dormant hepatitis C and hydroxychloroquine/Plaquenil

[Sarah Vashon]

I successfully completed interferon/ribavirin treatment for hep C in March, 2005.  I last tested negative for hep C in September, 2005.  During treatment, I developed rheumatoid arthritis symptoms.  I have seen two Rheumatologists and both have recommended I take hydroxychloroquine.  If I take hydroxychloroquine will I significantly increase my chances of suppressing my immune system enough that I will again test positive for hep C?

[mspriss]

Thank you. This is all crazy to me! Thanks for your insight. Missy

[Trinity4]

Antibody Tests
The first test usually done for hepatitis C is an antibody test such as an EIA. A reactive (positive) result means that, at some time in your life, you were exposed to hepatitis C and your body produced antibodies to fight off the virus. If the EIA test is reactive (positive), a second antibody test called the RIBA (which is more accurate) may be used to confirm the result. Most people who test reactive (positive) to both antibody tests are chronic carriers, meaning they carry the virus in their blood and can pass the virus on to others. However, some people (about 15-25%) who have a reactive (positive) result can clear the virus on their own without treatment. Further testing should be done to determine if you are chronically infected.

PCR
A PCR is a viral load test that detects the presence of hepatitis C in the blood. If the PCR is positive, you are infected with the hepatitis C virus, and are probably a chronic carrier. If you undergo treatment for hepatitis C, this test helps to monitor whether the medicines are working.

Dormant is not a word usually used to describe the outcome of blood tests for hepc.  Either you have cleared the virus on your own and only test positive for the anitibodies which will probably be the case for the rest of your life or you have the active virus is your bloodstream.  A PCR RNA test is the only way to determine if you still have the actual virus.  Blood to blood contact is the most common form of transmission.  
A good reference source for all your questions can be found at janis7hepc.com
Good Luck
Trinity

[mspriss]

I'm confussed. They tested me the first time and results were positive for hep c. then I went to a blood lab and they called today to say that it is dormant. ??? WHAT ??? can somebody tell me what this means? will it come back? Can I expose others? Is it gone forever? ???? I don't understand.     Missy

[NYgirl]

PS I am talking about drinking DURING tx btw...not after you are CURED    :)

Just reading that the one drink STOPPED the meds working until it got out of my body freaked me enough to keep reminding me if I ever get "tempted".  ;-)

Well that and the FIBROSIS pictures that I saw....

[NYgirl]

Oh no girl I'm not talking about people with the ability to have an occasional beer here in the slightest........I'm talking about someone like me who once they get that taste they just have to drink the entire vat after swimming in it for a bit.

I have no doubt that my really elevated enzymes (200s) were not only from the hep but from the gallons of smirnoff I was knocking back. As soon as I quit and started tx they levelled straight down to the 20s IMMEDIATELY.

I know smoking is not good for my liver...but so far I've not quit.  so who am I to be a hypocrite?  ;-)

[NYgirl]

Thanks for the site! I'm going to go put them into bookmarks right now. It's amazing that just laying here on my bed talking on here has made me "tired".  But for the first weekend since starting I WANTED TO GET ON and I did!  :)

You are one of the best and I hope that you know it.  If everybody was as loving as you, what a great world we would be living in.

D

[cuteus]

well, in that particular woman's case, the PCR was <1,000 iu/ml so she could have been a low vl person and not an svr case to begin with.  That is why I like to read the details in some of these studies instead of just the Headlines.
If it was true in most cases that the virus can be "coaxed" out by triggers, we would be seen more relapses of long term svr, and we aren't. that is encouraging! these svrs are not all taking supplements and following a healthy lifestyle, some might be binge drinking, who knows? But we are not reading in the medical literature about increasing relapsers. Just a thought.
I am not worrying about tip toeing through life to avoid a hcv serum explosion, not until I read medical literature telling me what "triggers" to avoid.

[DRAGON SLAYER]

I like that title....it's well earned to say the least.
Enjoy your HCV free life.....& whatever will B will B as long as it's NOT 2B.  :>).....

