Aa
Effect of Peginterferon Alfa-2a (Pegasys) on Liver Histology in Chronic HCV
This is very good news and adds evidence to the histolgic effects of interferon.
If anyone doesn't achieve the "12 week 2 log drop" magic number this is a good study to show to the doctors if they want you to stop treatment.
If anyone doesn't achieve the "12 week 2 log drop" magic number this is a good study to show to the doctors if they want you to stop treatment.
My brain is crossing it from all this reading ... anyway read onward and let me know if you think Dietrich is wrong.
If you think he is wrong please provide some evidence and let's contact him. That shouldn't be impossible.
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Question:
Doesn't HCV become so entrenched in certain parts of the body where interferon/ribavirin and their immune responses just can't get to: like the brain, CNS, bone marrow, the lymph system; and just clearing the virus from the blood doesn't clear HCV from the brain, CNS, bone marrow...etc.? Also, can't HCV lie dormant for long periods of time in these areas as well? Or does interferon cross the blood brain barrier or get into bone marrow and eradicate the active virus (or even the dormant virus) as well?
Answer by Douglas Dieterich, MD
Dr. Dieterich is Vice Chair and Chief Medical Officer Department of Medicine at The Mount Sinai Medical Center and an attending physician at New York University Tisch Hospital
HCV does cross the blood brain barrier, we now understand. However, so does interferon hence all those CNS side effects. When you clear the virus in the blood it is cleared everywhere and you are really rid of it everywhere in your body.
If you think he is wrong please provide some evidence and let's contact him. That shouldn't be impossible.
-----------------------------
Question:
Doesn't HCV become so entrenched in certain parts of the body where interferon/ribavirin and their immune responses just can't get to: like the brain, CNS, bone marrow, the lymph system; and just clearing the virus from the blood doesn't clear HCV from the brain, CNS, bone marrow...etc.? Also, can't HCV lie dormant for long periods of time in these areas as well? Or does interferon cross the blood brain barrier or get into bone marrow and eradicate the active virus (or even the dormant virus) as well?
Answer by Douglas Dieterich, MD
Dr. Dieterich is Vice Chair and Chief Medical Officer Department of Medicine at The Mount Sinai Medical Center and an attending physician at New York University Tisch Hospital
HCV does cross the blood brain barrier, we now understand. However, so does interferon hence all those CNS side effects. When you clear the virus in the blood it is cleared everywhere and you are really rid of it everywhere in your body.
NON-RESPONDERS are pretty much back to square one by year two post treatment according to the approval hearing transcript at the FDA. Research is ongoing as to how to make that benefit last beyond that point.
A discussion about "cure" is another discussion.
A liver that has been scarred does not go backwards in time and become a new liver. The improvements seen in histology are modest ones, for the most part, and appear to have a lasting effect in someone who is SVR at 6 months post treatment. It is not a universal result even for a sustained responder. But, unlike non-responders, the benefit for responders appears to last beyond year two post treatment, at least.
Hepatitis C is clearly a disease that affects other parts of the body. Reservoirs of virus CAN, but may or may not, remain after an SVR.
We have pictures (MRI photospectroscopy)of the virus on the glia in the brain and we know that interferon does not cross the blood-brain barrier, for exmple. It may account for symptoms that are associated with fatigue, etc beyond a course of successful treatment. (you might wish to see HCOP's presentation on this made to the NIH Consensus Management Conference in 2002. You will require realplayer.)
Anyway, an SVR is a good thing, but it may or may not be a "cure." So much depends on research not yet done in neurology, nephrology, pulmonology etc etc.
So far, we have just concentrated on livers. Hepatologist know livers, but they are not usually experts on lungs, hearts, women's health, neurology, nephrology etc... We might be expecting too much of this discipline if we are going to rely only on information from hepatologists about HCV.
I have, for example, an article on HCV skin infection on the website. This possibility will come as no surprise to most patients, but just as a GI or hepdoc if HCV causes skin infection. It was published in a journal of Dermatology.
okay, enough from me...
thanks for reading this far nd for your open mindedness.
thanbey
A discussion about "cure" is another discussion.
