Aa
RA & Hep C Reactivaton?
All,
I successfully completed 48 weeks of treatment Feb 08' I stopped getting checked for virus 1 yr after treatment as there was no activity. Since that time my liver enzymes have been in the normal range so I had no reason to believe that the virus may come back. It is possible to have a false/positive with Hep C. One of the many things I encountered during treatments was a false/positive for Rheumatoid Arthritis. Subsequent blood work showed no RA factor. I have recently been diagnosed with possible Rheumatoid Arthritis and am on Plaquenil. Past several days my feet and hands have become unbearably swollen. I went to see my RA Dr. and she is concerned that my virus may have reactivated; blood work to check for viral load was sent out today. Again, liver enzymes are in normal range. I cannot go on an aggressive RA treatment until Hep C virus reactivation has been ruled out. Has anyone seen/heard anything like this.
Peace.
I successfully completed 48 weeks of treatment Feb 08' I stopped getting checked for virus 1 yr after treatment as there was no activity. Since that time my liver enzymes have been in the normal range so I had no reason to believe that the virus may come back. It is possible to have a false/positive with Hep C. One of the many things I encountered during treatments was a false/positive for Rheumatoid Arthritis. Subsequent blood work showed no RA factor. I have recently been diagnosed with possible Rheumatoid Arthritis and am on Plaquenil. Past several days my feet and hands have become unbearably swollen. I went to see my RA Dr. and she is concerned that my virus may have reactivated; blood work to check for viral load was sent out today. Again, liver enzymes are in normal range. I cannot go on an aggressive RA treatment until Hep C virus reactivation has been ruled out. Has anyone seen/heard anything like this.
Peace.
I think this thread has morphed from it's original inquiry and I suggest we close it.
Thanks
Thanks
Actually, when I posted, I used the terms the original poster used (note thread title). I suggested Viperine start a new thread which contained detailed stats of her treatment and tests. I suggested she use a title similar to her own title of this thread, but one that might be more specific to what she was really asking.
By definition:
re·ac·ti·vate
1. To make active again.
2. To restore the ability to function or the effectiveness of.
In my post I was not agreeing with the terms the original poster used, just giving her some tips to perhaps get more responses after she posted her stats (so that people could look at them stats and the timeline and giver more informed responses). In fact, I was pretty sceptical about her time line. I thought something must be wrong in the timeline or in her actual VL numbers.
There was an article on Medscape in Nov. that talked about reactivation of the Hep B virus and the Hep C virus. I remember it being discussed on the forum.
http://www.medscape.com/viewarticle/753313
"November 10, 2011 (San Francisco, California) — Two separate studies, performed at the University of Texas M.D. Anderson Cancer Center in Houston, demonstrate the potentially life-threatening impact of reactivation of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in patients undergoing immunosuppressive chemotherapy. ........."
Interestingly enough, the article mainly talks about Hep B reactivation and only at the very end of the article is Hep C discussed. However, if one reads the part pertaining to HCV, not once do they mention increasing viral loads. Their criteria for HCV reactivation was increasing ALT. I would question if the terms they used were appropriate. Increasing ALT does not mean increasing VL or Hep C "reactivation."
"HCV Reactivation"
"A study from the same institution looked at HCV reactivation in patients who had undergone treatment with rituximab and gemcitabine. In this retrospective chart review, investigators looked at the records of 308 HCV-infected patients treated at M.D. Anderson over a 1-year period. HCV exacerbation was defined as a greater than 3-fold increase in ALT in the absence of hepatotoxic drugs, systemic coinfection, recent blood transfusions, and tumor infiltration of the liver.
"We found that 11% of patients who received this chemotherapy developed reactivation of HCV," reported coinvestigator Harrys Torres, MD, assistant professor of infectious diseases at M.D. Anderson. "Interestingly, none of these patients died with liver failure, which is different than with HBV reactivation."
What concerns Dr. Torres is that HCV reactivation necessitates discontinuation of chemotherapy. 'We have to stop chemo in 50% of cases," he said. "It seems that HCV reactivation does not compromise the patient from the biologic standpoint, but from the oncologic standpoint, with treatment interruptions,' it does."
I also remember when that article was posted in Nov. that there was a discussion on the forum. Here is a link to the thread:
http://www.medhelp.org/posts/Hepatitis-C/HBV--HCV-Reactivation-During-Chemotherapy-of-Concern/show/1626394
You will see that further down in the post Bali points out a key difference in the Hep B virus and the Hep C virus:
"It is my understanding that HCV unlike HBV and HIV does not enter
the cell nucleus to leave a reservoir. What this means is that
HCV can be completely eradicated whereas HBV does only get
suppressed to a ponit where ones own imune system can keep it
that way. I could therefore see the likelyhood of HBV being
reactivated a lot more than HCV. "
Stef2011 made these commens:
"i can clear all abou hbv because i am very expert, hbv is almost never cleared only immune controlled.the word clearance from acute hbv is scientifically wrong, hbv like herpes will always stay in the human dna of infected persons even if they cleared the virus
so hbv carriers, both cronic carriers or those who cleared the infection anytime in their life, are a risk of death with chemio without antivirals because they get a lethal type which most of the time leads to death
hcv should be different but i am not expert enough to say, i just know it is easier to clear because it doesnt integrate in human dna like hbv "
"hbv has also another bad thing, those who never got it in their life have the lowest risk of liver cancer. while those who had acute hbv and cleared, and those who are cronic carriers but hbvdna undetactable by antivirals, share the same risk of liver cancer.
unfortunately hbv integrated in human dna (which is called cccdna) remians but as long as immune system is working normally it can never reactivate an hbv infection, chemio probably destroys immune system complitely.....
this happens with steroids, artritis drugs, entercept, all immune suppressive drugs reactivate a cleared hbv infection.of course hbv antivirals can prevent this if taken before starting immune suppressive drugs
i dont know if entercept and artritis drugs can reactivate a clered hcv infection too"
Post by Bali:
"Exactly right , HCV is a RNA virus and HBV is a DNA virus.