[DRAGON SLAYER]

I would like to propose a toast to all HCV graduates, class of 2004. Lehaim from sunny Israel to all my classmates...lol.
May you know sorrow no more, only sunshine.

Ben & his mid-eastern clan.....

[Sarah Vashon]

I am very appreciative of the intelligent and caring responses. I wish I would have known about this website last year when I was in treatment.  It would have been so helpful at a very scary time.  Good luck to all of you/us.

[Califia]

Ah, my favorite libation!  Salut, Skol and L'chaim!   What a long difficult and well, let's face it, exceedingly strange trip this has been.   But in three months time I'm going to insist on being addressed as Dr. Califia, as in Dr. Califia, meet Dr. Hep.   Surely by now we've earned our doctorates in hepatitis, dubious honor though it may be.

NY Girl, I'm with you.   Those 21 months I lost to treatment  are the biggest incentive I can think of to take my grapes unfermented.   Never, alas, again.

[TnHepGuy_]

Congratulations on getting the wonderful news!!! As I'm sure you know, the 3-month'er has an excellent correlation with the 6-month'er. You're well on your way to SVR-ville!


Looks like we both get to gradutate from the Intron-A Failure Class of Early 90's to the Peg Clearer's of Mid 00's!


A large glass full of pomegranate juice gets raised in a westerly direction to you!


TnHepGuy

[NYgirl]

"person just harbors one of the lowest viral load seen, and is not truly clear of the virus? "

Isn't it possible though that the virus while not detectible in the blood test is in some tissue someplace and then gets re-introduced to the liver again somehow for replication and slowly and slowly slowly starts...until bingo it's back?

That is the thing that has worried me all along - our blood goes everywhere.

[dancegirl54]

PLEASE consult with your liver doc on this!!!!  I was on plaquenil for a number of years, my rheumy said I had lupus, my liver specialist said I DO NOT. And he sat down with me and went over my blood work. The symptoms I was having were from the hep C. Very surprised that the rheumy hadnt considered this knowing that I had had hep B many years ago.
There is no way to know if the Hep C was aggravated by the medicine since I hadnt been diagnosed yet, but it has been my experience with the 2 rheumatologists I have dealt with that they know very little about hep C. The one who prescribed the plaquenil has yet to answer all my questions. I gave up, just cant waste the energy, but the PA I was referred to at the rheumy's office told me after my diagnosis that I shouldnt travel(I travel for work)because I was a danger to others.

[cuteus]

never mind, I found the test used and a discussion of the case at
http://www.natap.org/2005/HCV/090505_13.htm

thanks

[NYgirl]

"Btw, I have heard anecdotally of a long-term SVR (ten years or so) who found herself with a reactivated virus after she indulged in heavy alcohol consumption."

I can't imagine that I'd want to fall victim to such a thing ever again.  Working so hard to get my liver back in some form perhaps better...my heart just broke for that person.  To achieve SVR and then go out and destroy your liver. I can certainly UNDERSTAND because WOW sometimes the cravings do come on so STRONG...what a complete heart ache.

It just goes to show that us alki/addicts had really better watch our steps AFTER SVR and not think we've won the game and can have a "couple" sometimes.  I guess we all really know there is no such a thing though.

That was a sobering thing to read...if you pardon the pun.

[cuteus]

I had read that article somewhere else, maybe Natap, and was hoping to find the sensitivity of the PCR used. could not find it, as I understand it, her hcv became undetectable again after they discontinued the steroids, whcih makes you wonder if this person just harbors one of the lowest viral load seen, and is not truly clear of the virus? Maybe the hypogammaglobulinemia is the key to this mistery? If you find the sensitivity of the test anywhere anytime, please share.

[Califia]

Excellent responses above.   It behooves all of us who have achieved SVR status (or anticipate doing so) to be as vigilant as possible about maintaining immune system strength.

