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Cell to Cell transfer of hec-c

I am really surprised that know one responed to my earlier post.  This research paper explains more about why some people handle the virus and others don't and most important why viral load means nothen. With cell to cell transfer there is no way that TX is going to work.  I suggest you all read this. It explains why the virus moves so slow in most and can replicate so fast in others. As I always thought and the numbers bear me out,  you are more likely to die with the virus than because of it.  Sure its causing damage slowly but for the most part if you don't have cell to cell transference your bodies own imune system will keep it at bay.  There is a lot we still don't know about this virus and it bothers me some to see the fear factor so high that some jump into treatment with the chance of doing more harm than good.  
                                                                                                                                        Ron
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Mr Liver
As for SVR, I have never seen one documented case of relapse beyond 24 months. I challenge you or anyone to find a documented and verifiable case meeting this criteria. I've been making this challenge for 7 years and so far I've not been presented with one.
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This one is borderline but shows that Relapse after 2 years is possible if extremely rare.
Its right on the 24 months but I am sure I have come across the same only it was 7or 8 years after SVR.
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijge/vol5n2/hiv.xml

Abstract
It is known that sustained virological response in patients with chronic hepatitis C is associated with sustained elimination of hepatitis C virus and that late relapse after SVR in HCV patients is doubtful. Α 47- year old man with chronic hepatitis C genotype 3, achieved sustained virological response after combination treatment with pegylated interferon and ribavirine for six months. Sixteen months later non Hodgkin's lymphoma was diagnosed. After successful completion of chemotherapy for non Hodgkin's lymphoma he presented with HCV infection recurrence of the same genotype. Retreatment with the same schedule resulted in normalization of aminotransferases and disappearance of HCVRNA from the serum. This case suggests that recurrence of ΗCV infection in a sustained responder may be probable after immunosuppressive therapy. Prevention is currently impossible but retreatment may be successful.

Swain et al reported that in only seven out of 845 patients who had been successfully treated with interferon monotherapy or combination therapy HCVRNA was detected after 391- 1076 days off treatment ( 20 ). None of these were in patients taking combination therapy for 48 weeks. These data indicate that the late relapse after SVR in HCV patients is very rare. In our patient recurrence of HCV infection happened after chemotherapy for non Hodgkin lymphoma,
24 months after the end of successful treatment.

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I do not know what in the heck you are trying to teach me?  I took enough college classes to understand I have a lowly bachelors in nursing with a pecialty certificate in geriatrics and Alz.  I use the word "process" to articulate, my cognition slowing down, my own failure understand as quickly as I used too.

In vitro we have to denate that and please cite your information.  The last very interesting micro class I took was at Nova University in Browad county and I have my text the class was in 2003, the text is a 7th edition torte - funke- case that is where my "information" came from.  I was not diagnosed at the time and therefore if this information is incorrect and you show me where to read otherwise I would say "thank you"

I am do not nor will ever be convinced speaking just from personal experience that this virus does not "travel" within the body and although it may not expressitself in the exact same way when it appears again it is my firm and EDUCATED belief that it is often times expressed through other diseases.
I live this virus, I know it is affecting my integumentary system, I know it affecting my immune system, I know it is affecting my cognition and the list goes on.  I am not alone I do not believe it is only me who  has developed these maladies as a normal part of aging.  ten years ago I was a person who dived, and repelled and lived a very active life.  Since 2005 when the disease surfaced and since treating I have developed many health issues.  Prior to diagnosis I had many health issues through the years. shingles, colitis, anemia, still have a very low platelet count to date after treating I developed integumentary and cognition issues I never had prior.  My symptoms and blood counts went crazy in areas I will not go into at this point.  I was acute by 17 years of age.  I have had my biopsy and ct scans and blood work and typing and viral loads done.

when I say "latent"  all I am saying is the virus is mobile to other systems.  when I say "does not need to hide" it is an expression, I have trouble with "tone" here I admit that.

I believe that like HIV this virus does tranfer itself to the cerebral spinal fluid and I believe it does cause other disease.  I can not say I have read all the studies and every current clinical outcome, I can say I am a health care graduate who loved the field and is self aware and knows from the inside out this virus is not going anywhere soon.

We have a whole new generation of the rich and famous to look forward too being carriers and they are no different than you and I, we were living the life like super hereos who could never get "caught" I never knew there was HCV when I apparently got it.  HIV mutates, do you think the young people who are getting the virus today by snorting or shooting in 30 years will be carrying the same HCV we are?
Your 1991 85% drop is BUNK, snorting in the new way our little darling are being infected and I just read your entire post and your a moron.  your telling me that you can not in all your "internet" education research find another clinical pharmicutical company that has more studies going in research for HCV.  Lets see I worked in healthcare for the better part of 20 years, alothough I have not read any internet hogwash, I rely on TEXT BOOKS I say just for fun look up a company called MERK, tell me what they are spending their clinical rsearch on?  and your "current rate" date where do you think it COMES FROM....LETS SEE BLOOD WORK, and lets just say for the fun of it.  that oh the average 20-30 year old who has snorted some good stuff in college or because he/she could afford it, has a normal liver enzyme....So he/she goes in and says 'YOU BETTER TEST ME I SNORTED SOME ILLEGAL DRUGS" AND I MIGHT BE INFECTED.  your living in a dream world those numbers you "quote are the same **** different day.  I had NORMAL liver enzymes 99% of my adult life and when I did not I thought it was becasue I ate to many lobster tails.  NOBODY with a healthy and otherwise normal homeostasis who goes to see their primary care is going to be give the not so cheap blood test for HCV.  Your ridiculous, do you even see the irony of what you have written.  Did you have a HCV test when you were 20?  boy your a miracle child ....not

do not infer or write that I do not have a complete understanding of MY illness.  I DO.  I also love health science and your full of baloney.  

I do not know which is more ridiculous the statement you made about the pharmacuticals companies or the 1.8 infection rate.  tell me which state in this country does HCV as a standard part of blood work ups, without the client identifying a reason, tell me how many graduates from college getting started in their field or poor little rich kids who go to the doctor tell them HCV I have made some bad choies while having a great time?????

I am not going to "edit" this I may have rattled on to much or repeated or gotten off point and the list is long, but your full of it.  and if there is one thing I can understand and PROCESS it's that fact.  

the current "treatment" is great for acute cases, however the truth is if you have had the virus for say 30 years and have have underlying other health issues and MANY people in their 50's do or have developed hyper-tension, Type 2 diab, gastrointestinal issues,heck theres one for evey oran system my point is the immune system surpression while carrying this virus known or unknown is affected and therefore you treat with peg and ribo and those other issues are exasserbated or even worse disease develops in that system.

go fly a kite or tell me you read text books and not pharmacutical pamplets and internet hogwash.

