Hep C interferon treatment

[angelab786]

If you complete the process of the Hep C interferon treatment, is it true that the virus is only in remission? I was explained that the virus never leaves your body but that the treatment will put it into remission. That this protocol isnt 100% cureable because this is in the blood. Whic is correct. My mother has Hep C and is in the 5th week of treatment and she is having a bad go of it. The side affects were explained to her and she believes the Doctors office misled her.

[ceanothus]

I've loved mine right on through MANY sicknesses - I've been seeing her since 1987, when I think she was almost fresh out of medical school. It was a difficult time when she decided in 2001 that she could no longer continue dealing with the contradictions of wanting to spend adequate time with each patient, wanting to spend time keeping up with current research, and needing to make a living at the same time. She choose a path that eliminated insurance companies and cut the number of patients in her practice dramatically, with a lottery to decide who got to stay and who got a list of carefully vetted referrals. We aren't rich and it is financially a bit of a strain for us but the quality of care is so good that I'm always wishing everyone could get such care, and taking every opportunity to rave about this system. Of course, it is only going to work so well with the right doctor.

[mikesimon]

I always say - everyone loves their doctor until they get sick.

[pooh55811]

I have had shingles twice, once in 1994 and once in 2005. I got the vaccine in 2011. My doctor at that time, who I have since replaced with a more knowledgeable doctor, tried to talk me out of getting the vaccine, but he knew very little about anything and never wanted to treat anything either. Since then he has been busy trying to discourage his Baby Boomer patients from getting tested for Hepatitis C, even those who had blood transfusions before 1992. Kind of says it all, LOL.

[ceanothus]

Do be sure to ask them. I had a very mild case at about age 52 (I'm now 59), and my doctor spent a little time considering whether I needed a vaccination or not, but finally decided yes, I should have one at age 60. For a little perspective: this is a doctor to whom I pay an annual retainer fee, and all vaccinations and regular office visits and many tests all then covered by her office, at no additional expense to me, so she has added incentive to choose the option that will really keep me healthiest. That, plus she is the smartest and most well-read doctor I've EVER encountered. I totally trust her judgement.

[mikesimon]

They say most people only get the shingles once and I already had my dose. I'll have to consult my vast team of physicians and see if I can get a consensus.

[pooh55811]

"As for the shingles vaccine - DO IT!"
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I agree. I had a friend who got shingles when she was in her late 30s. The acute blistering phase eventually cleared up, but she was left with debilitating back pain for the rest of her life.  My brother-in-law had shingles last Sept. and he still has a big open sore on his back which won't close up. In addition, he has debilitating back pain which is constant. He has to take pain medication all of the time for the pain but it does not entirely relieve the pain.

[ceanothus]

Thanks for posting the link to the studies! As for the shingles vaccine - DO IT! My mother had one of the really bad cases, with horrible pain covering one side of her face completely, including that eye and ear, and the pain was really severe for 6 months but never went away completely for the rest of her life. It also caused total blindness in that eye for several months, with the vision only gradually returning most, but not all, of the way. It convinced everyone who knew her that shingles is not a risk to take lightly.

[pooh55811]

As we age, we have a much greater chance of developing Post Herpatic Neuralgia (nerve pain after having shingles). The pain can be very debilitating. Here is a link to another article which discusses  Post Herpetic Neuralgia.

"The most common complication of shingles is a condition called postherpetic neuralgia (PHN). People with PHN have severe pain in the areas where they had the shingles rash, even after the rash clears up.

The pain from PHN may be severe and debilitating, but it usually resolves in a few weeks or months in most patients. PHN can, however, persists for many years in some persons.

As people get older, they are more likely to develop PHN, and the pain is more likely to be severe. PHN occurs rarely among people under 40 years of age but can occur in up to half (and possibly more) of untreated people who are 60 years of age and older.

Shingles may lead to serious complications involving the eye. Very rarely, shingles can also lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death."

http://www.cdc.gov/shingles/about/overview.html

Many insurance companies do cover the shingles vaccine.