A liver that has been scarred does not go backwards in time and become a new liver. The improvements seen in histology are modest ones, for the most part, and appear to have a lasting effect in someone who is SVR at 6 months post treatment. It is not a universal result even for a sustained responder. But, unlike non-responders, the benefit for responders appears to last beyond year two post treatment, at least.
Hepatitis C is clearly a disease that affects other parts of the body. Reservoirs of virus CAN, but may or may not, remain after an SVR.
We have pictures (MRI photospectroscopy)of the virus on the glia in the brain and we know that interferon does not cross the blood-brain barrier, for exmple. It may account for symptoms that are associated with fatigue, etc beyond a course of successful treatment. (you might wish to see HCOP's presentation on this made to the NIH Consensus Management Conference in 2002. You will require realplayer.)
Anyway, an SVR is a good thing, but it may or may not be a "cure." So much depends on research not yet done in neurology, nephrology, pulmonology etc etc.
So far, we have just concentrated on livers. Hepatologist know livers, but they are not usually experts on lungs, hearts, women's health, neurology, nephrology etc... We might be expecting too much of this discipline if we are going to rely only on information from hepatologists about HCV.
I have, for example, an article on HCV skin infection on the website. This possibility will come as no surprise to most patients, but just as a GI or hepdoc if HCV causes skin infection. It was published in a journal of Dermatology.
okay, enough from me...
thanks for reading this far nd for your open mindedness.
thanbey
Okay.
I have provided the information on the website on this and other topics. That's the best I can do.
And, it is unfair to say that I said Dr. Deitrick doesn't know what he is talking about. Where did I say that? Your description support that he is an expert in HIV HCV co-infection. And that is what I said, too. We agree.
He is not a neurovirologist to my knowledge and there is no mention of a Neurology residency in this bio.
He is a terrific guy and a good doctor. From all the information I am aware of, his patients love him.
thanbey
I have provided the information on the website on this and other topics. That's the best I can do.
And, it is unfair to say that I said Dr. Deitrick doesn't know what he is talking about. Where did I say that? Your description support that he is an expert in HIV HCV co-infection. And that is what I said, too. We agree.
He is not a neurovirologist to my knowledge and there is no mention of a Neurology residency in this bio.
He is a terrific guy and a good doctor. From all the information I am aware of, his patients love him.
thanbey
I agree with you. All are factors each person needs to take into account.
Certainly for those with mild disease who likely won't progress anyway, a year of treatment may be the choice they make. The critical factors are individual and an individual assessment and decision is made between a doctor and patient.
So, if someone wishes to treat, there is no shortage of doctors willing to treat them for any number of reasons. I have heard from patients who never had a PCR before going on treatment!
I offer information that I hope will help people make a decision that is right for them. Going in knowing up front what interferon may or may not be able to provide in terms of long term benefit against the prospects of other choices. There are other choices for some patients, but no choice is completely risk free and there may come a time to reevaluate interferon thera[py or watchful waiting or any other choice that is made.
We are not our livers. We are people with careers, parents and spouses and young women who want to have babies someday. We have a right to know what the impact of treatment might have on our lives, not just on our livers.
I share the information I obtain at the liver meetings and other places. It is up to the patients to decide whether it is useful to them or not. Board like this have helped countles patients hold their doctor's feet to the fire with regard to doing biopsies, prescribing pain medication, filling out VA, SSI, and other disability forms.
Talking about all the factors having to do ithe interferon therapy should be no different, in my view, or maybe I am just on of those folks who cannot shrug and say ...whatever...
So patient advocate or pain in the rear...you decide!
I hope this helps,
thanbey
www.hcop.org
Certainly for those with mild disease who likely won't progress anyway, a year of treatment may be the choice they make. The critical factors are individual and an individual assessment and decision is made between a doctor and patient.
