READY FOR SEX DO I TELL ABOUT HEP-C

[laytex]

I HAVE BEEN DONE WITH TREATMENT FOR A FEW YEARS NOW. I WAS MARRIED 16YRS. FOR THE PAST 2YRS I HAVE BEEN SINGLE (WITH NO SEX/DATING).I AM READY TO HAVE SEX. IT IS NOT A IN LOVE RELATIONSHIP JUST DATING. DO I TELL HIM I HAVE HEP C OR DO I TAKE ALL PRECAUSIONS AND SAY NOTHING. FOR THE LAST TWO YEARS I HAVE AVOIDED SEX TO AVOID THIS ISSUE. THE LACK OF LIVING/LOVING ISOLATION IS JUST TO MUCH ANY MORE. AND IF I TELL HOW DO I DO IT AND WHEN? SCARED AND CONFUSED

[mikesimon]

I try to be careful not to discourage or depress anyone and so a lot of the time I stay silent when I see threads like "Is there a cure?". I have been surprised and dismayed by what I have learned about HCV but I just can't slam shut Pandora's Box. And, as a practical matter for the majority, SVR is an end to their worries and I think it deserves to be. But, as much as I hate to be the bearer of bad news, I hate it more when I see misinformation go unchallenged. This isn't a game where winning an argument should be the overriding goal but rather the primary goal should always be an honest and open search for the truth about this devious disease. I get very disappointed when a sincere question ends up devolving into this kind of nonsense. But, HAPPY NEW YEAR - IT'S GOING TO BE A GREAT ONE. How do I know? My latest labs were fantastic! Mike

[mikesimon]

I am beginning to believe that for some this board has become their universe or their raison d'etre. And being the smartest or the winner is more important than anything else - including accurate information. I think you and I have gone over the line on some previous occasions and I promised myself that I wouldn't get mean or personal. I don't think I have but at times like this when someone makes it so adversarial it is trying just to remain civil. I don't think it should be so difficult to admit a mistake or even to apologize but, apparently for some it is.
Again Scott - Happy New Year and promise me you won't drink or smoke the evilest weed in the universe -  a weed more powerful than a locomotive - able to stiffen soft livers in a fleeting instant. Promise me Scott. Okay, I feel better now.
Mike

[mikesimon]

Have I wished you a Happy and a Healthy New Year? If not, I do now. Take care and stay well. Mike

[mikesimon]

Why didn't you just say that, and only that, and refrain from your misstatement of facts? I never took issue with anything you just wrote in your last post. If you really read and understood what I wrote you wouldn't have had to re-frame the issue to prove your point because I never said that SVRs could transmit the virus. I said we don't absolutely know this to be true and the articles I quoted from and referenced suggest that whether SVRs are still infectious remains an issue. It was your absolute and unsubstantiated conclusions about SVRs not having the virus that I took issue with and you were wrong that you cannot refute - nor can you admit it. But, I was foolishly optimistic thinking that you would or that you could. Happy New Year. Mike

[Kalio1]

Still not one shred of evidence that any SVR can possibly pass on this virus to any living soul. No links. Nothing. Of course I knew that, because the fact remains that once you are SVR, you are incapable of transmitting this virus to another person. That was the only issue. Undetectable by PCR after a year means you are SVR and can not pass on this virus. All the rest is just you guys obfusticating and has nothing to do with the issue at hand.

[mikesimon]

