Conversation with HepatitisResearcher

[DoubleDose]

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

[jmjm530]

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.

[Eisbein]

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

[Eisbein]

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.

[jmjm530]

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

[willing]

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.

[jmjm530]

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.