Viral load and non hepatic manifestations of HCV

[spectda]

I keep reading about how viral load does not effect liver damage, but I often wonder how it effects the rest of the body since there have not been extensive studies of non hepatic manifestations of HCV. Some of the non hepatic issues are as dangerous and life threatening as the liver disease and are more prevalent then many people care to believe.

The thought that having this virus running through every part of our bodies and not doing damage in other ways doesn't make a lot of sense to me.

[Trish77]

"While viral load doesn't correlate with the amount of liver damage, it seems intuitive that the more virus that's present, the more "virulent" the infection. "

You'd also think it would be intuitive that the higher the viral load, the more liver damage but that's not the case.  Viral load doesn't correspond to liver damage and it may or may not correspond to the presence of extra-hepatic illnesses.  It remains to be seen.  You would think that me having HCV for 25+ years and a viral load of 2.1milIU/mil would have given me at least SOME extra-hepatic illness but I had none and was only Stage 1 Grade 1 at that point.  What seems to be constant about this illness is that there is no constant as someone else with my specs could be in an entirely different situation altogether.  There are just so many additional variables that influence when combines with HCV and perhaps I had very few of those variables and perhaps someone else had more.....hard to say.  I think alot more needs to be known before equating viral load with the presence of extra-hepatic illnesses.

I do agree... "It can't be very good for things".  

[RobertBeWell]

While viral load doesn't correlate with the amount of liver damage, it seems intuitive that the more virus that's present, the more "virulent" the infection.

I do know there is research that supports lower viral loads getting better treatment results.

All I know is I want this sucker gone. I don't think we'll ever understand just how much all portions of the body are affected by having this disease - or really, any viral disease. It stands to reason that at the very least, your immune system will be working overtime for years on end, like racing a car motor continuously.

Can't be very good for things.

[Trish77]

I would agree that there's nothing that shows a relative impact for viral load and extra-hepatic illnesses, however what is clear is that HCV itself influences the histology of a person in unpleasant ways manifesting in extra-hepatic illnesses.  I would agree with Mike that this definitely needs to be included in any treatment considerations and I would have to concur that if a person is going to treat, the risk of incurring extra-hepatic illnesses is an excellent case for sooner than later as one of the considerations along with existing liver damage, life circumstances, age, gender, race, genotype, length of infection, etc. etc. etc.   Treatment decisions take so many factors into account which makes it NOT a one-size-fits-all decision!

Personally, I had NO extra-hepatic illnesses and my health issues have come AFTER treatment, i.e. hypothyroidism and arthritis onset.  Another consideration is that sometimes treatment can trigger additional health issues such as auto-immune issues however the risk there seems much smaller than the extra-hepatic front and it seems the more time goes by, the more they're discovering the higher incidence of various illnesses amongst those with HCV.  Eyes wide open on all fronts.

Interesting discussion.

Trish

[spectda]

From everything I have read you are correct. They have not found any correlation with viral load, I just wonder. There is so much they don't know.

Sometimes I wonder if people should treat earlier rather then later. Often the dr makes tx recommendations based on liver damage only, I wonder if they could prevent some of the other manifestations of HCV if they treated earlier and were successful.

It's great to have all of you to converse with and get intelligent input from,

Thanks

[mikesimon]

I agree with you that there are extrahepatic disorders associated with HCV but I have seen no evidence that suggests that viral load is a factor - if that is what you are saying.
The extrahepatic disorders frequently seen in HCV patients has been one of the reasons that, until recently when it appears that PIs are really just around the corner, I frequently argued against the "watch and wait" approach suggested to many HCV patients. Of course, liver histology should always play a major role in the decision regarding treatment but I think there are other factors that should be assessed. Although clear connections between the various disorders and HCV are not always understood the increased presence of diabetes, non-Hodgkin Lymphoma, arthritis, hypothyroidism, cyoglobulinemia etc in HCV patients made me question the advisability of basing the decision to treat solely on liver histology. In short having HCV entails a risk of developing other disorders.
But, having said that I have seen nothing that suggests that the amount of viral load plays a role in the development of extrahepatic disorders. It may but I haven't seen any evidence of that.

Mike

[Diane12855]

Right. Autoimmune means the body is having an immune response to itself. The antibodies that the body makes aren't like the normal ones, which is why they stick together when they get cool. When I was in college learning how to do blood typing, we looked at how cryoglobulins work. The sample at room temperature is all clumped together and when you warm it up a little bit it unclumps and flows freely.

