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I would like to know how many people have really been cured? Specifically who is UND for 3 yrs or more?
Who has been UND for 6 mos to a year and then relapsed?
Who has been UND for 6 mos to a year and then relapsed?
Your case is an example of why this subject warrants continued study!!! The fact that ANY percentage of SVR's end up relapsing is a red flag in and of itself. I understand, as Jim states, that maybe one or two were reinfected, but I don't think you can assume that all eight were reinfected. If one takes this position, then they are using the same unscientific, conjecture-oriented approach that they would scold others for using in different circumstances. My attitude is that as long as we see ANY recurrances of the virus after the one year SVR point, we need to be deeply studying and analyzing those cases, and fully determining whether they were indeed due to reinfection, or not.
If there is no evidence of reinfection, then the reason for recurrance must be discovered. The exception to the SVR rule is a potential big red flag, and even though 99% seem to remain SVR (over a 10 year period maybe), we need to completely understand what that nearly 1%, or even just .5% might represent. Only when these 'exceptions' to the rule are fully explained, and demonstrated to NOT BE an internally generated recurrance (relapse) of the virus, will we be able to use the word "CURE" with absolute confidence.
Also, we need to ultimately understand whether this is a virus that is capable of being totally eradicated, or whether it becomes more of a "dormant" virus, or goes into more or less permanent remission. If the latter is the case, we would want to better understand what might possibly trigger a recurrance of the virus. If the former case is true, we would have no concerns about having a relapse from ANY cause, other than a new infection.
The JHH department head that authored the article discussing 'cure' (referenced above)also seems to hedge a little bit, here and there, in not saying for sure that some of these cases were not due to a true relapse. I think he leaves that question open and unanswered. We are again left with the pragmatic definition of "cure", with the small letters....which is: almost everyone who gets the SVR remains SVR for periods of 2 years to in some studies up to 10 years.
That is my read on the current definition of 'cure' as relates to HCV....nothing more, nothing less. I am fine with that, and enjoy the fact that we obtain many benefits from being SVR. I am still curious as to whether and why there seem to be 'some' cases of unexplained relapse. Yours is a good example Deb! We have heard other anecdotal accounts of this happening to others, but I would doubt that they were intensively analyzed. Some of these cases may go beneath the scientific radar screen. Others may just be 'assumed' to be reinfection, or improper testing. Assumed.....Assumed...
DoubleDose
That's my take anyway!
DoubleDose
If there is no evidence of reinfection, then the reason for recurrance must be discovered. The exception to the SVR rule is a potential big red flag, and even though 99% seem to remain SVR (over a 10 year period maybe), we need to completely understand what that nearly 1%, or even just .5% might represent. Only when these 'exceptions' to the rule are fully explained, and demonstrated to NOT BE an internally generated recurrance (relapse) of the virus, will we be able to use the word "CURE" with absolute confidence.
Also, we need to ultimately understand whether this is a virus that is capable of being totally eradicated, or whether it becomes more of a "dormant" virus, or goes into more or less permanent remission. If the latter is the case, we would want to better understand what might possibly trigger a recurrance of the virus. If the former case is true, we would have no concerns about having a relapse from ANY cause, other than a new infection.
The JHH department head that authored the article discussing 'cure' (referenced above)also seems to hedge a little bit, here and there, in not saying for sure that some of these cases were not due to a true relapse. I think he leaves that question open and unanswered. We are again left with the pragmatic definition of "cure", with the small letters....which is: almost everyone who gets the SVR remains SVR for periods of 2 years to in some studies up to 10 years.
That is my read on the current definition of 'cure' as relates to HCV....nothing more, nothing less. I am fine with that, and enjoy the fact that we obtain many benefits from being SVR. I am still curious as to whether and why there seem to be 'some' cases of unexplained relapse. Yours is a good example Deb! We have heard other anecdotal accounts of this happening to others, but I would doubt that they were intensively analyzed. Some of these cases may go beneath the scientific radar screen. Others may just be 'assumed' to be reinfection, or improper testing. Assumed.....Assumed...