Btw, I have heard anecdotally of a long-term SVR (ten years or so) who found herself with a reactivated virus after she indulged in heavy alcohol consumption.   Let's all continue to protect ourselves with good research and an excess of caution.

[TnHepGuy_]

Given that hydroxychloroquine is an immunosuppressant (see: <a href="http://www.drugstore.com/qxdHydroxychloroquine+Sulfate_333181_sespider/hydroxychloroquine_sulfate/hydroxychloroquine_sulfate.htm">Hydroxychloroquine Sulfate</a> - though this article doesn't say just how much of an immunosuppressantit is considered to be), I would be cautious enough to learn more about it by calling a pharmacist, the company who maufactures it and an immunologist familiar with it's usage and side effects. Another consideration is this listed side effect - "<i>tell your doctor if you have or have ever had liver disease, psoriasis, porphyria or other blood disorders, G-6-PD deficiency, dermatitis (skin inflammations), or if you drink large amounts of alcohol.</i>" (from: <a href="http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601240.html">Hydroxychloroquine</a>). If you had any kind of liver damage prior to treating, this precaution might affect your being able to take the medication. (This example shows another reason to for any-and-all Hep C patients to receive pre-treatment biopsies. Accurately determining the status of the health of the liver cannot and should not be underestimated. And the information gathered from the biopsy can be critical/useful before, during and well after treatment).

Since occult hepatitis C infection is a fact in at least some post-treatment SVR's, any drug that can do a substantial amount of immunosuppression should be looked at very carefully prior to ingestion. It is a known fact that in hepatitis B cases, the occult infection can rebound to a full-blown chronic infection when the immune system is suppressed. Generally this happens in cases of extreme immunosupression (i.e. - transplant, cancer treatment, etc). <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16107964&query_hl=1">Here</a> is a hepatitis C case where they surmise that a patient relapsed 8.5 years after spontaneously clearing as a result of taking corticosteroid therapy. Whether or not long-term exposure to hydroxychloroquine can cause such a state is best answered by the professionals.

Short of knowing if you have any occult virus left in you (which most anyone patient be very hard pressed to find any doctor or lab who would test for it), the best you can do is learn more about the immunosuppressive properties of the drug itself, and if there are any other good pharmaceutical options out there for you.


May God's blessings and mercy be upon you.


TnHepGuy

[cuteus]

Hey Cali! I think what many drs are saying is that given the propensity/"urge" of this virus to replicate, a very sensitive PCR( I saw one that went to <2IU/ML in a qual), and given the SVR for over 10 yrs in many cases with no signs of returned replication, in spite of all the stuff these people were ingesting and doing during those yrs, that is safe to assume SVR clearance in the majority of SVRs. IF we were to believe the possibility of remains of HCV left in some hidden place, and since it is not getting "reactivated" by any behavior or substance ingested, whatever is left might have been deactivated or morphed into a harmless state.  Otherwise, we would have seen SVRs relapsing all over the place after several yrs of negative status.
Of course no one can be 100% certain of anything  with hcv, but looking at those retro studies, we can almost be.

[Califia]

I'm a little uncomfortable with this word "gone."    Various PCR's measure at different levels.  Someone correct me if I'm wrong, but the most sensitive test that I'm aware of right now defines negative as < 7 virions.   Viral levels can be medically insiginifcant, i.e., undetectable, but  undetectability does not equate with altogether absent.

Sarah, I don't mean to beg your question, which is a darn good one.   If I were in your shoes, I would bug as many doctors as possible to get their take on the matter.  You might also want to go to the Delphi Unity forum and ask the RN there, who can take your question to a web roundtable of medical practitioners who are treating Hep C and have a broad range of clinical experience.  Best to you!

[cuteus]

how sensitive was the test used in the PCR? If it was very sensitive, the chances that you are harboring a very low viral load are slim.  If you test negative by a very sensitve PCR, it means that the virus is gone, not dormant. Hep c gets erradicated and no chances of returning as this article sees it:
http://www.natap.org/2005/HCV/010505_02.htm