All autoimmune diseases are an inappropriate immune response to something in the body. Rheumatoid arthritis is the body attacking the joints, lupus is the body attacking connective tissue, etc.

Since we have had this crazy virus circulating in our blood for so long, it only makes sense that in the body's attempt to get rid of it, something would eventually go haywire... and then we have an autoimmune disease.

[spectda]

I don't get the impression that the scientists believe that all the extra-hepatic manifestations of hcv are caused by liver malfunction: Most of the extra-hepatic manifestations are auto immune type disorders, cryo, ra, lymphoma...


http://www.hepatitis-central.com/hcv/cryo/connection.html

"When the body senses an invasion by foreign organisms, such as HCV, chemical responses are triggered. Among those responses are various kinds of immunoglobulin, proteins that help kill the foreigners or regulate the immune response. For some reason * biologists are not sure why * these immunoglobulins can "glob" together and lodge on the walls of medium and small blood vessels.

The immunoglobulins that are involved are called cryoglobulins because they turn into a gel at cool temperatures (cryo comes from the Greek word for cold). Since cold temperature readily affects the small and middle-sized vessels in the body's extremities, the cryoglobulins are most likely to form in them. It appears that this glob-and-lodge action causes the inflammation of blood vessels. Cryoglobulinemia is the condition of having cryoglobulins in the blood.

Cryoglobulinemia and HCV became linked when researchers found bits of HCV and HCV-specific antibodies trapped in globs of cryoglobulin. They speculated that the cryoglobulinemia was HCV-incited, occurring when cryoglobulins specifically attacked the hepatitis virus. Other organisms can cause cryoglobulinemia * cancerous lymph cells, for instance * but the HCV-related version always involves a particular mixture of two types of immunoglobulins. Hence, the "essential mixed" of EMC."

[Diane12855]

I'll try to give you a simplified explanation because my brain is too foggy to give you the technical names. Viruses have what is called attachment sites on their exterior which is what they use to attach themselves to our cells and eventually work their way inside of the cell where they replicate. It kind of works like a lock and key system... the hep c virus is the key, the liver cell is the lock. If it doesn't fit perfectly, nothing works. Other cells in our body don't have places on them that the hep c virus can attach to.

The same thing applies to the influenza virus. It can only attack the cells in the lining of your respiratory tract, because they are the only ones that match it's attachment sites.

I hope this makes sense.
Diane

PS I think the extra hepatic issues may be caused by the liver not being able to do one of its hundreds of jobs correctly, or because of chemicals released when the liver cells are destroyed.

[spectda]

Hi trinity-
some diseases that come from having long term chronic HCV like cryo and vasculitis can kill you if the pooling blood clots in your brain, heart or kidneys, and you may not feel anything prior to this happening. One of the Gish Dr's told me this is very really and most doctors will treat for hcv quickly if cryo is confirmed.

from the above link:

"One-third to one-half of people with chronic hepatitis C infection have cryoglobulinemia (antibodies in the bloodstream attached to the hepatitis C RNA that happen to solidify when cold). Hepatitis C is recognized as the most common cause of mixed cryoglobulinemia. Most of the people with cryoglobulinemia from hepatitis C have had their hepatitis for a long time or have cirrhosis. People with higher concentrations of hepatitis C RNA in their blood do not seem to have a higher risk of having cryoglobulinemia. Usually the cryoglobulins are in low concentration and cause no symptoms.
About twenty-percent of people with hepatitis C and cryoglobulinemia have symptoms."

[Trinity4]

It may be some people do experience extrahepatic problems with hcv but then I don't think it applies to everyone.  An exptrahepatic that occured with me was PCT but very seldom do I see anyone post they have been afflicted with it.

My glucose, BP, heart, lungs are normal.  I'm in excellent health for a 58 year old.  I take no pills and that's fairly unusal at my age.  However, I do have a bum liver. :o( but so far no problems with that so who knows right?

Trinity

[spectda]

http://hepatitiscnewdrugs.blogspot.com/2010/06/extrahepatic-manifestations-of-chronic.html

Hi bill,
It's true what you say about bacteria, but there are many well documented extrahepatic manifestations of HCV and they haven't been studied extensively.

"Maybe I am not paranoid and people really are following me!" lol

[Bill1954]

Dave, I’m obviously not a biologist, but I believe we have plenty of bacteria in our bodies that we live with on a day to day basis, with no ill effects; and actually some of it’s beneficial. I wonder if a virus is similar; perhaps our body can adapt to live with it, outside of obvious liver disease?

Interesting thoughts, though…

--Bill