DoubleDose
That's my take anyway!
DoubleDose
abstract or no, I relapsed.
At my six month after tx i was still UNd, 6 months after that, still svr, then at last 9 month follow up, I had a VL again.
Follows up were all done, healthy living, Test were done and re done to make sure there were no false positives.
Please do not genralize.
At my six month after tx i was still UNd, 6 months after that, still svr, then at last 9 month follow up, I had a VL again.
Follows up were all done, healthy living, Test were done and re done to make sure there were no false positives.
Please do not genralize.
Here is the actual abstract from which the above quote was taken:
http://www.hcvadvocate.org/news/reports/DDW_2007/Abstracts/MondayAbstracts.htm
From the exerpt below, even the very low "0.8%" figure may overestimate the number of relapseers as one patient was a definite reinfection and it's unclear if some of the others were as well. Also, the issue of false positives is brought up.
---------------
"The author noted that of the 8 patients who became HCV positive during follow-up, that one was a clear case of reinfection because that patients tested positive for a different genotype than the genotype in the original study.
The authors are not sure if the other 7 patients are from reinfection or because the virus returned after therapy. Another physician stated that because there is a 1% false-positive result that there cold be a possibility that the viral load tests have been false positive. Unfortunately, those patients have not lost to follow-up. "
http://www.hcvadvocate.org/news/reports/DDW_2007/Abstracts/MondayAbstracts.htm
From the exerpt below, even the very low "0.8%" figure may overestimate the number of relapseers as one patient was a definite reinfection and it's unclear if some of the others were as well. Also, the issue of false positives is brought up.
---------------
"The author noted that of the 8 patients who became HCV positive during follow-up, that one was a clear case of reinfection because that patients tested positive for a different genotype than the genotype in the original study.
The authors are not sure if the other 7 patients are from reinfection or because the virus returned after therapy. Another physician stated that because there is a 1% false-positive result that there cold be a possibility that the viral load tests have been false positive. Unfortunately, those patients have not lost to follow-up. "
I a genotype 1a, this is my third time txing.
Last time I was SVR at 6 months, that is 6 months after finishing tx 6 moths, at 9 months after I had relapsed.
I am now on infergen
Last time I was SVR at 6 months, that is 6 months after finishing tx 6 moths, at 9 months after I had relapsed.
I am now on infergen
Oops,
From the above referenced study:
"...Swain and coworkers evaluated 997 patients who achieved an SVR in trials that included treatment with peginterferon alfa-2a with or without ribavirin.[1] Patients were tested yearly by use of the Roche COBAS AMPLICOR HCV test v 2.0, with a reported sensitivity of 50 IU/mL. Over a median of 4.1 years of follow-up, only 8 individuals (0.8%) had evidence of recurrent infection. Although the details of this study have not yet been published outside of a conference presentation, the results are a welcome support for the body of data indicating that SVR is indeed equivalent to cure for most patients..."
Bill
From the above referenced study:
"...Swain and coworkers evaluated 997 patients who achieved an SVR in trials that included treatment with peginterferon alfa-2a with or without ribavirin.[1] Patients were tested yearly by use of the Roche COBAS AMPLICOR HCV test v 2.0, with a reported sensitivity of 50 IU/mL. Over a median of 4.1 years of follow-up, only 8 individuals (0.8%) had evidence of recurrent infection. Although the details of this study have not yet been published outside of a conference presentation, the results are a welcome support for the body of data indicating that SVR is indeed equivalent to cure for most patients..."
Bill
Studies have been done on the durability of SVR, which is really what you appear to be asking. Basically, if you're UND six months after treating (i.e.SVR) then your chances of relapse are only around 1%. If you're UND one year after treating, the chances of relapse approach 0%. I believe these studies go out 8-12 years for logistical reasons, but no reason to believe that SVR is not durable to these numbers for a lifetime. Personally, it's been almost two years since I stopped treating and I was UND as of one year ago. Not sure if I'm going to test again at the two year mark as statistically the chance of relapse are quite remote and last time I checked my ALT was 9.
-- Jim
-- Jim
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