Article on Occult/Persistence and Other Posts

[TnHepGuy_]

Here's a good, comprehensive article by one of the leads (Pham) on research into occult Hep C:

<a href="http://www.findarticles.com/p/articles/mi_m3230/is_2_38/ai_n16084704">Occult hepatits C virus persistence: identification and characteristics</a>


(from the article):

"<i>Although HCV is considered to be primarily hepatotropic, accumulated evidence clearly indicates that the virus also invades and replicates in the immune system. In fact, the presence of both HCV RNA positive and negative strands has been demonstrated in lymphoid cells in both in vivo and in vitro settings. For example, T cells, B cells, monocytes, and dendritic cells from patients with chronic hepatitis C have all been shown to carry HCV genomes. (2), (10-12) Most recently, by applying assays of superior sensitivity mentioned above, replication of HCV has been seen to persist in lymphoid cells for years after spontaneous recovery or a sustained virological response to IFN-alpha/Ribavirin therapy. (1-3) In addition, low levels of HCV RNA in lymphoid cells have been detected in a significant proportion of patients with persistently elevated liver enzyme levels of unknown etiology. (13), (14) Along the same line, susceptibility of T and B cell lines as well as primary human T cells and macrophages to HCV infection have also been documented. (15-18)</i>"

[Dale_Ray]

I believe that the test facilities probably have operating standards concerning instrument cleanliness and processes. I would imagine prior to each colonostopy (spelling ?) they pull a brain surgeon out of surgery to clean the big silver snake. Let's face it the whole thing is about the individual. A trainee gets the cleaning duties in these matters and some are good and others...........well they should follow another career path. Have a little faith is about all you can do. Good luck on your procedures and hope all is well. Dale

[FlGuy]

The procedure wasn't bad.  I woke up in the same position I was put out in and was unaware of anthing going on around me. I'm sure they threw me around like a side of beef in a food locker. My main issue is the need to check all modesty at the door.  You would think that after all the procedures (scopes, hernia check, prostate exams, mri etc) that I'd get used to it. It was kind of funny, if not embarrassing, when the first thing the doc said to me upon waking was 'you'll need to do a better job of cleaning yourself out next time'.  Yeah, like I don't deal with a lot of **** from you either, doc.

[mikesimon]

I very seldom laugh out loud at anything I read here, or anywhere for that matter, but you made me laugh. Did the doctor really say that to you when you awakened? These guys kill me - well not quite but close. When I practiced law I had occasion to have a couple of docotrs as clients. They were in divorce actions and they were the most uptight and demanding clients I ever had. I'd make them wait sometimes just because they were such jerks. I can hardly believe the guy said that to you. It is way over the top. Do you have these procedures frequently for him to say that - like you'll be coming in for another one next week? I mean that is a strange thing to say and I'm still laughing about it. Mike

[willing]

tn: good summary, thanks for the post. Here's a <a href="http://www.mlo-online.com/articles/0206/0206clinical_issues.pdf">pdf</a> version that includes the images and cuts down on blinking-induced  headaches.
jim: perhaps you should consider qualifying that "no clinical significance has been attibuted" disclaimer in light of those recent papers.

Arguing against post-SVR persistence is starting to look like arguing against global warming (here's yet another study <a href="http://www.scipub.us/fulltext/ajid/ajid1134-42.pdf"> Falcon, et al. </a> ). None of this lessens the value or durability of that elusive SVR. However, given that even the well-established liver-associated risks of HCV are seen as infrequent/intractable enough for public health to address on a large scale it's hard to imagine post-SVR research getting much attention..

My reading, for obvious reasons,  has shifted towards, the new <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16107835&query_hl=4&itool=pubmed_docsum">structure-based  drugs </a>. This is one well designed, slippery, little critter... regardless of what we throw at it, it manages to mutate just enough to get by. There may be a lesson about staying flexible in there somewhere.

[willing]

I actually got back a report card on how well I had done on that elaborate pre-op prep... and got flunked with  a "poor", though I had followed all their instructions. I guess they get tired of guiding their scope through all that s**t, particularly when they've just come back from lunch.

[FlGuy]

He said it and waited to speak to me until I was awake and my wife was present. Since he's not my primary I see him only for these 'special occassions'.  But when we spoke last week I told him that when he does the endo and colon scopes later this month, do the endo first.  Much like a car mechanic, I don't care if he cusses - just make the darn thing run. I'm just glad he changed his scrubs before I woke up. I may have tie-dyed him.