You say: "There is no evidence that undetectable levels of virus can be transmitted." I never said there was. I simply said that we really don't know this with absolute certainty.
What you said and now appear to be retreating from is that SVRs do not have the virus in their serum. That isn't supported by the evidence that is currently available unless you want to qualify what you mean by your statement: "SVR's do not have virus in their serum". Now you say: "it doesn't matter if it can be found at "undetectable" levels, it isn't replicating and harming the patient nor is it transmittable to others."
Again from the Tram article:
<B>"Although these patients generally exhibit histologically apparent improvement after IFN-alpha/Ribavirin therapy, including partial regression of fibrosis, liver biopsies from many of them show evidence of persistent minimal inflammation or even of active chronic hepatitis."</B>
And also from Tram:
Furthermore, the persistence of traces of <B>replicating HCV</B> in lymphoid cells, from which viral infection may potentially rebound under favorable conditions, suggests that future treatments aimed at HCV elimination should take into consideration that both the liver and the lymphatic system are the sites of virus propagation.
You ask for evidence that SVRs can transmit the virus. What I have consistently said is that I believe and what the anecdotal evidence supports is that it is very unlikely that an SVR can transmit the virus but that we really don't know about this stuff. I did quote and I will again from: http://www.springerlink.com/content/h8767181tw711422/
"The precise significance of the HCV persistence in the host organism is still inconclusive; according to first research results, <B>however, it can lead to a deterioration of the liver histology. At present, it is also unclear if patients with occult hepatitis C as well as with evidence of HCV RNA in the liver and/or extrahepatic compartments after seemingly successful antiviral treatment are to be regarded as infectious</B>."
I have to say that Scott is right when he charges you with re-framing the issue so that you come out right, or seemingly so.
The point I tried to make and am still trying to make is that this stuff is still unclear and you should refrain from making blanket conclusive statements like "SVRs do not have the virus in their serum" when the Tram article and others scholarly studies in this area suggest that is not the case. Why are you so  incapable of admitting that you overstated your case and incorrectly stated the facts? That doesn't mean you're a bad person or not an intelligent person - it just means that some of your statements were inaccurate. I'm finished with this subject for now and I will allow the articles that I quoted from and  referenced to speak for themselves - and they do so loud and clear. Mike

[Kalio1]

PS trying to make the leap from occult virus to transmission is just that, a leap. This study does not in any way conclude that finding occult virus then indicates transmission is possible, far from it.

In my view, the Tram study has nothing to do with the point of the discussion, the discussion is if it was possible to pass on this virus once you are SVR and the answer according to all authorities I can find is NO, you can not pass on a virus you don't have replicating in your blood.


Sexual contact is considered a RARE form of transmission anyway even if you DO have replicating virus.

Why people here would overblow the risk is beyond me. That is the last thing we need, more stigma and false info. To extend that to ALL SVR's, and suggest they can in any way be contagious is beyond belief to me. That just is not true and scares people for no reason. The Tram study in no way suggests that people with occult virus can pass it on to others sexually!
We are talking about normal human sexual interaction, obviously a transplant situation would be a different scennario. The average person does not "interact" with other humans by exchanging organs, on that I would hope you agree. Having sex is a far cry from sharing organs.

SVR's can be confident they are not capable of passing this virus to anyone sexually and that they are no longer contagious to others in any way.

[Kalio1]

There is no evidence that undetectable levels of virus can be transmitted. If you have some info showing that it can be, I'd like to see it. People who acheive SVR are considered free of this virus and there is no evidence there is even a remote possibility of passing it to others.

The fact that some viral particles could be found through extensive testing does not mean that it can be transmitted nor does it mean the virus can even replicate. In fact, the evidence I have seen all shows that it can NOT be transmitted and that it does NOT replicate, it doesn't matter if it can be found at "undetectable" levels, it isn't replicating and harming the patient nor is it transmittable to others.


SVR's are considered DISEASE FREE. You can not pass on a disease you do not have. You can find evidence of many past illnesses in humans, this in no way means you can pass that illness on nor does it mean you "have" that illness any longer. No one has posted any info to the contrary, if you have some data showing there is even a remote possibility of SVR's passing undetectable virus on, then let's see it.