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You dont take any Sh1t do Ya.
FYI in Aust the rate of diagnosed HepC cases is 11,000 per year. These are documented actual cases not estimates. The estimated rate is 16,000. I'll let you and MrLiver decide if the US with a population 15 times that of Aust only has double the rate of new HepC cases per year.
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today...you have brought tears to my eyes.

by prompting me to look at the immune system,chronic hcv, and the inflammatory response you have not only re focused my attention but also filled in many gaps in my understanding!

your discusssion on eubiosis, fibrosis, metabolic stressors,anti oxidants, chronic disease may well have changed my life as well as provide me with valuable insights to share with others with chronic/ acute diseases and the inflammatory immune response. interesting, a critical care conference i attended this years focus was on inflammation. but i did not come away from the conference with near the understanding that you have evoked by your discussions but i can see how valuable it will be in my field of nursing practice.

i am on TNF inhibitors resulting from an auto immune arthropathy i developed some 20 yrs after chronic hcv. i have struggled to put this condition in perspective and have questioned every doc i know about it. (as i have no genetic predisposition). i thought for some time the chronic hcv  causing an immune imbalance was a culprit in the development of this auto immune disease. it is not until now that i realize a more complete explanantion may be found by examining your excellent observations and provocations. i specifically asked my rheumy (who tells me he is an expert on the immune system) for measures i can take to decrease the inflammatory response causing immunopathology and progressive damage to my joints and soft tissues.  he smiled when i brought up the anti-inflammatory diet i discovered with no comment pro or con but only to comment i need to take my prescribed meds.  thanks to you i may be able to put together a regime of supplements that may well be useful to achieve a remission and who knows perhaps even come off the TNF meds.

although at present i am not able to have an intelligent dialogue with you and explore your expertises give me some time to review and reference my studies.

thanks can hardly describe the feelings inside my heart at this moment of discovery you have stimulated for me. so now i will dubb you "SIR SAINT HR"
hugs xoxoxoxoxoxoxooxo
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ok i will try to put this together in reponse to your questions

Q- "the importance of preventing leaky gut syndrome"
A- the largest part of the immune system is in the mucosal lining of the gut. the immune system makes sure undesirable elements from digestion do not get into the bloodstream. when the intestines become damaged its creates a hyperpermeable state in the mucosal lining and allows the putrefaction and release of injurious toxins and pathogens to be released inot the blood stream. this process creates stress on the immune system to stop these toxins migrating through the body.
the immune system depending on the state of intestinal leak may become overworked and the toxins then may become settled into different tissues and organs of the body creating a new problem. INFLAMMATION.

the added toxic waste material is transported directly to the liver through the portal circulation. although the liver has a certain degree of imuno tolerance it must now work harder to detoxify these products. in a healthy liver and intestine the liver is able to easily perform this amazing process. but in the advent of leaky gut and chronic hepatitis the liver and the immune system may soon become unable to meet the metabolic demands of the circulating toxic loads.  as the liver becomes overwelmed (due to chronic viral infection or other metabolic diseases) the immune system/ inflammatory response is stimulated and the result is activation of liver macrophages and kupfer cells and the construct of fibrosis.

prevention of leaking gut may be achieved by a process of eubiosis or by keeping healthy bacteria in the intestinal tract.  this may be accomplished by diet, lifestyle changes (ie stop smoking or exposure of environmental toxins), stress relief, supplements ie probiotics and digestive enzymes,  recognition of medication induced imbalances, and replacement of underlying deficiencies. also the therapeutic effects of flavonoids (natural anti-inflammatories) and  some neutraceuticals also promote digestive/liver  health by their anti oxidant properties to aid in the metabolism of products of digestion of proteins, fats and carbohydrates. especially lipid peroxidation and promote the synthesization of glutathione(one of the bodies most natural anti oxidant and detoxifier. thus free the burden and stress on the immune system that will be more equiped to handle the release of endotoxin byproducts released by basteria and pathogens into the blood stream causing inflammation liver stress and in severe cases sepsis leading to organ distress, and failure.

Q- "in what way can NAC impact the pathway of LPS."
A- by improving metabolism, cellular function, stabilization of cellular membranes and replenish
deficiencies of certain immune cells such as T- lymphocytes. there are more specific benefits of NAC but as a liver protectant it is highly therapeutic.

btw....just to share a case that came to me as i was talking about this.
i recently has a 45 y/o m, in my unit with pneumonia/sepsis induced ARDS. after 2 weeks of a massive arsenal of antibiotics, and ventilatory support he was not responding to efforts to be weaned off the ventilator. inflammation was running a rampant course in his lungs. one night it took me 35 grueling and heart throbbing minutes to break up a mucous plug in his endotracheal tube. finally a doc responded to my frantic calls and came and re intubated him. at this time i asked him for an order for muco myst to prevent mucous buildup in the respiratory tract and ETT again.  now you have to remember he failed weaning trails for over 1 week prior to this incident.
within 5 dyas of muco myst delivered nebulizer treatments he was able to be successfully weaned off the ventilator. OMG!!!!!! i am now even more amazed to consider the therapeutic effects of the NAC. i only wish i could of been present in his rehabilitation to give nutritional education and discusss the benefits of supplementation.

again thanks Sir HR. this is only the tip of my ice berg of exciting research to explore
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315996 tn?1429057829
Heading off to take my NAC. Thanks.

Nic Nac paddy wack throw your liver a bone. . . . .
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LOL you are funny!
serious i hope and encourage ALL to really read HR comments about preservation of liver histology. especially the ones paying beaucoup monies for herbal remedies that they are trusting natropaths to prescribe for them. this info may create a meaningful dialogue with your docs and help you take the quack out of alot of ducks out there ;)
it may be one of the best things you do to help your liver!
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Must be careful with NAC though because it  can eventually become a pro-oxidant over time once a persons reserves are built back up.  A more safe way to build glutathione levels(nac's main job) is by daily intake of 1-3 grams of vitamin c or lipoic acid.
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funny now how my mind is swirling with past experiences that connect to your promptings.

a few years ago my prized show horse developed a colic due to intestinal impaction. (somewhat related to constipation but worse in the equine species.)  for 26 hours we fought to restore intestinal function and my vet did a few gastric lavages, administration of antibiotics, and intavenous fluid support. by the 40 something hour my horse died (one of the most grievous times in my life) due to what the vet described as endotoxemia. this was also confirmed post mortum.
now i wonder........if we could of administered N acetyl cyteine iv if my horse could of has a better chance of survival?(as the impaction had already to break up).  when faced with mortality this may be a useful adjunct?  although it is not used in human sepsis on my unit i will ask our resident intensivist for more info.  but my vet might be willing for a try the next time i am in this situation?

interesting NAC also may help prevent influenza infection and reduce flu symptoms. perhaps this is achieved by not only breaking up respiratory mucous, but promote cell homeostasis in the respiratory tract,  with its added beneficial effects on the immune system etc... good news for us going into flu season?
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Hi sparrow

the statistical stuff was just bunk, I could not stop myself.  I worked in emergency care and saw a large percentage of at risk behaviors that resulted in injury and emergency care.  The numbers are low of these young adults that were tested for hepatitis.  therefore for a 1.8 percent number to be put in writing "as if" it were factual is ludacrist.  I should not have said moron, I'm ashamed of myself for that.  I feel in so many ways that these inflated and inacurate numbers are as big a part of the problem as the disease itself.  