[mikesimon]

I had them too in 1976 and didn't treat. It was a mild case which resolved in a couple of weeks with no lasting pain.

[pooh55811]

You can get a vaccine for shingles. It is not 100% preventative, but it reduces your chance of getting shingles considerably.

As we age, our chances of getting shingles increases. It is advisable to get the vaccine. I got it and I am glad I did.

I had shingles in 1994 when I was on steroids for systemic vasculitits. Because I recognized it right away and my doctor treated it immediately, I had a mild case. However, even mild cases are very painful while one has them. And I would absolutely dread having a bad case of shingles, which can cause lasting nerve pain in some individuals.

http://www.mayoclinic.com/health/shingles/DS00098

http://www.webmd.com/skin-problems-and-treatments/shingles/shingles-topic-overview

[mikesimon]

Don't worry too much about shingles - they say stress can trigger the virus so please.......relax.

Mike

[Dee1956]

Interesting thread.  Now I am worried I am going to get shingles :)

[uncledudeness]

I can't provide any documented info on the subject. I should have stated that in my post. Just what I have read here and assumed that relapse occured.

Thank you for the response mikesimon, I will read it.

[mikesimon]

I do not believe that you will find anything definitive on this issue. I have been interested in this issue for years and I still am not certain about it.

If I had to bet I would bet that SVR does not necessarily mean complete viral eradication. I also question the likelihood or possibility of HCV recurrence in an SVR patient exposed to typical doses of immunosuppressive drugs. I am SVR and am on a daily immunosuppressive drug due to my liver transplant in June 2000. I have been SVR since June 2004 and have never had any sign of recurrence and I test yearly.

Having said that, I would not be comfortable taking the very high dose of Solu-Medrol (methylprednisolone sodium succinate - basically prednisone for injection) that I was given in 2001 to counteract an episode of acute organ rejection. The dose was 1 gram injected intravenously within about 1/2 hour. That essentially flattened my immune system/response. If there is still any viral activity (albeit at very low levels) and if it is controlled or held in check by my immune system then I would be worried that shutting down my immune system like that might trigger a recurrence. I know back in 2004 after my SVR when I asked my transplant surgeon/hepatologists whether they thought a dose of prednisone like that could trigger a recurrence they were not comfortable at all with that scenario. Of course, that was a long time ago and perhaps they feel differently now.

[Idyllic]

I thought I saw that study and another like it used in a article that demonstrated late relapse. It said it was difficult to differentiate since some of those studies did not not use detailed viral molecular analysis. Plus the conclusion itself says, It is generally believed that hepatitis C virus is not completely eliminated from the body.

Lemme see if I can find the link or thread.

[mikesimon]

Recurrence of HCV Infection in a Sustained Responder After Chemotherapy for Non-Hodgkin's Lymphoma: Successful Retreatment

THOMOPOULOS, K MD; GIANNAKOULAS, N C. MD; TSAMANDAS, C. MDΑ; MIMIDIS, K MD; FRAGOPANAGOU, E MD; PALLASOPOULOU, M MD; LAMPROPOULOU-KARATZA, CH MD
Collapse Box
Abstract

It is known that sustained virological response (SVR) in patients with chronic hepatitis C is associated with sustained elimination of hepatitis C virus (HCV) and that late relapse after SVR in HCV patients is doubtful. A 47-year-old man with chronic hepatitis C genotype 3, achieved SVR after combination treatment with pegylated interferon and ribavirine for 6 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 HCV infection in a sustained responder may be probable after immunosuppressive therapy. Prevention is currently impossible but retreatment may be successful.

http://journals.lww.com/amjmedsci/pages/articleviewer.aspx?year=2008&issue=07000&article=00025&type=abstract


J Med Case Reports. 2007; 1: 169.
Published online 2007 December 4. doi:  10.1186/1752-1947-1-169
PMCID: PMC2216033

Recurrence of hepatitis C virus during leucocytopenia and spontaneous clearance after recovery from cytopenia: a case report

