Aa
Aa
A
A
A
Close
1069625 tn?1262639524

Clearing the virus

Just wondering..does anyone know how quickly its possible to clear the virus?  From what I can tell from my pcr results today, I cleared it on my own..but I thought I got it like 4 months ago..?  I figured it might take awhile to a virus like this to just clear.  Does anyone have any knowledge about this?  Thank you!
39 Responses
Sort by: Helpful Oldest Newest
338734 tn?1377160168
You said:
-----------------------------------------------------------------------------------------------------------------------
"I really don't care if anyone follows up on the research I've already conducted or if anyone believes me or not.  I've had the disease for 40 years and have been attempting to control it for the past 18.  Now, I am in the end stage and have severe cirrhosis.  I'll be dead in another few years without a transplant and it is a pretty horrific way to go"
------------------------------------------------------------------------------------------------------------------------
First, sorry to hear your situation. I've been there as have some others on this forum, and I wish you a speedy and successful transplant and recovery.

Rather than go into my lengthy story of disease progression, ESLD, transplant, 84-week treatment with Pegasys and Ribavirin followed by relapse 12 weeks after treatment, I will just say that I think, from my research these last few years, that everything said by Trish, Mike Simon, and NYGirl are right on the money. This does not surprise me as I have come to notice over the last two years that these persons' opinions are pretty consistent with the studies I read and the opinions of a couple of liver transplant hepatologists at a University Hospital as well as the doctors here on MedHelp.

You said you are not a "know it all". If so, stick around, read and research, and you'll come to appreciate how much there is to learn and how much some people here do know, as I have. Join in on the fun. Besides being knowledgeable, most of them are immensely funny, too! It's a pretty good deal.



Helpful - 0
Avatar universal
"I don't understand the difference between drinking alcohol post tx and post svr. After tx the virus is gone or it's not,is that true or false? Time just has not verified it yet. If it's gone there is nothing for alcohol to trigger. If it's not gone it will be back anyway,is that true or false? The virus can't just come back,it was just never gone. How come there are not huge warning flags everywhere from Dr's that advise alcohol can make the virus "come back from being gone"?

No...the virus is not necessarily gone as soon as you stop taking the drugs.  To use a simplistic comparison - you get a throat infection for example, doctor puts you on 10 days of antibiotics.  You notice about Day 5 that the soreness is gone and you feel really good.  You consider stopping the antibiotics at Day 7 but you complete the 10 days anyway.  Shortly after that ... the infection creeps back in.  You find out that the infection was a little tougher than the medication and after the medication stopped, there wasn't anything fighting it anymore and it wasn't completely gone and crept back in.  Next time, different antibiotic .. and this time you wait after the 10 days after you've stopped.. two weeks..nothing.  Now you know the medication worked.  It's not a perfect analogy but hoping you get my drift.

That's the difference between end of treatment and SVR.  End of treatment is simply that.  You're done taking the drugs.  Now the waiting begins to see if there was any undetectable virus remaining because it will surge back when there are no drugs fighting it off anymore.  So you test at 4 weeks...12 weeks...and if you make it to 24 weeks and are still undetectable, you know the drug therapy was successful and it's not coming back.  At that point you are SVR.

In the meantime .. it would not be well-advised to drink alcohol or do anything that might trigger any virus that's still in that inbetween phase ... maybe remnants of drugs still left in your body or your body in that fighting stage still ... so hold off.  Save the celebration drink for SVR.  Some would say no celebration drink and that's an individual choice.  
Helpful - 0
Avatar universal
That would be good enough for me!
I have a theory related to post treatment relapsing...Since the ribavirin is fat soluble, and it has completely saturated the body for some time by the end of treatment, it takes about 3 months (some more, some less) for the viral suppressant properties to drop off enough to leave the body susceptible to viruses again. I was told by veteran heppers that the first serious illness post treatment is the real test to your immune system. If you make it through a hard-core bug that drags your immune system down without relapsing, then you have little to worry about.  A related theory also follows for those who haven't cleared the riba from their fat cells and it goes on to continue to irritate the body, causing pain and neurological symptoms. Did you now that in some individuals, traces of anesthesia have been found in their blood more than 10 years after a surgery? This has been found when they had a weight loss involving body fat. Hmmm...I wonder if medical insurance would pay for a sauna? ;) ~MM
Helpful - 0
179856 tn?1333547362
Me too Michael and you are one of the smartest guys I've ever known - I'm happy to agree with you and be smart too (for a change ;)
Helpful - 0
Avatar universal
"if you were to stay at <2 forever and have perfect liver enzymes and no more liver degeneration"