It's like MRSA used to be in the hospital or nusing home rehab setting, now it's moving into our children, all because of a simple task that even the lowest paid health care worker learns  from day one....wash your hands...change your gloves.  In the big scheme of things if you have the ability to understand what these percents that are so ridiculous are as bad as not following universal precautions.  It sends out a message that is incorrect, just like that message so many people go into a hospital with...they will not be given anything they did not come in with, they are safe.  

I should not have said moron, I am sorry for that, and my tone is like a bad meal.  

As you must know from experience documented and estimated numbers are never even close.  estimated is always off by a large number.  diagnosed is what it is, but I would love to know the age range of these 11k diagnosed.  I believe in my heart it has such a big connection.  and I would wage there were 11k in a younger age range that have the virus today and are not diagnosed.  So how can we get healthcare to routinely start doing not only HIV testing but HCV testing?  that would change Mr Livers numbers over night.
oh and how many HIV people have undiagnosed HCV, those would bump up the number also.  Many HIV people have hepatitis for years and do not know.

Cool and sunny here hope your sky is blue also
Lanier

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thanks, yes a very good point.  i will continue to explore therapeutic doses and toxicites.

btw, a article i read stated 1200mg/day for flu......but again as i am not sure of therapeutic dose ranges and serum levels, and length of treatments in an acute situation. i need more time to explore this more.  do we need to make sure we supplement with vit c and other trace minerals if taking?

i will go back a re read HR's comments on PPC as it may be the safest when looking at a liver health supplementation program.

please all do not take my ramblings as any verdict of what is best for you or certainly rush out and buy NAC!  i am just beginning to put this information together. safety  is to be the NUMBER ONE consideration before implementing any supplement.  from HR's information on PPC this might well be that. for sure we need to run by any supplementation program with our hepatologist before starting.
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HI.
intersting post and LOL i just have to get off this computer for awhile.

in my place of work i have taken the logo of "liver angel" by this title i encourage all to be screened for hepatitis especially if in the health care industry. we certainly can take alot of the unknown's out of the population by testing and educating the risk factors where testing would be  more important.
i bet you have red and golden wings also!

hugs   stay well :)
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315996 tn?1429057829
"Must be careful with NAC though because it  can eventually become a pro-oxidant over time once a persons reserves are built back up.  A more safe way to build glutathione levels(nac's main job) is by daily intake of 1-3 grams of vitamin c or lipoic acid. "

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I've been taking time--released vitamin C (4 grams a day) for the last 20 years religioiusly. I better watch my NAC intake, no?

I swear by Alacer Supergram IIIs. The guy that discovered vitamin C and the guy that discovered vitamin B-5 used to work for them. The theory is that vitamin C doesn't work unless on time release and normal C (acetic acid) has a pH too low for the intestines to handle. So. . . .by combining with a potassium molecule the C becomes neutral and thus can be more effective as time release. There is also a slew of B-complex in the Supergram IIIs. My stress and memory really are grateful. Now I'm thinking my liver is too!!
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Thank you for your kindness.  I am so happy you are working, I miss the field so much.

I have a sister who went the other direction in life and was a homepathic professional.  she had a health food store, and a reflexologist and visits from a irradologist on a scheduled basis.  It is amazing to me that way back when I was in clinical medicine and healthy any young professional should be, the irradologist told me I have liver flukes and needed to investigate my liver health and function.  that was in the early 90's and I laughed it off, same message came from the reflexologist about my immune system and liver function.  It was so asstounding to think about now, back then my sis packed me off home with a suitcase full of liver cleanses and supplements.  I drank the teas and took the tablets because I felt they could not hurt me, but had not doubt I did not need them.  On one visit she had a person their who read "colors or auras" I remember she said I was blue so maybe that is what you mean.  I was born in March and always have been a sucker for the needy and also blue is my favorite color so I laughed about that one too.

Life is such a journey.  Now days I think anybody might just have the answer and clinical is not the only road by a long shot.

thank you for not thinking I am a creep or mean person, I am not.  I want everyone to get well here.
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"Life is such a journey"  
yes it is...especially with hcv taking you on a few unplanned detours!
my that an interesting story. does your sis still have her health food store?
perhaps some of the interesting information taught by HR will be able to help you. it sure wets my appetite to understand the science behind it in my very best limited way and make a plan to promote the best health possible considering my immune sytem is shockingly shot at present.
well sweetie and sister of the white hat ya ya matching stockings ho. my professional love and best regards to you in THE H journey. we all need to laugh a little, cry a little, and most of all search
a little along the way. thats the story of.....
hugs
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Honestly, I don't know where to start with your rant. There are so many errors of fact that it would require more time than I'm willing to spend on someone who thinks they have it all figured out. However, from from your posts I think it can be safely determined that you don't know much about HCV at all.Your rambling diatribe didn't contain one cogent thought and was riddled with factual errors .

All of my numbers are valid. All of the countries on earth who have determined their population's infection rates on every disease do so based on statistical modeling. Every one of them is wrong and you are right. lol   So, pray tell, just WHAT is the infection rate in the U.S. for HCV if its not 1.8% ?  And guess what---the infection rate for health care workers in the US is also 1.8 %. No different than the general population. I'm predicting right now that you won't be able to wrap your head around that one. Many people are walking around with heart disease and don't know it, yet the CDC ,for example, can give a very good estimate for how many people total in the US are afflicted. How is that done ?

People like you condemn any numbers reached by statisticians simply because they do not understand statistical modeling and the various formulas used to determine such numbers. It is an arrogant position to take when you think something is in error simply because you can't figure it out on your own has it was done.

The antibody test for HCV is relatively inexpensive. Another of many incorrect statements you made. At the yearly health fairs throughout the state I'm in the test is offered for $10. Most people can afford tha,t but if not you can get a free home test or go to your county health service and get tested for free there as well. More doctors everyday are making HCV antibody tests a normal part of their patient's (we still call them that here because it fits the definition better than 'client') yearly physical exams---that's how I found out almost 8 years ago. I know many, many others who found out the same way.

