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Conversation with HepatitisResearcher

I thought that a thread devoted to remaining comments from HR and any relevant questions from the forum might be useful.

To HR:
My question is this:  If there is residual virus left after successful treatment (and SVR) as is generally becoming an accepted fact (such as lymphatic system virus), then might the SVR's and the spontaneous clearers be dealing with an ongoing 'autoimmune' issue, in that their systems are perpetually dealing with viral suppression, and possibly generating a constant, or near constant state of immune system stimulation?

Might this be a major cause of the ongoing symptoms that many SVR's continue to experience long after tx?

AND...if THIS might be the case....what about the family members and intimate contacts that may also be 'receiving' the virus in tissue or fluid transmissions (non-blood), possibly setting up the same pattern of constant viral suppression and immune system stimulation , without a generalized or typical HCV blood infection?  In other words, might there be a similar 'persistent HCV infection' taking place in close contacts of HCV infected, but without provoking a full blown infection, and without any antibodies evident in the blood?

Here again we might see symptoms of 'autoimmune disorder', or CFS-like problems, but would have no confirmation of cause, since the blood would yield no HCV+ antibodies, nor would there be a positive PCR on blood testing?  It might be a good idea to look closely at large populations of HCV+ intimate contacts to assess their health and symptoms.

Thanks for your input!!!

DoubleDos
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Avatar universal
Hi everyone:
HR is pretty busy, I understand that, but still he's willing to come in an answer extremely difficult questions.
So I was wondering if we could set up somekind of webconference using MSN messenger or some other kind of delivery method or software that could be recorded and then distributed within MH forum users in a common format... He could do a presentation that includes the questions already asked in previous posts and could also be opened to questions from Europe or Asia...
We do it all the time at work in our corporate intranet, but I guess with MSN and Yahoo he could only have a video call with one designated person in the forum in the US that could gather all our questions in writing...And then that person would distribute such meeting in AVI format o MPEG or mp3..
this way we could replay it over and over until we understand all the concepts without being infoxicated.
I could even translate the data into spanish and I know some of the users could into french or dutch...
Wouldn't it be great? and it would be so helpful for us heppers..
The good samaritan goes global

salu2
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Avatar universal
Ina: Jim you were a moderator at some other board, could we do that?
------------------
LOL. I said I was a "co-owner", but yes, I did act in "moderator" capacity at times. "Could we do that"? Like I have any real say around here :) Look, like you say, people are opening threads all over the place for HR and they will do what they want and that's OK. As to very structured threads with 15 questions and 15 answers that sounds more like the paid -- doctor on board -- side of MH.

Personally, I think interaction with HR, or anyone posting, is important. You can get strict Q & A's elsewhere like at MH's paid side or over at the AIDS/HIV forum where a doctor answers a question with no other comments.

The difference here is that all members can interact with their comments so it becomes a discussion rather than a treatise. HR is a valuable addition, but some of us -- Willing, myself, others -- have not and may not agree with every point he makes --- or we may agree and seek clarification. I think this is good and it further the learning process for all of us. Ina, I hope this makes some sense and hopefully HR will have some comments as well. BTW what you say makes a lot of sense as well, I just don't see a rigid Q&A without other member participation being in the spirit of this type of discussion group. And, even if I did, just take a look around at the myriad of threads being directed at HR and you'll see that what you and I think on the matter doesn't really matter because people will use this place as they want :) Guess no one picked up on my sequential number idea. LOL. Be well and thanks for the suggestions. Like Cuteus I know you're just trying to make things work better here but the place seems to have an ebb and flow of itself. I got called "Sheriff" at one point because I tried to "organize" things but I gave up -- not because I was called a name but because it doesn't seem to work here.

What might work, however -- do the expanded member and thread count, is a software upgrade more in line with UBB Threads, as used on some other boards. That would in effect help organize the discussion group more topically and do other handy things like bring threads to the top as someone makes a new post. Am I recommending this? H*ll no, can't recommend anything here :)

Anyway, thanks for sharing your thoughts, now you have mine.