I think that would fulfill the definition of SVR and would constitute "cure" - as we know it.

Mike
Helpful - 0
179856 tn?1333547362
By the way just out of curiousity - what real difference would it be if you were to stay at <2 forever and have perfect liver enzymes and no more liver degeneration...........wouldn't that still be considered "cured"?
Helpful - 0
179856 tn?1333547362
I still believe that  this information is very old - nobody has used mono-therapy in years not even for acute infection.

“Complete abstinence from alcohol is an extremely important behavioral modification, and has been shown to affect the likelihood of progression as well as the efficacy of therapy."
It sounds to me as if he is talking about during treatment here and not post treatment, SVR and also as Joey said above behavioral modification to me speaks to the chance of a. further liver damage and b. the chance of getting high on drugs while drinking.

By the way we will never be able to donate blood because we will always carry those antibodies and how could you prove that you were truly SVR rather than just coming in to the acute phase and recently infected under the vl radar?
Helpful - 0
Avatar universal
I have seen some articles which suggest that shortly after stopping treatment a patient may be more susceptible to relapse. These involved patients who were administered immune suppressive drugs.

".....We report two patients that relapsed when immune suppressive therapy was given within a few weeks of achieving SVR. Patient 1 received prednisone for bronchitis and patient 2 relapsed soon after immune suppression was started post renal transplantation. These data suggest that the early phase of SVR might be associated with incomplete protective immunity. They suggest that sterilizing immunity with complete elimination of virus is unlikely. The cases also caution against the use of immune suppressive therapy in the immediate aftermath of SVR. J. Med. Virol. 80:1720-1722, 2008. © 2008 Wiley-Liss, Inc."

So perhaps immediately post TX we may be at increased risk for relapse. That is why I have consistently limited my position to people who are true SVRs. I define that as undetectable per sensitive PCR 1 year after discontinuing HCV treatment.

I should make it clear that I am not advising SVRs to consume alcohol nor am I condoning the consumption of alcohol by SVRs.  I am discussing the durability of SVR by exploring the evidence we have available to us.  And, from all that I have seen, there is no evidence that alcohol consumption triggers or hastens or has any effect on SVR status. And SVR may have a damaged liver which deteriorates with alcohol consumption as will a healthy non HCV liver if enough alcohol is consumed. But alcohol has not been shown to cause relapse in any of the literature that I have seen.

You ask: "How come there are not huge warning flags everywhere from Dr's that advise alcohol can make the virus "come back from being gone"?"

The virus is not really gone for our practical purpose until a patient is undetectable at 1 year after treatment. Just because a PCR shows UND does not mean there will not be relapse. We see relapse post TX frequently and it doesn't take long to occur - within weeks most of the time. .
Helpful - 0
Avatar universal
I don't understand the difference between drinking alcohol post tx and post svr. After tx the virus is gone or it's not,is that true or false? Time just has not verified it yet. If it's gone there is nothing for alcohol to trigger. If it's not gone it will be back anyway,is that true or false? The virus can't just come back,it was just never gone. How come there are not huge warning flags everywhere from Dr's that advise alcohol can make the virus "come back from being gone"?
Helpful - 0
Avatar universal
You sure do complain a lot.
Helpful - 0
Avatar universal
Too bad we cant get a VL sensitivity test below the < 5 limit,if we had an absoulte zero  VL number this would be great,maybe one day this will happen.