You have mentioned your education and your job about 10 times now. I'm not sure if it is intended to impress, or you are offering it as an excuse for your lack of knowledge pertaining to all things HCV. If you really think those two things gives you some sort of advantage over others in the understanding of viral kinetics, epidemiology ,and the natural history of HCV- think again. Like I said your posts stand in testimony of just how little you know about the subject.
Even your speculations lack merit since you employ factual errors as the foundation and guiding light  behind them.

And I will repeat---no other disease has as many drugs in the pipeline as HCV does right now. What any individual pharm is doing has no bearing on that fact. I can point to at least 20 pharms that have their future vested in bringing an HCV therapy to market. People don't assume that type of risk because there is no money to be made.

We are discussing HCV which is not your disease alone. Its shared by nearly
5 million infected US citizens. And where have you been ? HCV has been recognized as a systemic, rather than  an organic disease, for many years now.

Does your anger stem from a failed treatment by any chance.? I've seen this happen before.

Not many people can squeeze so many inaccuracies into one post. You have a gift.

"your' a moron-----lololol----you should at least spell the words right if you are going to call someone a moron.

If you want it, you can have the last word as I see no reason to continue with this exchange.
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Thanks for your reply. I want to further explore this BBC story--I just found some of the research info last night and really haven't had any time to digest it.
I kinda got sidetracked and to be honest I haven't devoted much daydreaming time to the topic yet. I would like to look into a couple of things that I'm not totally clear on, to see if my initial thoughts (speculations) have a comfortable amount of science behind them. I know there are many viruses that employ a CTC transfer of virions and I know it would be helpful to me to review the known and/or suspected methods used by the other viruses for CTC transfer. I think the discovery is interesting-- I guess I'll probably start with trying to ascertain if this mode of transmission has any clear benefit to the virus. I need to read all of the comments posted above---I briefly read a few of yours that addressed this question of benefit and a few other people's and thought many were intriguing.
regards,
Mr Liver
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no lets play some more. and I spelled it wrong because I never speak in such a way, I was wrong too.  HOWEVER it still does not change my perspective.  AND I do not care about education I could care less.

So your saying this 1.8 number is including all the diagnosed and not yet diagnosed HCV people ?

would you be willing to include the "possible" variance, you know like in all the other great "polls" and statistical guesses we have.  lets see an average is 7-10% error one way or the other.  how many "healthfares" would you say you go to in a year and sell these 10.00 kits?  and how many people buy them?  that would be interesting to read.  And if it is 10.00 why were we not doing it in the emergency room for the 20 years I was there?  

I have not "failed" anything I am still here and moving right along.  just because I do not accept your pharmacutical packet sales pitches.  what exactly have you "seen"  
and what is your gaggle and systemic and organic?  

and point to 5 of these pharmacutical companies please?

are you in politics or related to hilary clinton? your "more doctors everyday" is a political pile of ****, they do not have your 10.00 test at the primary care, or am I wrong there too?

and if these little "health fair dream test: NOT ANTIBODY OR SURFACE ANTIGEN" are  EVERYWHERE
why don't our primary care doctors use them???
why Labcorp would be thrilled...

why don't we just have "HEALTH FAIRS" AND COUNTY FAIRS AND SELL ELEPHANT EARS AND SIDE BY SIDE.  explain to me when I had my hepatitis titers for clinicals the test I did take at the local health department (becasue I was a poor college student) came back fine and off I went into the hospital.

we are writing about 2 differnt tests here rocket man.  I am NOT speaking on ANTIBODY TESTING in a 10.00 kit or at the health department and I live in florida and I know hundreds of doctors and I know of NOT ONE WHO DOES HCV testing as a standard blood work up. of any kind for an elevated liver enzyme unless the client identifies a reason or is going into the EMT program.  healthcare workers would have a higer %%%% of having this test at the doctor (not the fair) than any other group.  I have many freinds who have elevated liver enyzmes, air traffic controllers, lawyers, accountants, real estates people and they have other issues hyper tension yada yada yada, and NOT one has had any HCV testing done PERIOD.  so what is the criteria >>>>

and are you suggesting we all go to the health fair if we suspect we have HCV, but what if we feel fine or what if we think its a joke, and would rather check our blood pressure at CVS and buy our "kits' there with our malox.  I am laughing now.  

go into ploitics even if your a dishwasher your a natural.  you have the gift of B/S statistics and polls and health fairs are way better than anything concrete.  

be sure to post those pharmacutical companies I have 3 girlfriends who are reps and I would love to let them in on the secret.  how much money in dollars would you say is shot over to the HCV researh labs every year?  have you got the stats on that?  and is it more than erectile dysfunctions? is it more than diabetes?  is it more than colon cancer?  is it more than HIV? is it more than heart disease? is it more than Alzheimer's?  where is it on the list ?  look way, way, way down and cite me the dollars not the little companies on the NYSE that are trying **** that is going nowhere fast.  

I am familiar with the CDC I have been to meetings in Atlanta and I am going to look into you 1.8 numbers and the correct information to go along with it.   it the only valid place you have cited, in fact it is the ONLY name you have used for any of your gaggle or reflux.

Lanier

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here here! i second this discussion and return to the original intention of the post.

in reviewing immune response and CTC transfer i will take a guess that perhaps the only benefit of this transfer to the virus is that it will escape the adaptive immune response (specific primed Tcells of viral epitopes, formation of new antibodies, stimulation of further specialized T-cells, and throw another monkey wrench into research trying to develop an vaccine. i am also in suspicion that CTC infection might infer a greater advantage in the viral envelope proteins to lock onto the cell surface in a way to further disarm the immune system?
perhaps also this is an viral survival techinque to preserve its host cell?

however the cellular innate response will be there to give a fight but probably unsuccessfully as it was designed to work with the adaptive or humoral response in viral infection.

i really liked HR analogy to describe the process of reinfection vs elimination of the virus intracellularly.  this has got to be a classic!
"it is the difference of fire spreading house to house or being spread all over the city by trucks using the streets throwing our burning ambers or by tornado winds"
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please share the site of this BBC article as ron did not in his post.
thanks
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I just read your post here, got so wrapped up with defending my opinions I admit I had not, I understand the histological orginazation of the liver and what your writing here is really good information I am speaking to the post from 11/14/07

I should have read it before the others and then we might have more common ground.  Mr liver and I will never be anywhere on the same solar system but your kuffer information is right on target.

lanier
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"Number of new infections per year has declined from an
average of 240,000 in the 1980s to about 26,000 in 2004"----www.cdc.gov.

I'm doing the math....dang ! I said an 85% reduction in my earlier post and guess what ? It's even MORE than that.