All the best,

-- Jim
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Avatar universal
Didn't you came to the board looking for Alinia patients.
Maybe you saw this poster, maybe not. Didn't see a response of yours, so just in case you didn't see it, here it is:

ald_Dork
10/31/2006
C39 . Hi everyone, new to the forum and thought I would add my .02.

I have just started taking Alinia this morning. My doctor has me set-up to take it twice a day for two months. Starting the third month I will continue with the Alina and begin taking an anti-depressant for the next 30 days. At the end of 3 months I will begin the more traditional treatment for Hep C.

A little about me. I'm a 52 yr old male who has probably had Hep C since I was around 20. I had a two-year struggle in my life where I did quite a bit of drugs and wasn't even thinking about my future. I have been a two drink a day drinker for the last 15 years and just recently went cold turkey (3 weeks now). My liver is showing signs of scaring but the doc says things look good if I just follow his directions.

Was doing some research regarding using the Alinia with regards to Hep C and found this forum and will take time to look through it and see what I can learn.....

-----------------------
Sorry if you saw it, one can get lost between these many threads.

Ina

Jim, look below.
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Avatar universal
Another Alinia post found below. Bit dated but might be of some interest:

http://www.medhelp.org/forums/Hepatitis/messages/43331.html
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Avatar universal
Thanks very much,
You are correct, these days I am looking for answers if "sledge hammer tx" might have helped with occult SVR.
DD, Sandi and I never even thought about residual SVR, all we wanted was plain old SVR.
It's only as of late, since Mikesimon posted his unusual story, and Willing and Tnhepguy started linking us residual/occult studies, that I was wondering if I could have benefitted in that department as well.
I don't look back, wondering if a shorter tx could have produced the same result, it was the right approach for me (relapser, older age, now 60).
But if by serendipity I received an additional benefit of "low, or no residual virus, or more trashy, deformed, less capable of reproducing virus, or a stronger trained immune system", I TAKE IT ANYTIME.

Hey researcher, do you need a test subject. I let you poke me, take samples...no charge :)

You understood correctly, I am not concerned about relapse, I am concered about how a stressed liver would hold up under chemotherapy.

I was estimated stage 3 before tx, and 6 month post tx, Fibrosure  gave me a score of O, and Fibrospect II results put me at end stage 1 beginning 2. I am not complaining.

But I still think our livers remain more sensitive, or delicate, whatever you want to call it, then those of "normal" people.

EX. My ALT's have been 20 since end of tx, my liver didn't hurt.....I just took 5 days of Zithromax (hard on the liver)...liver started hurting, did a blood draw, ALT's 32.

If 5 days of a Z-pack can do that, I don't even want to think what month of chemo can do.

Miss miss and I wait for your Cryo answers.
If you want to comment on the discrepancy of the Fibrosure, and the Fibrospect II, taken 1 month apart, I would appreciate it.

No other questions today, but plenty more should you stick around.

And don't worry about Jim, I won't clobber him, I need him here. When the dust settles, he has to translate some of the topics into plain english for me....then I clobber him :)

-------------------------

Cuteus, Jim

Ivette, thanks for helping me out.You said:
It seems that people are trying to answer the questions that were directed to HR and that might be what is taking most of the slots? People trying to clarify other people's posts or answering them instead of letting HR come back and addressing them himself?

Like Jim said, all our threads are open to comments and clarifications, but with researcher on board, it may be best to keep that at a minimum, I mean in the threads in were a number of questions are directed at him.
I can't see him being interested in our back and force (maybe I am wrong), but it certainly makes it harder for him to sorte out any questions directed at him.

I thought it would be a good idea to open a thread just for questions, albeit limiting questions to 15, which gives room for  15 answers, as well as about 15 further clarifications before the thread gets closed.
Jim you were a moderator at some other board, could we do that?
I do see today though, that members are opening threads strictly directed at him...don't know what would work best.

Like Ivette said...I only work here.

