SVR Eradicates HCV

[mremeet]

Not sure if this has already been posted, if so it bears repeating:

http://www.natap.org/2008/EASL/EASL_77.htm

"SVR Eradicates HCV

SUSTAINED VIROLOGICAL RESPONSE IS ASSOCIATED WITH ERADICATION OF HEPATITIS C VIRUS AND DECREASE IN ANTI-HCV TITER IN PATIENTS TREATED FOR CHRONIC HEPATITIS C

Reported by Jules Levin
43rd Annual Meeting of the European Association for the Study of the Liver April 23-27, 2008, Milan, Italy

M. Martinot-Peignoux1, S. Maylin1, N. Boyer2, A.C. Cardoso1, M.P. Ripault2, N. Giuily2, C. Castelnau2, M. Pouteau2, P. Bedossa3, P. Marcellin1,2 1 INSERM, U-773, Centre de Recherche Biomedicale Bichat-Beaujon CRB3 Hopital Beaujon, Clichy, 2 Service D'Hepatologie, Hopital Beaujon, Clichy, 3 Service D'Anatomie Pathologique, France

ABSTRACT

Background-Aim: Hepatitis C virus (HCV) eradication, in patients with chronic hepatitis C who achieve a sustained virological response (SVR), is still controversial. In this study performed in patients with chronic hepatitis C who achieved an SVR, HCV-RNA was measured in serum, peripheral blood mononuclear cells (PBMCs), liver and anti-HCV antibodies titers were assessed, during follow-up.

Methods: 278 patients with an SVR after treatment with IFN alpha-2b or PEG-IFN alpha-2b+ribavirin, were studied. HCV-RNA was tested: in serum for all the 278 patients every year and at the time of PBMCs or liver collection; in PBMCs in 71 patients 3.9±3.4 (0.5-10) years after treatment; in liver 38 patients 3.2±1.6 (1-5) years after treatment. HCV-RNA was detected with the VERSANT HCV-RNA Qualitative assay (TMA). In 142 patients HCV antibody titers were measured with the Axsym HCV 3.0 (Abbott), and with the third-generation HCV recombinant immunoblot assay (RIBA) (CHIRON RIBA HCV 3.0 SIA), before therapy and 4.7±2.2 (0.5 to 11) years after treatment. Liver histology was assessed in 92 patients with paired biopsies 1.4±1.9 (0 to 10) years.

Results:

Patients were followed up for a mean of 3.5±2.4 years (range, 0.5-17) years.

Serum HCV-RNA remained undetectable in all the patients (1050 samples).

None of the patients had detectable HCV RNA in the PBMCs or in liver.

The mean anti-HCV titers were 93±19 IU/ml and 45±21 IU/ml, before therapy and on the last serum sample available, respectively (p < 0001).

The most significant decrease was observed with anti-NS5 antibodies (p = 0.001); anti-c22 antibodies remained unchanged.

Normal serum ALT levels were maintained in 94%, fibrosis stage was improved in 57%, stable in 32%, deteriorated in 11% of the patients.

Regression of cirrhosis was observed in 7 of 10 patients.

Conclusion:

In our 278 patients with chronic hepatitis C and SVR, evaluated up to 17 years after treatment cessation, none demonstrated late relapse or the presence of HCV RNA in serum, PBMCs or liver.

HCV antibody titers showed a marked decrease. These results demonstrate a durable response to IFN alpha 2b or PEG-IFN alpha-2b+ribavirin and indicate that SVR is associated with HCV eradication and progressive decrease of anti-HCV."

[nygirl7]

Jim

I think it might be easier for you or I to let bygones be bygones but with someone who's been transplanted it might be a bit more of a pressing concern.  We haven't dealt with nearly the physical or mental aggravations and pain - personally if they were gonna be in my liver I'd feel like what the heck you might as well but if I'd been through the whole mess that he has...I'm pretty CERTAIN I'd want it done.

[jmjm530]

Let me take that back. In your very specific case -- liver transplant -- maybe the data could become useful in some very specific scenarios where a decision to use interferon again might come into play -- such as what happened last time. In other words, if they didn't find HCV in your tissue then it might make less sense to use interferon, but I'm way over my head in this area so please take this as speculation from someone that really doesn't understand the transplant and post transplant process.

[jmjm530]

My main point was what would you do with the info once you had it?

To my knowledge there are no tx protocols for people who are serum UND but liver tissue positive.

Personally, I would leave my SVR as SVR until someone showed me the clinical relevance of looking beyond, i.e. to leave well enough alone.  Not so much that "ignorance is bliss" but that more data without underlying clinical relevance doesn't really get you anywhere.

That said, I respect your desire to know "the real facts", and do let us know what you find out if and when the time comes.

-- Jim

[mikesimon]

I figure that if they are going to take a tissue sample of my liver then they should test it for HCV. That seems so obvious to me I wonder whether I am understanding your question. I like to know as much as I can about me, my liver and HCV.
If your point is that there are more specific tests then the PCR that would probably be used I agree with that. But, if that is the threshold for testing why do we even get serum tests? We used them in the past when they were less sensitive than they are now and the current tests will likely not be as sensitive as they will be in the future. You use what you have. Mike

[jmjm530]

Willing: "...You might ask (your doc) was the last time he picked up a pipetman.
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But he's both married and straight. Maybe a pipetlady in his younger days.

[jmjm530]

Mike: He said "don't trust anyone" and I replied "except you, right?" and he said "no, not even me".
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Are you sure your surgeon isn't James Bond? Daniel Craig uttered similar to "M" at the end of "Casino Royal".
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Thanks for the detailed summary but curious why you would want a PCR of your biopsy tissue, esp in lieu of no other clinical problems.
]
If it's UND, that's great, but as DD will probably tell you , it still doesn't mean you are UND if  using ultra sensitive testing (in serum and/or tissue) that has been used only in studies, should you be in that camp.

And if it's positive, so then what? How would that alter treatment or your life? I doubt they would put you back on interferon if serum UND, unless you had other clinical issues. I personally see it as a lose-lose proposition until there is more understanding of what these things actually mean if they mean anything. Anyway, that's just my personal take, I'm sure you have your reasons.

-- Jim