You inferred that my claim the least. There are  a multitude of reasons to explain the differences in infection rates between countries.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?&pubmedid=16614741



The case presented in the abstract I read did not show any data showing that the relapse didn't actually occur between the time period leading between EOT PCR and the PCR which was administered after EOT for his lymphoma, many months later. Furthermore, there is no evidence that would eliminate the possibility of re-infection before the last PCR was taken, as well.There would have been plenty of time in between PCR' s for this to have happened although I'll say that the odds would be extremely low for this to have occurred, yet entirely possible.  Even if the relapse was genuine it was not beyond 24 months. So, once again an unverifiable claim has been given.

" Swain et al reported that in only seven out of 845 patients who had been successfully treated with interferon monotherapy or combination therapy HCVRNA was detected after 391- 1076 days off treatment ( 20 )."

This presents zero data to confirm that the relapses didn't occur well before testing was done post-SVR. And no mention of how often tests were peformed. Even if they were every 6 months this allows time for re-infection to possibly take place. Obviously, this is not a well-documented claim.

"In a recently published study no recurrence of HCV infection was seen in any patient from a total of 187 HCV patients with SVR after a median follow up time of 29 months (range 12-172). Three out of 187 patients in this study had transiently borderline positive HCVRNA once within the follow up period but it was negative in subsequent examinations and no patient developed hepatitis. "

This part of the abstract showed  NO RELAPSE in this study of 187 patients tested at a mean avg of 29 months from EOT. This was in the SAME abstract, yet no mention of it in your post for some reason.

"but I am sure I have come across the same only it was 7or 8 years after SVR"  -
If you are sure of yourself then present the study. If you saw it on the internet I'm sure it still exists. To be honest I would think finding a >2 year post-SVR relapse would be much easier than finding an 8 year case of it. Perhaps its in Medline, Elselvier, Wiley, Pubmed, CDC, NIDDK,NIH,or maybe in some of the journals like Hepatology, Gastroenterology Today, Virology, etc etc. All searchable for those who want to take the time and learn.

Do you think I have nothing better to do than hang out on the web and make up phony numbers so I can post them on a support forum to misinform or mislead ??? Exactly WHAT would be the point in that ??? I can assure you Cocksparrow if I post a statistic I CAN back it up. I don't pull imaginary numbers out of thin air, unlike some. And I don't cherry pick paragraphs out of
abstracts in an attempt to bolster my claims.

And if you have a problem with anything I say related to HCV in the future why don't you just address ME about it ? You don't have the cajones or what?



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Just to chime in my two cents:  I do not personally believe that 'relapse' is the issue when we discuss the 'viral persistence after SVR ' found by a number of researchers over the past few years.  When this virus is successfully treated, it may well go into a tightly controlled remission, which is almost impossible to overcome.  In other words, no relapse, but possibly also not total and complete eradication., I can't support the potential for the virus to remain at sub-detyectable levels after SVR because I don't do the research.  But I can read the research, and clearly there is something causing quite a bit of interest, which is being identified in the PBMC's, liver tissues, and other organs after applying higher than normal amplification in testing.  If there were no issue here, none of us would even be discussing the potential for viral persistence.  If you look above, HR also posits that this phenomenon may well be valid.  I thought that most of the board contributors had discussed this issue ad nauseum over the past year or so.

My point is this:  Yes you are correct, we are essentially "cured", but that does not automatically presume or prove that there is no dormant, or 'controlled' virus left in the body.  This concept does not really bother me,and does not seem hard to believe.  The concept of a virus being placed into a more or less 'permanent' dormant state is just as likely as the virus being absolutely eradicated.  I do believe that many prominent researchers from all around the world have come to similar conclusions.  Or at least that is how I read their discussions.  

DoubleDose
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Written Testimony of Bruce R. Bacon, MD, presented to the House Appropriations Committee, Subcommittee on Labor-HHS-Education April 29, 2004, Washington, DC
========================================================================
Written Testimony of Bruce R. Bacon, MD, presented to the House Appropriations Committee, Subcommittee on Labor-HHS-Education April 29, 2004, Washington, DC
========================================================================
Mr. Chairman, I would like to thank you for the opportunity to present written testimony to the Subcommittee on Labor-Health and Human Services-Education and Related Agencies of the House Committee on Appropriations.

My name is Dr. Bruce R. Bacon and I am testifying before the subcommittee in my capacity as the President of the American Association for the Study of Liver Diseases (AASLD).

AASLD represents more than 2,800 physicians, researchers and allied hepatology health professionals. Throughout the Association’s 50+ year history, the members have been committed to its vision and mission and have strived to achieve the goals, objectives and principles set forth by the leadership. For generations, AASLD and its members have been a catalyst for the investigation and treatment of liver diseases. AASLD upholds the standards of the profession and fosters research that generates improved treatment options for the millions of patients with liver disease.


I would like to discuss with you the funding issues related to the National Institutes of Health, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration. I would also like to discuss the fiscal needs created by the passage of HR 3926, the Organ Donation and Recovery Act, which was recently signed into law by President Bush.

National Institutes of Health

Mr. Chairman, the AASLD fully understands that incredibly difficult dilemma that faces this committee. We look at it as a classic situation of supply and demand – the demands for funding that you are receiving from groups like ours far outstrips the supply of funds that you are likely to have available when the Appropriations Committee divides up the available resources later this spring.

We are fully confident that the committee and the subcommittee will carefully consider these competing issues and will endeavor to establish priorities that reflect the best interests of the American people, no matter how difficult that challenge may be. It is for this reason that we feel secure in joining with our colleagues in the health research community in seeking an 8 to 10 percent increase for funding for the NIH in the FY05 Labor-HHS bill.

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Within the NIH, Mr. Chairman, liver disease research takes place in more than a dozen different institutes. However, the largest volume of research occurs in NIDDK, NCI, NIAID and NIAAA. With your permission, I would like to take a few minutes to discuss this important work and some of the challenges that continue to confront researchers.

Because the liver is part of the body’s digestive system, the NIDDK is the lead institute for liver-related research. Their focus is on the impact of various diseases and conditions on the organ itself. Much of the work that NIDDK does in its intramural program and funds in its extramural program is related to diseases like hepatitis (particularly A, B and C), acute liver failure, and fatty liver diseases (including non-alcoholic steatohepatitis or NASH), as well as research related to transplantation. While fatty liver diseases are not as well known as the various hepatitities, they are important co-factors with such critical disorders as diabetes and obesity.

Hepatitis C is a particularly vexing problem. Mr. Chairman, approximately four million Americans have been infected by the hepatitis C virus (HCV) and nearly three million of them are chronically infected. However, most do not know it. Because HCV infection can be asymptomatic for more than 20 years, most persons suffering from hepatitis C do not discover it until their liver is virtually destroyed by the virus.

For this reason, hepatitis C has become the largest cause of liver transplantation in this country. Given the incredible shortage of organs and the number of deaths that occur while persons are waiting for a liver transplant, research into early diagnosis and improved treatments of hepatitis C is essential for the well being of our patients.