"We're often so blind. Our demand for the credentialed so colors our perception of believeability, that we wouldn't recognize God if he appeared within us."
Helpful - 0
Avatar universal
No evidence of occult hepatitis C virus (HCV) infection in serum of HCV antibody-positive HCV RNA-negative kidney-transplant patients.

Nicot F, Kamar N, Mariamé B, Rostaing L, Pasquier C, Izopet J.

INSERM, U563, Toulouse, France.

Persistence of hepatitis C virus (HCV) in patients who cleared HCV is still debated. Occult HCV infection is described as the presence of detectable HCV RNA in liver or peripheral blood mononuclear cells (PBMCs) of patients with undetectable plasma HCV-RNA by conventional PCR assays. We have assessed the persistence of HCV in 26 kidney-transplant patients, followed up for 10.5 years (range 2-16), after HCV elimination while on hemodialysis. If HCV really did persist, arising out of the loss of immune control caused by institution of the regimen of immunosuppressive drugs after kidney transplantation, HCV reactivation would have taken place. Their immunosuppression relied on calcineurin inhibitors (100%), and/or steroids (62%), and/or antimetabolites (94%). An induction therapy, given to 22 patients, relied on rabbit antithymocyte globulin (59%) or anti-IL2-receptor blockers (32%). All patients had undetectable HCV RNA as ascertained by several conventional tests. At the last follow-up, no residual HCV RNA was detected in the five liver biopsies, the 26 plasma, and in the 37 nonstimulated and 24 stimulated PBMCs tested with an ultrasensitive RT-PCR assay (detection limit, 2 IU/ml). No biochemical or virologic relapse was seen during follow-up. The absence of HCV relapse in formerly HCV-infected immunocompromised patients suggests the complete eradication of HCV after its elimination while on dialysis.
Helpful - 0
Avatar universal
One more theory - perhaps heavy drinking (or drug use) could lead to behavior that causes reinfection. The cases anecdotal cases you mentioned may have been reinfections. Even with the same genotype, they could have been.

I was reinfected. Treated and SVR in 05 (GT 1a) then re-infected through sex in 08 (GT 3a) (I didn't believe sex could spread it but all the studies at that time were monogamous heterosexual couples whereas now HCV is spreading rapidly in the HIV positive gay community - perhaps as high as 30% are co-infected).

Notwithstanding, I think there is still not enough research to conclude that the virus is gone forever and something couldn't trigger it to recur. We are still very early in terms of knowledge around this disease and the long-term effects of treatment. Many "accepted facts" about Hep C from 5 or 6 years ago have been discredited and I am sure much of what we "know" about Hep C now will also be discredited in several years. I think it is smart to avoid more than light drinking and always engage in protected sex if having multiple partners.  
Helpful - 0
Avatar universal
Lets hear from someone out there who has SVR`ed and now has a drink now and then. I alsoI wonder if alcohol is the worst substance that causes liver damage?,how bout valium,tyenol,pot and other drugs?..i wonder if these will cause "relapses" cause if they do,a lot more relapse cases should have been reported cause i think ALOT of people have been taking benzos and pain killers all tru TX and even beyond....and God knows what other pharma drugs...do u think valium would be a cause for relapse as it is classified as a liver toic from what ive read
Helpful - 0
Avatar universal
" I do have to say that Chronic Hep-C by definition is just that; chronic.  It never goes away.  The acute phase is just the beginning of Hep-C.  From there it generally progresses to the chronic phase.  As you pointed out the antibodies stay in your blood forever.  Please read the article on this site."

Marty...to quote a phrase..."I think what we have here is a failure to communicate".

I do not quite concur with your interpretation of my comment.  I never mentioned antibodies in the blood at all.  

Antibodies in the blood do not necessarily equate with chronic Hep C infection. Those with acute Hepatitis C who clear the virus without progressing to chronic Hep C will always have antibodies in the blood.

