteases. Results: We have identified a conserved NS4A protein sequence for HCV genotype 3a reported from four different continents of the world i.e. Europe, America, Australia and Asia. We investigated 346 sequences and compared amino acid composition of NS4A protein of different HCV genotypes through Multiple Sequence Alignment and observed amino acid substitutions C22, V29, V30, V38, Q46 and Q47 in NS4A protein of genotype 1b. Furthermore, we observed C22 and V30 as more consistent members of NS4A protein of genotype 1a. Similarly Q46 and Q47 in genotype 5, V29, V30, Q46 and Q47 in genotype 4, C22, Q46 and Q47 in genotype 6, C22, V38, Q46 and Q47 in genotype 3 and C22 in genotype 2 as more consistent members of NS4A protein of these genotypes. So the different amino acids that were introduced as substitutions in NS4A protein of genotype 1 subtype 1b have been retained as consistent members of the NS4A protein of other known genotypes. Conclusion: These observations indicate that NS4A protein of different HCV genotypes originally evolved from NS4A protein of genotype 1 subtype 1b, which in turn indicate that HCV genotype 1 subtype 1b established itself earlier in human population and all other known genotypes evolved later as a result of mutations in HCV genotype 1b. These results were further confirmed through phylogenetic analysis by constructing phylogenetic tree using NS4A protein as a phylogenetic marker.  

[roostermom]

I have type 1b and somehow passed it to my older daughter who also had 1 b. She was cured in the Incevik trial.

I waited until my younger daughter was over 18 to have her tested, and she is negative ( I cried like a baby when I heard that news!).

I have been married for 28 years and my husband does not have it either.

[nygirl7]

I had two separate subtypes 1A and 1B and both of them showed up perfectly well in my PCR, nothing changed or anything they were both always there till I kicked their butts!