NIAID also has an important role to play with regard to hepatitis C. This is the lead institute with regard to the development of a vaccine. While the spread of hepatitis C has slowed as a result of improved testing of the blood supply, new cases continue to be diagnosed, at a rate of about 20,000 per year.

Unlike hepatitis A and hepatitis B, there currently is no vaccine for dealing with hepatitis C. NIAID is funding research in this area and a small human trial of an experimental vaccine is underway. This could represent a substantial breakthrough in stopping the further spread of the disease.

Mr. Chairman, on another topic, the number of persons who develop and die from liver cancer is increasing, with 24 percent more cases diagnosed since 2000. This is in stark contrast to many other kinds of cancer, which are actually decreasing in incidence and in deaths. This month, NCI is holding an experts conference, along with NIDDK, to help define the most urgent areas requiring additional research, professional education and public awareness initiatives. AASLD believes it is essential that NCI, working with NIDDK, follow this conference with the development of an aggressive and targeted research portfolio, using all available mechanisms of program announcements, requests for applications, center grants, training grants and more.

Centers for Disease Control and Prevention

Mr. Chairman, the Centers for Disease Control and Prevention (CDC) also plays an important role with regard to the public health impact of viral hepatitis, especially hepatitis C. Within the Center for Infectious Disease, the Division of Viral Hepatitis’s National Hepatitis C Prevention Strategy is a key program that assists state health departments and voluntary health organizations to provide testing, counseling, outreach and referrals. It is critical that this program receive significant funding increases to begin to come to grips with this epidemic.

As I mentioned earlier, most persons suffering from hepatitis C do not know it. An aggressive campaign of physician education and public awareness is needed to bring a focus on this disease. Early diagnosis and treatment may be the best defense we have at this time against liver damage, the need for a transplant, and eventual death from liver disease.

Health Resources and Services Administration

Mr. Chairman, the Administration’s budget has again requested $25.0 million for the organ transplant related activities of the Health Resources and Services Administration. These funds support a scientific registry of organ transplant recipients, as well as the Organ Procurement and Transplantation Network (OPTN) to match donors and potential recipients. A small amount of the funds are used for public education and to support agency staff, which provides a clearinghouse and technical assistance.




rock on
Lanier
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CDC IS FLUSH WITH CASH....NOT.  your 1.8 number comes from a dieticians research study how far of the mark could that be...on just about as much as your ridiculous statement of hundreds of pharmacutical companies beating down the doors to research this virus. BUNK.

Maybe the penny stocks on the NYSE are what your using for this data. who knows.  I agree now I have no need to discuss anything with you again.  dieticans and penny stocks are not my field.

rock on your a legend in your own mind
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232778 tn?1217450711
"on just about as much as your ridiculous statement of hundreds of pharmacutical companies beating down the doors to research this virus".
I don't understand most of this thread, and probably be no better off if I did. But this comment is unfair. We are very very lucky to have a disease that is common. There is money in this disease, so there is research occuring. If we had some uncommon, as many people do, there is just often not the money to commercialize potential drugs.
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In the big picutre HCV is not getting it's fair share of dollars.  the statement you qoute is out of context.  Mr liver and I have been debating this.  I never said there was NO research, but I can tell you in the past ten years there were more dollars that is what I am talking about spent of erectile dysfunction than HCV.  and since I have no penis I feel like I got the "shaft"  

I don't want to argue the point anymore you guys are sold that HCv is just the cats meow when it comes to research so dream on.

I did not mean to offend you, but if I did life goes on for us both it really is no big deal, this is a BLOG
I thought people were "allowed" to share there knowledge and not have to fight for a different idea?  I am not right about anything heck I am wrong all the time I am human, I don't want a blue ribbon.  I just know what I know from where I have been.

have a nice day go Packers and crown 24 king

Lanier
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233616 tn?1312790796
sorry this is going to take me a long time to read through,

but a dumb question, regarding thick protein shells you said

>>>>>>>>>>>>>>>The virus manages this extremely critical  “escape from neutralizing antibody” feature by having evolved such a surface coat of proteins that it has enough lipophilic amino acid residues placed at strategic points as to bind circulating lipids, that give it a secondary, soft coat, that prevents the antibodies to reach the epitopes and hence effective, strong binding.

ok so help me understand, if more lipid protects the HCV from the antibodies being reached by the eritopes, then why would adding PPC to the health.meds regime not aide the virus as well by giving it extra protection?

I may be misunderstanding something here, granted, but with my limited knowledge of your lingo, it's kinda hard to be sure if this new info does damage to the PPC equation.
thanks
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All I have to say about your rants is to repost why HepC is called the Dragon.
The liver is represented by a dragon and is said to store anger.

Certainly applies to you
Have a Nice Day
CS
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as usual as i reread HR comments i find a new gems to explore

your question stimulated this re read. although your inquiry was about PPC in relationship to circulating lipids i found something more remakable from his explanation.

i would guess that PPC has no effect to increase the development of the secondary lipid envelope coat of hcv because 1- PCC composed primarily of polyunsaturated fats actually decrease plasma triglycerides and cholesterol. 2- the addition of polyunsaturated fats in circulating plasma would not have any effect in the ability of the lipid envelope layer of hcv binding to plasma circulating lipids.
will be nice if HR comes in to elaborate! would be nice to clarify if the virus binds circulating HDL's or LDL's in plasma?

but even more remarkable in his explanation was the statement that hcv envelope proteins  bind to circulating lipids thus giving it that soft coat that interferes with antibody attachment to the viral epitope. in effect preventing the ability of the antibody from processing the viral epitope and neutralizing it.

wow! i thought antibodies were ineffective because of the envelope proteins E1E2 especially E2(envelope proteins) are hypervariable thus preventing effective antibodies forming due to the constant development of variable epitopes. (the genetic drift causing mutation and development of quasi species cause the hypervariability that are capable of neutralizing antibodies).

i never considered that the lipid layer on the envelope would also prevent antibodies from forming a strong bond to the viral epitope!  wow wow. this is the firist time i considered this aspect.

also i never understood the lipid coat to be able to attach more lipids when circulating in plasma. i always thought the bi layer lipid coat was formed from intracellular lipids during the virion maturation inside the cell and by the process of exocytosis. interesting now to realize the viron has the ability to attach circulating lipids in its defense system.

now my coggs are spinning lol!
i came across an interesting article about an emerging science in viral immunotherapy whose focus is to develop agents that will remove the lipid viral coat (delipidation) thus increase viral antigen presentation and processing.  
site     http://sec.edgar-online.com/2006/03/15/0001047469-06-003438/section2.asp
would love HR to comment on delipidation as a prospect to aid the development of an effective vaccine.