Antibodies in the blood is not the same as having chronic Hep C.  

Nor do I concur that chronic Hep C never goes away.   I'm SVR.  I no longer have chronic Hep C.  I only have antibodies left.  I do not have any virus left in my blood.  

Prior to treatment, I could not get life insurance because I had chronic Hep C.  Now that I am undetectable for Hep C virus in my blood more than 6 months post end of treatment, they are willing to re-evaluate my life insurance.  That indicates that they see a difference between antibodies and actual virus in the blood.  I have antibodies..but no virus.  No Hep C.  

I do understand you don't quite see it the same way which is why I phrased my question to you in that manner.  I hope this clarification helps.

Trish

P.S.  I do have to say I don't think the other posters are being argumentative with you. Your claim that alcohol can cause relapse in someone who is SVR is rather controversial and it's the first I have ever heard of that point of view - and there are a number of "seasoned" posters on this forum.  It bears discussion.
Helpful - 0
Avatar universal
"I am spending too much time on this subject when I already know the answer, but I'm doing it for those who ARE naive about it."
While your posted credentials seem most impressive, unfortunately imo the information you've posted so far has not been. Perhaps you may be used to talking down from a high pedestal to us "naive"'s, but you know what they say about those on high pedestals......I for one would certainly appreciate clinical trial info, studies etc. as opposed to hearsay and opinion...Where is the beef?
Thanks Pro
Helpful - 0
Avatar universal
I have been hearing that from several people here on the Medhelp forum, they say they've never heard of it.  I personally know of two and a Dr. I am dating who is also an instructor at a medical college has seen three.  All five had completed treatment and were declared SVR with a non-detectable viral count but they all relapsed after returning to a drinking lifestyle.  Three are now dead.

I may be wrong about this, and if I am I'll gladly post a retraction.

I've got an e-mail in to Dr. Robert O'Shea, Fellowship Director of Heptology and a physician in the transplant department at the Cleveland Clinic asking him to speak about the direct relation between relapse and alcohol use.  We're not talking about a glass of wine or a couple of beers, it's about habitual drinking.  What he says in his published paper on Hep-C is, "Complete abstinence from alcohol is an extremely important behavioral modification, and has been shown to affect the likelihood of progression as well as the efficacy of therapy."  

I am spending too much time on this subject when I already know the answer, but I'm doing it for those who ARE naive about it.  I believe that many people want to hear that the virus is gone forever and they can drink and party again.  If anyone DOES believe the virus is completely gone, just go to your local blood bank and try to give blood.  Don't tell them you had Hep-C, just let them take your blood and test it themselves.  Believe me, they will know you are still carrying the anti-bodies and will NOT accept your blood for donation.

At any rate, I'll post Dr. O'Shea's response to my inquiry just as soon as he contacts me.

Considering the number of people and the extent of the responses to this subject, I would say it's worthy of pursuing.

I just can't believe that anyone would even consider drinking or doing anything that might even remotely harm the liver after enduring tx.  I wish to God that I had that opportunity.  I've been told that without a transplant, I have another year or so to live.  I'm waiting for the VA to approve my transplant request and then I'll pray they find a healthy liver for me.  I wish the same for anyone else who is at this point in their disease.
Helpful - 0
Avatar universal
Just thought of something,is it possible that the people you say who SVR`ed and relapsed after going back to heavy drinking was just a coincidence because as we know normal relapses do happen...BTW..in my above post mentioned my nurse never seen a relapse in her 20 years/...i meant to say she never had anyone who SVR`ed go on to end stage liver problems.I remember asking her about the occult virus lingering in the liver after SVR .
Helpful - 0
Avatar universal
Wow, this certainly DID trigger a major response.  Trish, I must say you have posted a very intelligent and well researched response.  Not just argumentative like some others.  I do have to say that Chronic Hep-C by definition is just that; chronic.  It never goes away.  The acute phase is just the beginning of Hep-C.  From there it generally progresses to the chronic phase.  As you pointed out the antibodies stay in your blood forever.  Please read the article on this site.  It is an accurate, well written article by Dr. Robert O'Shea, a heptologist in the transplant center at The Cleveland Clinic.  
  http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/hepatitis-C/

It is one of the most concise explanations I've yet come across.