Ina
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Avatar universal
Oh, yeah, I did post to you much further below where you were having a discussion with Mike Simon. So, if you have further thoughts for me on this issue (holding my breath :) ) you might want to post there, not that I'm folley enough to tell any of the tough MH Women what to do :)
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Avatar universal
Just one last comment Ina, akin to one of Kalio's remarks in another thread. A war takes TWO people. I never was at war with you so please stop repeating that. You were at war with me for whatever reason. I'm a big believer in John Lennon's words. War is a waste of time and energy and will not help the immune system one iota. If you want to continue this please do it way down below so you won't clog up a thread you accused me of doing. I probably won't look down there for few days but will eventually.
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Avatar universal
Just to help things along --  I believe the question Ina wanted answered is in post "C30" (above) as transposed by "MissMiss". If I'm wrong, no doubt I'll be corrected :)

-- Jim
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Avatar universal
so now there are 10 slots left in this thread for HR to come back and pick up where he left off. Or maybe by the time he can come back, the whole thread will be full and he will have to direct himself to yet another new one, which he already mentioned is not easy to do.  It seems that people are trying to answer the questions that were directed to HR and that might be what is taking most of the slots? People trying to clarify other people's posts or answering them instead of letting HR come back and addressing them himself?  it just seems that way...don't ask me what the solution is, I only work here!
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Avatar universal
Here are all the threads I could find related to HR. Hopefully, this will be helful both to HR and the rest of us following the discussion.

Perhaps whoever opens the next thread might label it "Conversations with HR #2" or something like that, so they will be easier to navigate both for HR and the rest of us.

I believe this list is more or less complete and in chronological order, but if someone has the time and inclination they can check and work on it.  One suggestion is to repeat the updated list of HR threads at the beginning of a each new thread, that way people can back-read if so inclined.

HR, I think you should take all this the minor friction and confusion as a very big compliment. Obviously you have something to say that people want to hear. Thank you again for your valuable time and efforts, and if you have your own ideas on how this will best work -- not just for us but for you -- please let us know.  

PS Please try and answer Ina's questions before she tries to clobber me again :)

Here are the threads mentioned:

http://www.medhelp.org/forums/Hepatitis/messages/43686.html
http://www.medhelp.org/forums/Hepatitis/messages/43684.html
http://www.medhelp.org/forums/Hepatitis/messages/43669.html
http://www.medhelp.org/forums/Hepatitis/messages/43657.html
http://www.medhelp.org/forums/Hepatitis/messages/43631.html

###
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Avatar universal
Since when hasn't a thread been open to other people's comments, clarifications? Or when sub discussions between people (on topic) take place, for example between Willing, DD, and myself?
I've had threads directed toward me -- as you've had to you -- but everyone with information always chipped in.

One positive (yes, I know there are negatives) about the new format is that we have unlimited threads so it's not like when this one fills up we can't continue on with another.

Doubledose, myself and some others have tried to help the process by opening a new thread for HR's questions when we saw one being filled, as this one is now.

I'd be happy to open a new one now and number it sequentially which seems to make sense to me, but no doubt will get accused of trying to monopolize or "run" this thing :)

So maybe you'd like to help out in that fashion, or maybe someone else. As I mentioned in my post to Ina, I understand that HR is "backlogged" so I've pretty much stopped asking questions until he catches up. I think both of us agree HR is a tremendous resource here -- both for the information he directly imparts -- as well as for stimulation of discussion between members.

I'm just trying to help things along as I know you are.

Be well and enjoy the week.

-- Jim
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Avatar universal
MEDICAL PROFESSIONAL
you wrote:
"Some of us here, including myself, have taken a sledge hammer approach to killing our HCV.
Doubledose did double Peg for 72 weeks, Sandi tx with standard drugs for 2 1/2 years, and I treated non stop for 111 weeks with standard Peg and 800mg Riba (type 2a).