also one of my fav sites on hcv viral biology is
www.natap-org/2001/jun/MoleBio.PDF
i have lots more of such if you are interested

another insight in to the way the virus evades the adaptive (humoral) branch of the immune system!
thanks merry....i enjoy your comments and posts! our understanding is alike a baby compared to HR but perhaps together we babies can reach better understandings of chronic hcv
hugs
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clarification of above.

it is the proteins on the lipid envelope that attach to circulating lipids. as there are only 2 main envelope proteins on the hcv- E1 and E2. i wonder if both or one has this ability?
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151263 tn?1243377877
Since you seem to be getting off on the lipid-confounding-antibody groove, you might find the study referenced below interesting reading. Basically it states that high levels of cholesterol, and specifically high levels of LDL (the "bad" cholesterol) were found to strongly correlate with RVR/EVR and eventual SVR. I actually employed this strategy during my treatment by loading up on the saturated fats prior to treatment and during treatment by eating lots of fattening foods (whole milk, pizza, ice cream etc etc). Can't know if it helped, but based on the strongly correlative LDL->RVR/EVR/SVR data reported in this study, it just mighta!

http://www.natap.org/2006/HCV/080806_02.htm
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MerryBe

The virus manages this extremely critical  “escape from neutralizing antibody” feature by having evolved such a surface coat of proteins that it has enough lipophilic amino acid residues placed at strategic points as to bind circulating lipids, that give it a secondary, soft coat, that prevents the antibodies to reach the epitopes and hence effective, strong binding.

ok so help me understand, if more lipid protects the HCV from the antibodies being reached by the eritopes, then why would adding PPC to the health.meds regime not aide the virus as well by giving it extra protection?

1. The antibody binding is already unable to prevent reinfection due to this mentioned feature, together with the constant adaptive evasion by mutation (correctly mentioned by whrose above , but left out in my earlier discussion so as to not further complicate the issue)  as part of the viral strategy to escape neutralization. Therefore, even if PPC would add to that " lipid coat" it would not matter. Once you are coated, you are coated.

2. The exact nature of these binding lipds is not known ( at least AFAIK). Chances are that the overall plasam lipid profile would not be altered by PPC so as to enhance this feature, even if  it would not alrready have maxed out .

3. There is a small component of neutralizing antibodies in place that seems to have some role in the ability to prevent reinfection in a setting, where there are only a few viruses trying to infect a virgin liver, like in the transplant setting.The HCIG experiments - passive immunization using plasma enriched for HCV antibodies in chimpasnzees- to prevent de novo infection-  had a small degree of efficiacy, but not enough to make the difference. But, as mentioned above,  Innogenetics in Belgium  is currently trying to develop two human monoclonals with the intenion to help prevent reinfection after transplant. I had a discussion in that specific regard with the two lead researchers actually working on this  at the Boston meeting, so I am up to speed on that approach.



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This is of course yet another twist to the HCV-lipid story. Since HCv seems  - among other attachment / transfer  receptors - to use the LDL receptor as anchoring/plasma membrane translocation enhancing mechanism, the protective effect of high LDL might be correlated to a competitive binding/blocking  of that receptor by high LDL levels, reducing reinfection efficacy.

Alternatively, high LDL levels may lead to "overlipidation/lovercoating" of the virions, where their trick starts to backfire, reducing attachment  efficiency at the hepatocyte membrane.

Please note that the HCV viral entry mechanims at present are only incompletely understood.
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haha ya, i admit i do get a kick over the "lipid confounding antibody groove"  

of course during my tx i did increase intake of fats ( with riba ) and in % TDI.  my geno 3a
pre -tx i had a lipid profile done and my LDL were abnormally low causing an alert for cardio vascular disease. this led to a full blown cardiac work up(all negative) and then an interest in dyslipidemia in chronic hcv.
material was hard to come by for this foray because of the lack of research on lipids and hcv.

from my limited understanding i thought that my LDL levels were somehow influenced by the virus perhaps causing the increase risk of steatosis (i did have this on BX). i got confused that othere however had higher levels of lipids with infection which then i assumed were related to diet and perhaps a hereditary influence. after tx my lipids all came back normal with perhaps a need to > HDL's in diet. i do enjoy my handful of almonds and walnuts daily.

the article referenced previously and others discussed the possibility of hcv using the LDL receptor to gain entrance in the cell. (one of many ways for cell entry) HR has it right on that the process of hcv entry into the cell are still not fully understood. i look forward to more coming as you know i am a "lipid nut" lol

back to using HR posts as a study stimulus....hugs HR... hope you are well!

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315996 tn?1429057829
"loading up on saturated fats"
____________________________________
Outrageous! We get to increase the *HDZ factors and the **CG factors!



*Hagen Daz
**Cherry Garcia
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ROFL.  ha! i was thinking of asking HR to marry me but if you are serving hagen das, starbucks, and cherry garcia...maybe i will change my mind.....ahhh are you....
(of course i would have to leave the love of my life for 34 years)
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315996 tn?1429057829

:-O
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What a thread! OOOOOOO Baby baby!
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I have trouble with processing in general,"  Andy, boy do we know that. My God even here you must give these people a hard time. You no nadda on HCV, as you drank all through your tx, and continue to do do. Please get help, contact your local AA.
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Please do not waste your time responding to Mr. Liver, who is also earthman, aka andy and an assortment of fake names.  He has very serious issues and has been shunned by other HCV forums.
Please keep an watchful eye on him, as he can be upsetting to people on tx.  I enjoyed your informative and was happy to see that you saw right through this nitwit.
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What a nice thing to know, I only came here I think around May-Aug this year.  I have never been on a blog or anything in the chatting, "im" video cam kind of stuff.  I was desperate, pitiful and still am in many ways.  Yhid forum has helped me.  I can vent and try to relatate to others like me.  I loved healthcare so much and miss the clinical setting and excitement, but I broke ranks years ago when it comes to Doctors, lawyers or Indian chiefs...lol   I was out spoken and asked questions about care plans long before I knew I was afflicted.  Now I am a ruthless advocate for people who need to be more proactive with their own health.  I wish we all could wake up well, I wish I could see my only child for 30 more years, inside my self awareness tells me it will never happen.  I just wish more people could get screened when acute.  they have made invto study this past January in a laboratory setting and so I am hopeful for those coming down the pike.  It's why I always  ask how old people here are?  (so rude)
anyway thank you again

regards
Lanier
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YOU ARE A KEEPER..
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DONT FORGET THE THE TRANSFAT BABEEE
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315996 tn?1429057829

lanier: I can out pain-in-the-neck you anyday of the week

Xquizit: that is what is so crazy. They are saying that Riba stuff goes down better with a lot of fat. So . . . .once you are done with treatment you can sign up for a heart replacement
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233616 tn?1312790796
hey, yer ruinin' all my dove bar moments....cut it out!!!!!!!!!
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233616 tn?1312790796
thanks for pulling this thread up again, I was going crosseyed in the wee hours trying to finish readin it, then and hadn't gotten back to it....people do read, rest assured.
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233616 tn?1312790796
whroose
thanks for that great response, and I need all the help I can get, so between the two or you, (HR) I'm getting the idea albeit slowly on some of this.
Just so you know, you're not a light weight, I'd not go there my friend, cause you are great