[mikesimon]

You say that SVRs do not have virus in their serum. Will you not admit the possibility that in some SVRs the virus may still be in their serum but at levels that are below the level which current tests can detect? That is really what I was saying. 6 years ago the RNA/PCR tests that were available were not capable detecting the low level of HCV they can today and therefore people were considered clear when they weren't clear - yeah, I know, they would rebound once they stopped TX and show the virus but that's not the point I am addressing. Today we have tests that detect 5 and 2 IU/ml but in the future tests might be far more sensitive and perhaps we'll see tiny traces in serum in cases where it was presumed that no trace existed. I wasn't taking issue with your position that SVRs couldn't pass the virus. It was your flat out unequivocal statement that SVRs don't have the virus that I believe is inaccurate. The fact that some doctors use the word "cure" doesn't convince me. You know my situation Kalio - how do you explain me? You might say it's the immunosuppressive drugs that I take or the fact that I am a transplant recipient but I don't think those factors can explain the fact that I have been serum undetectable <5 IU/ml since April 2003 and stopped TX June 2004 and test undetectable monthly and yet I still showed HCV on biopsy in June 2006. I think it is clear that I, like other SVRs who have shown HCV on biopsy, still do have the virus. Now, that doesn't mean we can transmit it sexually or otherwise but I really don't know that for a fact. I had a lot of partners in the 70s and 80s and early 90s and never infected any that I know about and I contacted quite a few of them so it isn't easy to transmit the virus when you have a high serum VL. You also say: "The only possible way to pass it would be through a transplant not through any other normal human interaction." I just don't know how you can make these statements Kalio and that is really my problem with your post. You arrive at conclusions that are not supported by any serious research studies with which I am familiar. The research into SVRs is still in its infancy and I am not prepared to make categorical statements about what is or isn't a fact regarding any of this stuff. I know we want to believe that once we attain SVR status that we are cured and HCV will never rear its ugly head again but, as yet, I don't think that has been proven. A major immune treatment has triggered a "relapse" in at least one patient that I have read about and if, in fact, the virus was not there how could anything trigger it, aside from a new infection?
From the Tram article @ http://jvi.asm.org/cgi/content/full/78/11/5867?view=long&pmid=15140984
"The present study shows that HCV RNA can persist, albeit at very low levels, in the serum and circulating lymphoid cells for years after apparently complete clinical and virological resolution of chronic hepatitis C. If the present findings reflect the existence of the biologically competent, infectious virus, this silent persistence may have important epidemiological and pathogenic implications. Among other factors, these trace amounts of the virus may lead to reactivation of hepatitis C after termination of antiviral therapy or due to severe immunosuppression and may support perpetuation on the subclinical level of liver disease which becomes symptomatic years after exposure to the virus. They may also constitute a source from which HCV may spread through blood and organ donations to susceptible individuals."
From http://www.springerlink.com/content/h8767181tw711422/
"Despite favorable longterm data with regard to viremia, liver histology and serum liver enzymes in treated patients who comply with the criteria of sustained virological response, a complete elimination of the hepatitis C virus (HCV) is rarely observed. Besides liver tissue, peripheral blood mononuclear cells (PBMCs) could be proven as locations of HCV persistence."
And from the same article:
"The precise significance of the HCV persistence in the host organism is still inconclusive; according to first research results, however, it can lead to a deterioration of the liver histology. At present, it is also unclear if patients with occult hepatitis C as well as with evidence of HCV RNA in the liver and/or extrahepatic compartments after seemingly successful antiviral treatment are to be regarded as infectious."
If you haven't studied the Tram article I suggest that you do because if you accept his study, and many experts in the field regard it very highly, then I think it is clear that your unequivocal statements about SVRs not having the virus are unsupported and are actually rather careless. I know that it feels good and sounds good but it isn't proven to be correct despite what some doctors might tell their patients.
Mike

[dragonslayer1]

Hi,

I think that you are kind and sweet for your concern for others. However, I have been married twice while with chronic hepC, the first time for 9 years and the second for 8 years. I didn't find out about the bug until about 10 years ago. Both spouses tested neg for hepc...and the first used to regularly use my razor on her legs! No, this razor sharing did not please me and ofcourse I did not yet know about the hepC, but the point is between that and lots of sex still NO transmission of the bug!