1)
My question is this...since I tx so long, any of the cells in which HCV can be found, liver or otherwise, must have turned over at least once, and have taken any remaining virus with it.
What I am saying, do those of us that have tx so aggressively have a better chance of having gotten rid of residual virus.
THERE IS LITTLE DOUBT THAT, IN A STATISTICAL SENSE, YOU HAVE BETTER CHANCES FOR SVR WITH LONGER TREATMENT. THERE IS THIS ENORMOUS LOGICAL DESIRE TO PREDICT AND OPTIMIZE CHANCES FOR SVR AND NOW EVEN FOR SVR WITH LESS RESIDUAL VIRUS.Or maybe more permanent supressive Immune memory power to keep remnants supressed. Naturally the "post sledgehammer SVR patient" wants to know if it was worth the pain.
As already discussed several times, the residual HCV viral sequences in liver and lymphoid tissue look like a reality that is hard to deny. Again, the actual amount and the "quality" or potential capacity of such residual virus is likely to vary over a huge quant range from SVR to SVR. I said quality also, because even if we had a commercial test at this time to quantify - as willig suggested - those residual amounts ( I called a Swiss Hepatitisresearcher this morning who personally knows Franco Negro very well to call him and ask about the Pugnale paper.)-it would not be clear if higher amounts in the lymphocytes reflect a lessser potential stability of SVR> It might be just more " trash virus residuals" or this might be the reason the immune system keeps on higher alert against the residuals - because they are there. We see this in HBV treatment all the time ; If you super supress the virus with non IFN antivirals, and then let go of them, the immune system "forgot" whatever supressive power it previously had, the virus comes up strong and then, then the response reinvades the liver with a big, dangerous flare. AT THIS TIME, IF SOMEONE IS SVR, THEY SHOULD ENJOY THE FACT THAT LOSS OF SVR IS QUITE RARE AS WE KNOW THROUGH FOLLOW UP (see JmJms remarks.
But if immune supressive therapy is needed, a prophylactic antiviral treatment, just like in HBV under chemo or antirheumatic therapy will become stamdard of care in the future once such antivirals will become available. Meanwhile the "feel" seems to be that the resurgence tendency of HCV under these circumstances is LESS IN HCV THAN IN HBV.

2)
Since most of us SVR's don't have post tx biopsies which could detect occult virus, our only option is to watch for mild elevations of ALT's or GGT's which is not very reliable.
However, since I had also Type II Cryo, which cleared with HCV, can I assume, that should Cryo ever become detectible again, while remaining PCR neg, that I still have some low levels of virus somewhere?
I WILL TRY TO COMMENT ON THAT TOGETHER WITH THE FUTURE COMMENT ON THE CRYO ISSUE.
Do you think that crippled leftover viruses can stimulate the B-cells enough to start this auto-immune response again.
Willing here linked a paper that lets me to believe my thoughts are on the right track.

I am concered about about reidual (occult) virus and the damage it might do to our livers over a 20 year period. IF THE ALTS ARE IN THE TRUE NORMAL RANGE AND NO FIBROSIS PROGRESSION OCCURS IT IS LIKLEY THAT THE LIVER IF OTHERWISE WELL CARED FOR - WILL DO JUST FINE. THE ISSUE OF INCREASED HCC RISK IS A SLIGHTLY DIFFERENT ONE, DEPENDS OBVIOUSLY IF CIRRHOSIS WAS PRESENT BUT IT IS ALSO REASSURING THAT INTERFEERON TREATMENT HAS BEEN CLEALY SHOWN TO REDUCE THIS RISK EVEN IF NO SVR WAS ACHIEVED.