PS. I have all the autoimmune stuff you do, oiy, and a hornets nest in my liver this year, so it's hard to get caught up to speed in the middle of this horserace, so to speak,

but indulge me one more dumb question if you will:

and HR as well, or at least to ponder:

somewhere in here I think, Lord who knows where cause if life depended I probably couldn't recall enough of the wording to pull it up again with this search engines limitations,

, I seem to remember that the Riba worked by, in laymens terms, chopping up the RNA/DNA and thus interrupting the normally voracious replication aspects of the virus.

If this is not faulty memory on my part, then I would have to assume this means it get's done having penetrated the outer coat of the virus, sticky lipids or not, it has to get INTO the cell to effect the RNA strands before it can start chopping, and are these not inside the viral structure for the most part??  

If this is true then, that Riba has to get inside,
and then on the assumtion all cells are serviced to some degree by the bloodstream,
it means the Riba is getting around,
in which case whether the virus can do cell to cell transfer or not,
what real difference would that make assuming the saturation point of the Riba stays high enough? And, would not this somewhat explain then why the higher dosing seems to yield the more reliable results?

I mean since blood carries the Riba to every cell I'm just not sure the cell to cell replication is really a matter for alarm.

I did wonder a while back, could fat retain virus since it get's less blood supply proportionately,
also wondering could bone matter itself be a hiding place.

but ultimately my main question is, even given a circutous route through the circulation before a Riba molecule reaches a neighboring infected cell let's say,
won't each cell still ultimately get serviced with Riba soon enough....
and if often and long enough in duration then why would it matter so much???
And,  isn't that what the SOC is basically now proving out to a greater degree?
Isn't the longer duration tx resulting in people going UND for years now??

ok so that's not just one question....so much for my one time math major!!!!!!
: )))))))))))))))))))))
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oh my, LOL, your note reminded me of myself as i started to explore the incredible world of hcv.
one question leads to many others, time consuming to delete flaws in conclusions, time consuming to fill in the gaps of understanding. i am no expert by a long shot as i still have some big gaps, but time and persistance has been a friend along with many peers and their excellent discussions/debates and wisdom from experts like HR. another valuable base to focus study on is cell and viral biology along with the human immune function. lol a math degree may be challenged but certainly be an asset in comprehension on the molecular side of things!  then there is the school of hard knocks...sure to teach you some important lessons.

well to take on  the "Q"s as i can read em
CTC replication has No effect on ribavirin circulating and plasma levels, nor in riba's intracellular function.
the exact mechanism of ribavirin in the function of viral kinetics is still not well understood but some studies show it accelerates phase 2 fall in hcv rna.( very important to get that viral load down early in treatment for prediction of tx response).  the lethal mutagenesis effect of riba causing hcv error catastrophe only partially explains its effect on viral kinetics. as evidenced by ribavirin mono trials inability to reduce viral rna. there is a theory well described by a researcher called Sallie that explains the anti viral effects of ribavirin to be more due to replicative homeostasis as opposed to error castrophe. the article is tough reading though. (will give a link below).  riba also effects immune modulation and stimulation in concert with IFN synergistically, and that is why it not only functions importantly in the beginning to reduce viral loads but also to reduce relapse thus SVR rates. however as we know all genotypes are not created equal in terms of response to SOC. the reasons being not only host related but perhaps better explained by viral charactersitics.

high dose riba has its inherent risks not only with life threatening anemia but in renal impairment.
i am like many others impressed with some reports that state high dose riba (1600-4000 mg/day) changes SVR rate in geno 1 from 50% to 90%. however there are not enough studies to confirm or recommend this due to this dose is above recommendation and the associated SAE's.
our resident expert JIM can certainly give alot more info about this than i can.  so high dose riba may in this regard profoundly effect those early viral kinetics to favor rapid viral rna decline to achieve that undetected sooner (but only in combination with IFN) but as i said there are risks and one should only do this with the support of an experienced hepatologist.

when i did my treatment (geno3) i had a negative predictive factor of age and high viral load. i pushed for higher dose riba max wt based even though it has not been proven to increase SVR in my geno. however my doc agreed and by week 4 i was undetected. i personally believe the extra riba may have been a factor as my  pre-tx viral load was over 20 mill. for sure it did not hurt! although again with my geno a 4wk undetect is more likely the norm but relapse rate still not understood well. another reason i stayed on the wt based dose through out tx. btw i did SVR and for me my tx regimen was a success. would be interesting to compare me to me taking the 800mg recommended riba dose for my geno. i will never know this difference and glad of it.

so therapeutic or high dose riba has no relationship to CTC infectivity. you are right to conclude this.
longer duration in SOC has been shown to increase SVR in some response patterns such as relapse and partial responders.  i think this is due more to viral charactersitics/mutations that respond favorably to longer dose regimens.

in regards to fat or other organs where hcv hides. in my understanding hcv does not hide out in other organs, but has been proven to be able to replicate in other cells in the body outside the liver (its [liver] best and preferred medium for replicative success)perhaps thus providing a reservoir to some degree.  how this fact influences its ability to cause disease outside of the liver is still not well understood and debated. HR has explained the durabilty of SVR and this would support any reservoirs of virus out side the liver would not be disease causing once SVR is achieved.
it is known that hcv increases risk of lympoproliferative diseases and alters immune function(along with IFN) that may be the genesis for other immune related diseases. also Hr explained well the relationship of immune stress caused by inflammation especially with his leaky bowel pathogenesis of circulating immune complexes systemically as well as localy in the hepatocyte.  the evidence of its tropism has not proven to directly result in other diseases....but the jury may still be out in this regard as i understand it. without getting in occult virus which is another subject all together.

i hope this helps.. for sure HR and others can give alot more meat into your questions.
hope you are feeling well. sometimes study is a great way to divert anxiety. it sure helped mine although i am not as diligent as i was on treatment perhaps my understanding is improving without the effects of tx meds and SVR. some articles you may enjoy
http:www.medscape.com/viewarticle/543530   explains viral kinetics of riba and IFN
also http://www.virologyj.com/content/4/1/29    replicative homeostasis by Sallie good luck....it may take several readings to get his gist. however it is for sure a most excellent explanation and worth the study time to understand it.

hugs Whrose
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