HepC is very RARELY transmitted via man/woman sex...it requires blood to blood contact. Knowing what I know about this now I do not  believe I would care to have a date spill out the whole story right off...even and especially if sex was in the air.

BTW...I'm in week 39 of treatment and tested "undetectable" at 12 and 24 weeks. Crossing my fingers. But honestly, even if my treatment turned out to be a cure, which is ofcourse my hope, I would not be put off or apprehensive about having a meaningful relationship with a partner with active hepC...including getting physical.

Hope this helps, John

[Kalio1]

SVR's do not have virus in their serum. No virus in your serum, how can you possibly be contagious? To suggest that people who cleared the virus could possibly pass it on, as was being done here, is what I took issue with. There is not one shred of data I can find that indicates that is possible. The fact that there is some evidence that the virus might be found in small amounts in our livers does not mean you could pass it on to others at all. Nothing indicates that has happened in all the people who have cleared this virus. Many doctors use the word CURED and tell their patients to go on with their lives, they are free of this disease. They are not instructed that there is even a remote chance of passing it on sexually or otherwise. The only possible way to pass it would be through a transplant not through any other normal human interaction.

[mikesimon]

Kalio said: "There is already enough stigma and misinformation surrouninding (sic) this disease, we don't need to add to that by suggesting it is possible to pass on this virus once you are SVR. It is not medically possible to pass something you don't have to another person."
The fact that one is SVR doesn't necessarily mean that one does not have the virus. While some people apparently do completely eradicate all traces of the virus others reach SVR (serum undetectable 1 year post TX) and still have evidence of the virus. We've all read the articles or references to them. I am not disagreeing with your assumption Kalio that sexual transmission is very, very, very unlikely (it's difficult enough to transmit with active high VL HCV in a monogamous heterosexual relationship) but to say it is impossible might be reaching just a bit. The fact that there are no documented cases of transmission by an SVR is compelling but considering the amount of research on this particular issue I don't think it is conclusive - at least not yet anyway.
Mike

[Kalio1]

The only one spreading misinformation is you. As usual you labor under the misconception that if you say it loud enough and often enough it would be true and as usual, you are wrong.

[Kalio1]

the whole issue was not even about people who have HCV at all, it was about people who do NOT HAVE HCV and are SVR so your data isnt even on point. Just more vitriol and hot air as usual.

Of course, there IS NO DATA showing anyone who says HCV can be passed in ANY manner if the person is no longer HCV positive and has obtained SVR. You must tell if you are still positive, there is no debate on that subject.

Try to keep your info on point.


There was never a debate over telling partners you have HCV if you are positive at all, of course you should.
This woman did not know if she is SVR or not.
ry reading the text before you respond with off topic info just to try to create controversy.

I notice you cant provide one shred of data showing SVR's can pass on a virus they no  longer have, because that is impossible.

[Myown]

you did the right thing, good for you! it is common sense that this can be trasmitted through sexual contact. studies are good to read,,but this is just simple logic,,you CAN get hep c through sex period.

you'll meet someone in time. don't worry about being alone the rest of your life. maybe ask your doc if the local hospital has a hep c support group. it would be great to meet someone there!

good luck,,,you'll be fine.

[Kalio1]

You really need to have a PCR DNA test to see if you have a viral load since you don't know and you did go through treatment. You need to find out if you still have Hep C.

Here is a study on sexual transmission, and as you can see by the conclusion posted below, the risk is extremely small. This was a large study.