Most of us here are at the age were other disease (cancer) occur more frequenly.
It would be comforting to know that we can endure possible chemotherapy without having to worry about our compromised livers. I ASSUME YOU ARE NOT TALKING ABOUT THE RISK TO REACTIVATE HCV BUT ABOUT THE INCREASED GENERAL VULNERABILITY OF A PRESTRESSED LIVER WITH LESSER RESERVE TO TOLERATE THE INHERENT LIVER TOXICITY OF THESE CHEMOTHERAPY TREATMENTS? The liver has great potential to regenerate if under nonstressed, noninflammatory conditions. Functional liver mass will increase and the lobulus architecture improve  and the functional impairment through fibrosis diminish in parallel. REally "taking care of the liver" is of cause a must. What that entails might be a good topic for a future discussion. Some concepts are easy and well accepted, others are controversial. Some "liver support formulas" even support this site. How does one go about having reasonable opinions about them?? Very very difficult.
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Avatar universal
Please read my post C17 and C24 above CAREFULLY. I am well aware of HR's time constraints and other members needs and was already addressing that, therefore I absolutely see no need for your posts.
Yes, I have questions, but MANY of my posts were not addressed to HR but to further discussion on topics (persistent, occult, familial transmission) that I DID NOT initiate. These discussions were open to everyone. You caught me in a foul mood today in case you didn't read my post over in Rev's "apology" thread, so I apologize in advice for any curtness. I've been accused before of being the Sherfiff, etc. Please don't Sheriff me. I think I've cotributed my fair share here and have nothing to apologize for in these threads. Let's be friends and talk about our skin problems next time. I will have no further comments on this. Period.
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Avatar universal
Sorry, pushed post to early.

What I meant to say is, I have the impression you are hogging the field. If you would step back just a little, maybe some other posters could get their question answered as well.

Hope this could stay just between us, as we have gone over issues in the past.
And hopefully researcher will take this in stride too. He doesn't know that we cemented a peace treaty a long time ago.

Ina
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Avatar universal
Hmm, I am trying to think how to approach this without starting a fight.
Diplomacy is not my strong point, but I give it a shot.

There are 36 posts here, and 15 lengthy ones are taken up by you.
We are all aware that researcher has limited time, and he already stated, that going from thread to thread is not easy, and that focusing was needed.
We all have so many questions for him, yet he can answer only a few
during the day.
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Avatar universal
Willing: A decision to lower your IFN dose because your week 2 PCR is <5 may feel right, but you obviously can't estimate how this reduction will affect tx outcome because in the absence of comparable data "there's no there there", you're off the trail.
----------------------------------
Sorry. I should have clarified. The plan was to *double-dose* peg until non-detectible, therefore by "reduction" I meant going back to SOC. My doc has had good results with this approach and in fact it's also currently being touted on the Jensen video for prior non-responders, although unclear if that protocol stops or doesn't stop at non-detectible. You're also correct about comparing apples to oranges. I corresponded with a European researcher and was also told their was no clinical significance for VL testing below 50 IU/ml. This was consistent with the fact that all their studies used the 50 IU/ml. But I still call your attention to a later studied of EOT PCR negs who were TMA positive. They all relapsed and I argue some of them could have been caught earlier, perhaps with a treatment re-work, or maybe just mercifully stopped. How many of that group was PCR neg but TMA positive at let's say week 4? Yes, probably no studies. But I was -- well almost, I think I was 53 or so at week 4 but would have to look that up. Yes, my cat was a pretty good mouser, but alas is in cat heaven now. As discussed in the other thread, I think I got them all -- four to be exact. If no traps are sprung tonight, and there's still peanut butter left on them, I'll feel pretty good. Of course no studies on this, well, maybe in the Skippy archives, dunno :)I'll tell you one thing, getting rid of mice is a lot easier than getting rid of moths, and that's no joke. Now, keeping the mice out is another issue. Are you thinking of getting a Fibroscan with HR, or just rest with your biopsy results for now? Of course who knows, but I really think within the year some exciting treatment options will start emerging. And with four years, they will have this thing almost licked. At least that's what one hepo told me. Of course I was also told 35 years ago by another expert that my hepatitis would burn out within 5-7 years. Still, I think they're going to get it right very soon. Be well.

-- Jim
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Avatar universal
I believe Neumann has reported various studies showing the predictive importance of early (<48h) VL reduction, e.g. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12225328&query_hl=14&itool=pubmed_DocSum">Layden'02</a>. However there is a wide gap between early research that reveals underlying mechanism and large trials that generate enough data to support outcome probabilities. A decision to lower your IFN dose because your week 2 PCR is <5 may feel right, but you obviously can't estimate how this reduction will affect tx outcome because in the absence of comparable data "there's  no there there", you're off  the trail.