I am glad to have triggered this debate and it is refreshing to find someone who is seeking accurate answers and not discounting the findings of the medical community.

Good posting, Trish.

MARTY
Helpful - 0
Avatar universal
"remains undetectable in the blood for many years,"   - I read this later and no idea why I stated it in this way.  I should have said "remains undetectable in the blood."  Period.  Full stop.  Not just for many years.  Forever.  That's SVR.
Helpful - 0
Avatar universal
Veteran....I was reading through the article you posted and it seems they're talking about an acute Hepatitis C infection ... not even chronic Hep C and certainly not SVR .... I'll explain as I go .. which begs the question...why would you use an article about treatment phase for acute Hep C as supporting evidence for resurgence for the virus in SVR post-chronic Hep C?:

----------------------------------------------------------------------------------
How is it treated?

The usual treatment is rest, having a healthy diet, and avoiding alcohol for at least 6 months. Usually it is not necessary to stay at the hospital.

>>>>>The usual treatment is rest, having a healthy diet and avoiding alcohol for at least 6 months?   I'm reading this and I'm thinking they're talking about an acute Hepatitis infection here ... because this is certainly not the usual treatment for chronic Hepatitis C.    So..with that in mind, I keep reading ....

You may be given shots of an antiviral drug, such as interferon.

>>>>>>>>>>>>>Okay...you MAY be given shots of interferon...what about the ribavirin, I'm thinking?  .. so I'm thinking we're still talking about acute Hep C, not chronic Hep C ... because this isn't the treatment for chronic Hep C.. and I keep reading......

Doctors are continuing to search for the best ways to treat hepatitis C. As new information becomes available, treatments change. You should discuss possible new treatments with your health care provider.

How long will the effects last?

Symptoms may last 1 to 6 weeks and usually go away completely. It is common, however, to have hepatitis again (relapse). Relapses can be triggered by drinking alcohol  or not getting enough rest before you are fully recovered. They may be caused by another infection, such as a cold. Relapses are generally milder than the initial infection.

>>>>>>>>>>>>>>>>>>>Okay...relapses can be triggered by drinking alcohol....we're still talking acute Hep C and we're talking during that treatment phase before the acute Hep C has been fully treated....it mentions that relapse occurs if you don't take the proper precautions "before you are fully recovered"...... fair enough...I get this.......and I keep reading....

Some people who have hepatitis C develop the chronic form of the disease. This means the virus continues to affect their liver for several months.

>>>>>>>>>>>>>>>>>>Okay.  This is where it's CLEAR that they're talking about acute Hepatitis C as evidenced by the comment ...."some people who have Hepatitis C develop the chronic form of the disease" .... so all along this has been talking about someone in the acute phase of Hepatitis C ....and this is what you're using as your supporting evidence that alcohol can trigger relapse in those with chronic Hepatitis C who have achieved SVR?  

They're not even accurate... they say SOME people who have (acute) Hepatitis C develop the chronic form of the disease.  It would be immensely more accurate to say MOST people develop the chronic form of the disease.  It would be immensely more accurate to say that some people clear the virus but most go on to develop chronic Hepatitis C.  

It gets worse....they continue on to say that "This means the virus continues to affect their liver for several months."

Several months??  I'm thinking they don't have a whole lot of knowledge about Hepatitis C if they're saying that having chronic Hep C means the virus continues to affect the liver for several months.....we all know it means a whole lot more than several months, doesn't it.