So, if someone wishes to treat, there is no shortage of doctors willing to treat them for any number of reasons. I have heard from patients who never had a PCR before going on treatment!
I offer information that I hope will help people make a decision that is right for them. Going in knowing up front what interferon may or may not be able to provide in terms of long term benefit against the prospects of other choices. There are other choices for some patients, but no choice is completely risk free and there may come a time to reevaluate interferon thera[py or watchful waiting or any other choice that is made.
We are not our livers. We are people with careers, parents and spouses and young women who want to have babies someday. We have a right to know what the impact of treatment might have on our lives, not just on our livers.
I share the information I obtain at the liver meetings and other places. It is up to the patients to decide whether it is useful to them or not. Board like this have helped countles patients hold their doctor's feet to the fire with regard to doing biopsies, prescribing pain medication, filling out VA, SSI, and other disability forms.
Talking about all the factors having to do ithe interferon therapy should be no different, in my view, or maybe I am just on of those folks who cannot shrug and say ...whatever...
So patient advocate or pain in the rear...you decide!
I hope this helps,
thanbey
www.hcop.org
Douglas T. Dieterich, MD, Contributing Editor
Dr. Dieterich is Vice Chair and Chief Medical Officer Department of Medicine at The Mount Sinai Medical Center. He is also an attending physician at New York University Tisch Hospital, a clinical assistant attending at Bellevue Hospital Center, and an attending physician at Beth Israel North.
A graduate of Yale University, Dr. Dieterich received his medical degree from New York University School of Medicine, and completed his internship and residency in the Department of Internal Medicine, Bellvue Hospital Center.
A fellow of the American College of Physicians and the American College of Gastroenterology, Dr. Dieterich is a member of several professional societies. He has also served on several committees of the AIDS Clinical Trials Group (ACTG) and the National Institutes of Health (NIH), including as a member of the steering committee of the Opportunistic Infections Core Committee, and a member of the Cytomegalovirus (CMV) Committee. He has also served on the NIH Study Sections for CMV and cryptosporidiosis.
Dr. Dieterich has authored numerous journal articles, abstracts, and book chapters on viral hepatitis and AIDS-associated infections of the gastrointestinal tract and liver, and their treatment. He is an internationally-recognized expert on hepatitis C infection and is involved in several research programs evaluating the management treatment of chronic hepatitis C virus (HCV) infection and co-infection with HIV/HCV.
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Dieterich doesn't know what he is talking about? Hmmm ...
As I stated before: If you have some proof contradicting the doctor's statement re: the blood brain barrier let us see it. If not I believe the matter is settled.
Dr. Dieterich is Vice Chair and Chief Medical Officer Department of Medicine at The Mount Sinai Medical Center. He is also an attending physician at New York University Tisch Hospital, a clinical assistant attending at Bellevue Hospital Center, and an attending physician at Beth Israel North.
A graduate of Yale University, Dr. Dieterich received his medical degree from New York University School of Medicine, and completed his internship and residency in the Department of Internal Medicine, Bellvue Hospital Center.
A fellow of the American College of Physicians and the American College of Gastroenterology, Dr. Dieterich is a member of several professional societies. He has also served on several committees of the AIDS Clinical Trials Group (ACTG) and the National Institutes of Health (NIH), including as a member of the steering committee of the Opportunistic Infections Core Committee, and a member of the Cytomegalovirus (CMV) Committee. He has also served on the NIH Study Sections for CMV and cryptosporidiosis.
Dr. Dieterich has authored numerous journal articles, abstracts, and book chapters on viral hepatitis and AIDS-associated infections of the gastrointestinal tract and liver, and their treatment. He is an internationally-recognized expert on hepatitis C infection and is involved in several research programs evaluating the management treatment of chronic hepatitis C virus (HCV) infection and co-infection with HIV/HCV.
---------------------------
Dieterich doesn't know what he is talking about? Hmmm ...
As I stated before: If you have some proof contradicting the doctor's statement re: the blood brain barrier let us see it. If not I believe the matter is settled.
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