For sensitive (<50) tests there currently seems to be good comparable data on which to base tx duration at weeks 4 and 12 (Berg, Sanchez, etc.). There's no doubt (a lot of) information in vl tests done at other points but I don't see how that information  can be extracted: what do vl tests that can't be compared mean?

PS : good luck with the rodent hunting. In my experience, it takes a cat.
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Avatar universal
Took a quick look but many of the links where I believe I found the article (www.hivandhepatitis.com) no longer work in the SVR/EVR/RVR category. http://www.hivandhepatitis.com/hep_c/hepc_news_svr.html

What I did find is an older presentation here:
http://www.hcvadvocate.org/news/reports/DDW_%20Day1.html
Scroll down the the Ferenci study titled: "Prediction of Early Virologic Response to Treatment with 40KD Pegylated (PEG)-Interferon (IFN) Alfa2a/Ribavirin in Patients with Chronic Hepatitis C (Genotype 1)

In part it reads:

In summary, the 24hVR is a good predictor of the 12 week EVR in patients on 40KDPEG-IFNalfa2a/ribavirin therapy. A 24 hour change in viral titer >1.4 log drop has a 100% predictive factor according to the presenter. Patients with predicted poor response to standard-IFN/ribavirin therapy may still achieve a virologic response on PEG-IFNalfa2a/ribavirin therapy.
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Avatar universal
You know, maybe it was MKAndrew or someone else who suggested they would test very early on re-treatment. For some reason I thought it might have been you. If I hypothetically treated again, I'd test the same way but probably add a 24-hour and 48 hour test.
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Avatar universal
Briefly, as a weekend of mouse hunting has left me in need of sleep :) there have been studies showing let's say very, very early response.

My memory is inexact, but I believe one suggested either the 24 or 48 hour PCR was most representative of SVR. I'd be happy to try and dig it out, but if your're looking for very large trial data like with the 12 week, I'm sure that none exist. Still the principle of RVR seems to suggest the earlier the response the better the results.

And yes, I would have had more clinically useful information if for example my week 2 PCR came out negative <5 IU/ml. For one thing , I probably would have immediately stopped double dosing the Peg and perhaps even dropped the riba down a notch. While I will never know, there's a chance my high-dose riba strategy backfired as I ended up having to stop riba for a week around week 3 or 4 due to anemia  During that time my viral load bumped up, but fortunately it came back down.

My hepatologist who I have a lot of faith in orders weekly PCRs from week 1 until non-detectible, and then monthlies. Does he have studies to back this up? Probably not, because very few doctors treat like that, but it sounded like a reasonable approach to me and obviously to him.

As to the 48 week test, again, a study showed a certain percent of PCR negatives are TMA positives, and 100% of this group relapsed. It therefore seems reasonable to me that many of these PCR negatives/TMA positives at week 48 were also PCR Neg/TMA pos earlier on -- perhaps at week 24 or even earlier, perhaps even from their first negative PCR.

Had these patients had more sensitive tests, their doctors might have either bumped up the drugs, extended treatment, a combination, or even terminated treatment. Negative is what they really want these days, not two log drops.

As it is, this hypothetical group was in effect treating with its head in the sand thinking themself negative while really being positive. Again, probably no studies, but in such a fast-paced field like Hep C, clinical practice often leads clinical trials, and reasonable things are tried.

Again, another hepatologist I spoke to regarding length of treatment specifically asked the sensitivity of my tests and their frequency. He made a point to tell me that being negative *throughout* treatment with very sensitive tests worked to my favor. Any studies on this, probably not.

I can't *prove* to you that sensitive and frequent viral load tests are better, but it does seem the trend among a group of clinicians I respect. In fact, Jensen talks about it over at the Clinical Options site to some extent. Not sure if he does weekly tests but I believe he does sensitive monthly VLs througout treatment.

I may be confusing you with someone else, but didn't you say way back a while that if you re-treated you'd start getting tested early on? Maybe not, but why wouldn't you get more frequent and more sensitive tests if insurance allowed?