"Conclusion
These findings indicate an extremely low or even null risk of HCV transmission within heterosexual monogamous couples."



here is the link:

http://www.hepcassoc.org/news/article86.html

[laytex]

it was the hardest thing i ever done, harder than that damm treatment that almost killed me. but i told him and he was very nice not at all what i excepted. it wont go any further but i did what was right thank you for your support. i was asked doesn't treatment make it go away, well i was unaware that it could i am going to the dr to get the suggested test.
you are right by not telling i take away there choice and i never wont to do that. i wished i had this place when all this stared it would have been nice to have a place to go when i was really sick. i know i can not do this each time i go out with some one. i can't handle the emotions here. maybe i should just not have sex and keep things at friends. its hard to be alone all the time. its alomost like what was the point of surving. sorry i am a wreck

[AMAZED]

Laytex,
     First of all being coinfected with HIV and HCV like me is the last thing you want to be dealing with.  I know what it is like to be alone.....not even dating......nothing, but that is my choice. I still have people asking me out or for my number, believe it or not.  What you have to remember is that if you decide not to tell him or anyone for that matter then basically you've made the choice for them.  You have taken the choice away from them.  It isn't a question of should I tell or not, you have the responsibility to inform.  You don't have a choice, they do.  Whether they choose to be with you or not, then it's their choice.  What do you have?  Not only the morning after with a clear conscience, but someone who in the long run will thank you and respect you.  Character....is what you are even when you're alone.  You have the responsibility.  So please whatever you decide, ALWAYS keep it safe.  Trust me if you are one that has gotten rid of HCV....you DO NOT want to get something that you can't wash off.  I am doing great on the meds for HIV, and I will soon start with the tx for HCV with hopes to rid myself of it.  

In Him,
Rick

[Kalio1]

B the way, RTS had a false positive test, he was and is clear of the virus according to several tests he had subsequently.

[Kalio1]

I didn't in any way say she shouldnt tell if she is not SVR however if she is SVR there is nothing TO TELL because she can not pass on a virus she does not have and she no longer has HCV. She was unclear on that issue but if her PCR's are clear, she is fine .

You can indeed KNOW you are SVR and not infectious one year after she is SVR on her PCR she is done with it. You can know to a great certainty at 6 months but to be absolutely sure, one year.

As to the extremely low low chance of it returning after a year, nothing in life is 100% but the chance is so rare she would be more likely to be hit by lighting while winning the lottery.

Aside from that, sex is not a likely way to contract HCV, if it was, it would be considered a sexually transmitted disease and it is not a sexually transmitted disease.

There is already enough stigma and misinformation surrouninding this disease, we don't need to add to that by suggesting it is possible to pass on this virus once you are SVR. It is not medically possible to pass something you don't have to another person. Once you are SVR, you do not have to notify anyone of having this unless you decide you want to tell them for another reason, not because you could pass it to them.

[Better_Angels]

When are you SVR? 6 months, one year, two? You cannot answer that. In fact we cannot even be 100% confident in the PCR results, as evidenced by what RTS just experienced.

This is not something to be withheld from an intimate partner, period. Strangers, co-workers, the milkman, the mail carrier?  perhaps. But, to suggest the concept of "don't tell" when it comes to having sex, promotes irresponsible behavior.  

Since I don't have HCV, I can speak for those of us who would be at risk from a partner who does not disclose the truth, even if those odds are nearly non existent. We have the right to go into this with our eyes wide open.

Obviously we don't see this issue in the same way, so let's just agree to disagree. I hope you and yours enjoy peaceful and hopeful holidays.  

Debbe

[Better_Angels]

No disrespect, but I emphatically disagree with Kalio. When is one actually SVR? There is much speculation and debate about that, and as long as questions, any questions regarding SVR persist, it is misleading to proclaim that there is no risk involved.

As I stated above, there are just too many unknowns. No one has the moral right to expose another person to risk without informing that individual, regardless of how minuscule the odds are. It has to be their choice, not yours.

[Kalio1]

Once you are SVR you can NOT pass this virus on to anyone. There is not one shred of data showing you can. SVR means you are no longer infectious and no longer able to give it to anyone in any manner.

[Kalio1]

If Laytex is SVR, then she does not have the virus, so she has nothing to tell. She cant pass on a virus she does not have. She needs to use condoms for OTHER reasons but not due to her having cleared HCV.

If she wants to tell him that she had it in the past but has cleared it and is no longer HCV positive, that is a different story.