hepatitisresearcher

[spcecst2]

Your opinion please? Lets say a patient went thru treatment (1b) pegasys/copegus 180/1200 for 48 weeks, starting VL was 10 mil, middle aged male, slight liver damage, still detectable at 600 week 12, clear week 16 (less than 50), relapsed, waited 3 months and started treatment over, VL 500,000, double dose pegasys 4 weeks, 1400 copegus, no VL detected at week 4 using heptimax, did shot every five days from week 4 thru week 12, did 1600 copegus for month and half, waited full seven days at week 12 and got negative heptimax, doing 180/1200 rest of treatment, ast/alt normal at week 12, does this person have the same chance with RVR statistics (as high as 85% SVR) with 48 weeks, or are those RVR statistics only good for someone who does treatment the first time using the SOC? I hope you can understand what I’m asking here?

[Whrose]

thank you for the reassurance, much appreciated. the only glitch is i am not sure humira and HCV are considered in the stats of durable SVR. i can not find exactly what the immunosuppressvie treatments were that factored in SVR relapse...do you by chance know?

however like DD, i have an uncomfortable lingering wonder what the significance of occult hcv is really all about. i am not losing sleep though...just that uncomfortable question lurking and waiting for more information in the sea of conscious random thoughts, lol

[jmjm530]

Please ignore the accidental copy and paste below my name in the post above.

[jmjm530]

Wh: why would my docs give me the heads up knowing occult studies, immune response, that this med would not reactivate hcv?
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If the question is will Humira reactivate HCV in someone who is SVR, I think you can go to bed at night with the knowledge that there is no clinical basis to worry, as related to you by your doctors and pharn company.

That's because SVR has been shown over and over again to be durable in studies going out 8-10 years. As far as I know, there have only been 2-3 documented cases where the virus was reactivated because of immunosuppressive treatments.

-- Jim


btw...i know of another person hepc SVR on the same med and after 2 yrs on treatment has sustained SVR.

HR...am i being paranoid or do you think my concerns have any merit?

[Whrose]

more food for the soul...another excellent discussion

i have an interesting (at least to me) curve ball to throw into this. time will tell if perhaps the CTL sentries that are still on patrol in my SVR status will continue the good work of maintaing my SVR.
assuming that occult hcv is a fact as research clearly shows and i have occult fragments status SVR

Hr am i assuming incorrectly that in SVR the occult fragments that are present are held in check by the primed CTL's successfully preventing any occult fragments that "could replicate" , find their way to happy hunting grounds in the hepatocyte and cause pathology?

for me this may be a mighty big news. sucessful treatment EOT 7/06. negative PCRs since week 4 of treatment. .
start of humira  4/07 which is tumor necrosis factor inhibitor.  this med is known to activate hepb and TB in clinical remission.

consult with 3 docs (2GI's and 1 Hep) before starting and ALL said this med would NOT affect my SVR.  i specifcally asked in view of occult hcv studies if the med could suppress immune function that could cause successful replication and activation of any occult virons left. again the answer was NO.  also i wrote the pharm co and they said there was no evidence of it reactivating HCV.
however my rheumy was concerned and would not give me the same reassurance. the need for intervention was considered and because of the GI docs go ahead i started med.

now after a better understanding of the cellular immune response (thanks HR) and perhaps any occult virons left after SVR perhaps controlled by primed sentinal CTL's vs adaptive anitbodies present,  i now might be a guinea pig.

although i do not have a clear understanding of the role of TNFa except as it being a key pro inflammatory cytokine in the inflammatory immune response; increases liver inflammation and apoptosis.  i have failed trying to figure the interactions of all those cytokines. geesh they "talk " a different language i have yet mastered)  i can't figure by my research if it is associated more with the TH1 vs TH2 response. ( my guess it is TH2 but am not sure of this or how it affects T cells? )                                                            

i had a PCR done 3 months after starting humira= undetected july 07
will request another Jan 08 instead of waitiing till july.

the result might be interesting in view of the occult phenomenon. i am a bit more nervous now.
why would my docs give me the heads up knowing occult studies, immune response, that this med would not reactivate hcv?
btw...i know of another person hepc SVR on the same med and after 2 yrs on treatment has sustained SVR.

HR...am i being paranoid or do you think my concerns have any merit?
also.......considering telaprevir effects in decreasing hcv replication (however not on resistant populations) would the T-cell vaccines be adjunctive to these resistants...any resistants; or are the resistants present by their morpholgy not able to stick to receptors on the MCH1 molecules thus to designed Tcells no matter how programmed?

DD maybe my situation might bring in more information about the significance of occult hcv.
if this med reactivate's  HBV i may be in for another ride on the tx rollercaster in regards to HCV reactivation. >0<  

[Hepatitis Researcher]

You might want to take a look at the current "vaccine" thread where the cellular immune response is explained in more detail, it can explain, how household contacts could show only Cell Mediated Immune responses (CMI) as shown in the Egyptian study.

[Hepatitis Researcher]

"hard and fast" are not really quantitative expressions. Vertex reduces  the replication speed by a factor of 10000 for those HCVs that are not resistant to its action. So the Vl goes down even much much faster than on high dosing SOC. This reduces the chance for adaptive mutations, except for the a priori telaprevir resistant HCV portion.