If it wasn't for the doctors telling me to get these tests, I might also think myself neurotic with all these tests. But it wasn't my idea, and looking back I'm glad I got them.

All the best,

-- Jim
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Avatar universal
I apologize I copied a post you answered.  I meant to copy a post by Ina relating to cryo.  Here it is.

"Some of us here, including myself, have taken a sledge hammer approach to killing our HCV.
Doubledose did double Peg for 72 weeks, Sandi tx with standard drugs for 2 1/2 years, and I treated non stop for 111 weeks with standard Peg and 800mg Riba (type 2a).

1)
My question is this...since I tx so long, any of the cells in which HCV can be found, liver or otherwise, must have turned over at least once, and have taken any remaining virus with it.
What I am saying, do those of us that have tx so aggressively have a better chance of having gotten rid of residual virus.

2)
Since most of us SVR's don't have post tx biopsies which could detect occult virus, our only option is to watch for mild elevations of ALT's or GGT's which is not very reliable.
However, since I had also Type II Cryo, which cleared with HCV, can I assume, that should Cryo ever become detectible again, while remaining PCR neg, that I still have some low levels of virus somewhere?
Do you think that crippled leftover viruses can stimulate the B-cells enough to start this auto-immune response again.
Willing here linked a paper that lets me to believe my thoughts are on the right track.

I am concered about about reidual (occult) virus and the damage it might do to our livers over a 20 year period. Most of us here are at the age were other disease (cancer) occur more frequenly.
It would be comforting to know that we can endure possible chemotherapy without having to worry about our compromised livers.

I think I speak for all of us....you are greatly appreciated here.
Ina"
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Avatar universal
jim: I don't see how sensitive serum-VL tests at weeks 2 or 48 can contribute to decisions about therapy simply because there is no published data to compare the test results with.  For example, how could you have interpreted the implications of VL results of 500 or <2 at week 2 ? that is, if had you had used a TMA how much better would your outlook have been than just knowing you were <600?

Since measuring serum-VL only provides an indirect measure of viral activity, the primary value of the tests is the outcome prediction obtained by comparison with that of other patients at the same point in tx. Currently,  few large studies with sensitive VL results are available so the main predictive value seems to be in deciding to shorten tx if you're UND at week 4( and meet other requirements) or extending if you still have VL at 12.

hr: thanks for your reply. I now understand your objection, though even in the absence of an RNA/cell estimate it wold seem the % reduction shown in their Fig. 6 measures something explictly about the immune response's ability to eliminate HCV-infected cells, as opposed to eliminating inter-cellular virus. In that regard the test would seem to have  some (small) diagnostic value even while not calibrated over a large patient pool.
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Avatar universal
MEDICAL PROFESSIONAL
The LFT will give you an early idea if the Herbs attack your liver, thats important, and the basic metabolic is well -very very basic..... Beyond that - well there is the clinical picture
..feeling more energetic, less Kleenex, knee pain, fatique, nightly trips to the potty.....

No it would not be proper to discuss reasonable immune function assessment here. Kalio has my email and if you send your tel. writers cramp can be avoided. Frankly, the discussions I sometimes have with people re real issues verbally would cover 50 pages easily.
Writing is extremely restrictive and you send your comments deeply frustrated with the limitation and all the unstated relevant info ommitted.
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Avatar universal
Yes, while still speculative, reassuring even while confirming some of your concerns. Reassuring because in spite of possible immune system alternation after SVR, normal measures like eating well, exercise, etc, may make a difference. I'd also like to throw the possiblity of TCM or other alternative medical approaches into the post tx mix because in theory they deal with balancing the immune system. Forgot, if you've ever looked into TCM. Something I'm considering right now.

Be well,

-- Jim
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Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
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Learn about this treatable virus.
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Getting tested for this viral infection.
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3 key steps to getting on treatment.
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4 steps to getting on therapy.
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What you need to know about Hep C drugs.
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How the drugs might affect you.
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These tips may up your chances of a cure.
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.