I'm a little surprised you would include this article as supporting documentation when a) it's talking about acute Hepatitis C during treatment phase and you're suggesting that relapse can occur for chronic Hep C after SVR from alcohol. The one has absolutely nothing to do with the other.  This isn't even apples and oranges. It's more like onions and peaches.

Do you consider this to be part of your supporting documentation??  With all due respect, it's not that authoritative overall, not very accurate and not relevant to the topic.  Odd choice...perhaps there's something I'm missing as to why you chose this to back up your theory?

I did read your other article, btw....it seems you're of the camp where we never really have a cure - am I correct in that assumption?  That you think the virus never really goes away, even though it remains undetectable in the blood for many years, it's still lying in wait in the body somewhere and can re-emerge?  If that were the case, I can see where you would think that alcohol can trigger a relapse...see if I'm on point where you get this from....

"The researchers found that alcohol increases the activity of a protein called nuclear factor kappa B, and thereby causes the hepatitis C virus to replicate, or produce multiple copies of itself. That protein is an important cellular regulator of gene products involved in inflammation. Furthermore, they found that alcohol interferes with the antiviral activity of interferon-alpha, a key therapy used for patients infected with hepatitis C"

This is fascinating stuff, btw...and a wry thanks for triggering yet another research direction.  

The thing is .. if there is no virus in the blood to intermingle with, then there's nothing to replicate.  So if there is no virus to replicate in the blood, there is nothing for the alcohol to trigger.  

So I go back to your comment that the virus is never really gone.  If we agree that it's gone from the blood but not necessarily completely from the body......are you suggesting that alcohol can intermingle with the traces of the virus that are known to be found in organs of the body and whatnot in other forms than is found in the blood and that this triggers the replication and passes it back into the bloodstream?  Is that your contention?  I'm not agreeing or disagreeing at this point .. not that it matters to you, I'm sure...just saying :) ... I just want to be clear on what you base your supposition on.

Trish
Helpful - 0
Avatar universal
Just my 2 cents worth...I was told by my hepatologist, who is also a Dr out of UW Medical Center and one area expert on Hep c treatment that, if a person infected with my genotype (3A) is RVR at 4 weeks of treatment, and SVR at 6 months after treatment, I have only a 2% chance of relapsing ever as long as I maintained a liver healthy lifestyle. He said an occasional social drink wouldn't change those odds, -but why take the risk? I am 16 months post treatment now, still SVR, and liver enzymes at AST -15, ALT-16. I may have a rare sip of wine on holidays, or a even rarer piece of rum cake, but that's it, and I don't feel like I'm missing out on life and I celebrate daily that this cr@p is gone from my system~MM
Helpful - 0
Avatar universal
Ive heard most "relapses" after years of being SRV,are just the  result of getting re-infected by going back to  drug use.The true relapse rate for SVR` ers may never be known in my opinion because of possible reinfection( known or unknow reasons),but the fact remains,relapse rates after 6 month SVR are EXTREMELY low...i think its 1or 2 in 1000 will "relapse"..or is it re-infect...my study nurse has been workn with HCV about 20 years and she tells me she never seen one of her patients relapse yet

Just my thinkn and dont mean no dis-repect.



"I have learned from experience that the greater part of our happiness or misery depends on our dispositions and not on our circumstances."
Helpful - 0
Avatar universal
Just for the record.... according to my research:

You said: "....Splenomegaly  (enlarged spleen due to fluid retention)...."

"The obstructed flow of blood through the portal vein (portal hypertension) causes the spleen to enlarge by causing an increase in pressure inside the vessels of the spleen."
http://www.janis7hepc.com/spleen_hepatitis_c.htm

Increased pressure inside the vessels and not fluid retention is trhe cause of an enlarged spleen. And the the spleen traps and sequesters platelets which results in a low platelet count which leads to Thrombocytopenia.

Mike
Helpful - 0
2
Have an Answer?

You are reading content posted in the Hepatitis Social Community

Top Hepatitis Answerers
317787 tn?1473358451
DC
683231 tn?1467323017
Auburn, WA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.