Discussion and conclusion

"....Anti-HCV positive patients without HCV-RNA (>6 months) are considered cured of hepatitis C. These patients have either cleared the virus spontaneously or after treatment. It is generally believed that hepatitis C virus is not completely eliminated from the body but is under control of the immune system. HCV-RNA has been reported to be present in the liver and peripheral blood mononuclear cells [3-5] of patients with no detectable serum HCV-RNA. The clinical relevance of this phenomenon is unclear. Chemotherapy has been shown to increase serum transaminase concentrations in HCV-RNA positive patients, an increase thought to be due to immunosuppression [6]. To date, however, only one case report has described HCV RNA recurrence after chemotherapy [7]. Our case shows the risk of HCV recurrence due to leucocytopenia caused by reasons other than chemotherapy. Patients positive for anti-HCV antibodies but negative for HCV-RNA are therefore at risk of HCV reactivation due to cytopenia. Our findings also emphasize the importance of virus specific T cell responses in viral diseases. Thus, HCV recurrence should be considered in the differential diagnosis of anti-HCV positive patients who experience cytopenia.

In summary, our findings indicate that greater attention should be paid to liver function tests, not only in patients chronically infected with HCV but in HCV-RNA negative patients with a previous history of hepatitis C virus infection...."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2216033/

These articles appear at:

http://www.medhelp.org/health_pages/Hepatitis/Detection-of-occult-hepatitis-C-and-hepatitis-B-virus-infections-from-peripheral-blood-mononuclear-cells/show/54?cid=64

[ceanothus]

Can you give examples of any confirmed cases of spontaneous relapse? I thought all such cases were presumed to be reinfection.

[uncledudeness]

Great answers to an important question. I have a follow up question. Can someone explain why there is a small percentage of people that relapse years after SVR?

I can understand reinfection, but spontaneous relapse is confusing to me.

Thanks

[mikesimon]

I agree with you on that but I think it's important to be careful with language and with facts.
But, on a piratical level I don't care what you call it - I'm elated to have achieved SVR and I am not at all worried about hepatitis c anymore.

[hrsepwrguy]

"If it looks like a duck and acts like a duck and sounds like a duck, it might as well be called a duck. SVR may not meet some very esoteric definition of cure, but for all practical purposes it is a cure"

+1, very well said

[Idyllic]

"That this protocol isnt 100% cureable because this is in the blood."
___________

Which treatment protocol is your mother following?
What is her genotype and which meds is she taking.

Just to split hairs for a moment here, while I understand I agree with what has been said (SVR means 'cure') I agree that a particular treatment protocol might not be "100% cured. There are different rates of SVR for different treatment regimens.
_______________________

I know you did not really ask all this but if you are curious and since you are on line maybe you could post your mothers Genotype and stage of fibrosis and the meds she is taking the people on here might be able to give you an idea of what your mother has to look forward to. Some of the side effects are manageable with the right intervention and she may not have to be as miserable as it sounds like she is.

Did she have a viral load drawn on week 4? Week four can be a key indicator with how your mother is responding the meds based on certain treatment protocols.

[ceanothus]

If it looks like a duck and acts like a duck and sounds like a duck, it might as well be called a duck. SVR may not meet some very esoteric definition of cure, but for all practical purposes it is a cure - at least that is my personal take on it. It certainly isn't what we normally think of as remission - where the disease might suddenly return at some unknown point in the future.

[Frank J. Perrotta]

Thanks for that explanation.

Everyone is throwing around cure all the time while when I treated the Liver Center was very careful on how they used that "c" word... always reminding me that the current blood test were not sensitive enough but all together they would know if I had reached SVR.

[mikesimon]

Here is a link to a MedHelp health page devoted to the topic of Occult or Persistent Hepatitis C. The Pham article appears here too.

http://www.medhelp.org/health_pages/Hepatitis/Detection-of-occult-hepatitis-C-and-hepatitis-B-virus-infections-from-peripheral-blood-mononuclear-cells/show/54?cid=64