HCV can be eradicated in the true meaning of the word
whereas a DNA virus such as HBV will always stay in the human DNA.
thanks for confirming that stef2011"
Step2011, in a later post in the same thread, explains even more and gives us much more information.
I would suggest to read the entire thread because several people posted important data and observations.
By definition:
re·ac·ti·vate
1. To make active again.
2. To restore the ability to function or the effectiveness of.
In my post I was not agreeing with the terms the original poster used, just giving her some tips to perhaps get more responses after she posted her stats (so that people could look at them stats and the timeline and giver more informed responses). In fact, I was pretty sceptical about her time line. I thought something must be wrong in the timeline or in her actual VL numbers.
There was an article on Medscape in Nov. that talked about reactivation of the Hep B virus and the Hep C virus. I remember it being discussed on the forum.
http://www.medscape.com/viewarticle/753313
"November 10, 2011 (San Francisco, California) — Two separate studies, performed at the University of Texas M.D. Anderson Cancer Center in Houston, demonstrate the potentially life-threatening impact of reactivation of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in patients undergoing immunosuppressive chemotherapy. ........."
Interestingly enough, the article mainly talks about Hep B reactivation and only at the very end of the article is Hep C discussed. However, if one reads the part pertaining to HCV, not once do they mention increasing viral loads. Their criteria for HCV reactivation was increasing ALT. I would question if the terms they used were appropriate. Increasing ALT does not mean increasing VL or Hep C "reactivation."
"HCV Reactivation"
"A study from the same institution looked at HCV reactivation in patients who had undergone treatment with rituximab and gemcitabine. In this retrospective chart review, investigators looked at the records of 308 HCV-infected patients treated at M.D. Anderson over a 1-year period. HCV exacerbation was defined as a greater than 3-fold increase in ALT in the absence of hepatotoxic drugs, systemic coinfection, recent blood transfusions, and tumor infiltration of the liver.
"We found that 11% of patients who received this chemotherapy developed reactivation of HCV," reported coinvestigator Harrys Torres, MD, assistant professor of infectious diseases at M.D. Anderson. "Interestingly, none of these patients died with liver failure, which is different than with HBV reactivation."
What concerns Dr. Torres is that HCV reactivation necessitates discontinuation of chemotherapy. 'We have to stop chemo in 50% of cases," he said. "It seems that HCV reactivation does not compromise the patient from the biologic standpoint, but from the oncologic standpoint, with treatment interruptions,' it does."
I also remember when that article was posted in Nov. that there was a discussion on the forum. Here is a link to the thread:
http://www.medhelp.org/posts/Hepatitis-C/HBV--HCV-Reactivation-During-Chemotherapy-of-Concern/show/1626394
You will see that further down in the post Bali points out a key difference in the Hep B virus and the Hep C virus:
"It is my understanding that HCV unlike HBV and HIV does not enter
the cell nucleus to leave a reservoir. What this means is that
HCV can be completely eradicated whereas HBV does only get
suppressed to a ponit where ones own imune system can keep it
that way. I could therefore see the likelyhood of HBV being
reactivated a lot more than HCV. "
Stef2011 made these commens:
"i can clear all abou hbv because i am very expert, hbv is almost never cleared only immune controlled.the word clearance from acute hbv is scientifically wrong, hbv like herpes will always stay in the human dna of infected persons even if they cleared the virus
so hbv carriers, both cronic carriers or those who cleared the infection anytime in their life, are a risk of death with chemio without antivirals because they get a lethal type which most of the time leads to death
hcv should be different but i am not expert enough to say, i just know it is easier to clear because it doesnt integrate in human dna like hbv "
"hbv has also another bad thing, those who never got it in their life have the lowest risk of liver cancer. while those who had acute hbv and cleared, and those who are cronic carriers but hbvdna undetactable by antivirals, share the same risk of liver cancer.
unfortunately hbv integrated in human dna (which is called cccdna) remians but as long as immune system is working normally it can never reactivate an hbv infection, chemio probably destroys immune system complitely.....
this happens with steroids, artritis drugs, entercept, all immune suppressive drugs reactivate a cleared hbv infection.of course hbv antivirals can prevent this if taken before starting immune suppressive drugs
i dont know if entercept and artritis drugs can reactivate a clered hcv infection too"
Post by Bali:
"Exactly right , HCV is a RNA virus and HBV is a DNA virus.
HCV can be eradicated in the true meaning of the word
whereas a DNA virus such as HBV will always stay in the human DNA.
thanks for confirming that stef2011"
Step2011, in a later post in the same thread, explains even more and gives us much more information.
I would suggest to read the entire thread because several people posted important data and observations.
Hi Dee,
Maybe "reactivation" is a strong term. I had been told by my GI in 08' that yes I am clear of the virus but it is a virus and as such can never really be irradiated. We, as it look like you have, can reach a sustained remission.
Hep C might be too new to have any good data on this but my GI warmed me of same as has 2 - RA Doctors.
Maybe "reactivation" is a strong term. I had been told by my GI in 08' that yes I am clear of the virus but it is a virus and as such can never really be irradiated. We, as it look like you have, can reach a sustained remission.
Hep C might be too new to have any good data on this but my GI warmed me of same as has 2 - RA Doctors.
Hi I am wondering what "reactivated HCV" means, if you have time can you point me in the right direction? It is odd, last night my husband said if I keep pushing myself I am going to relapse and I kind of scoffed at him. Now I hear this.
I will go search for this, I had never heard of it Thank you
@Viperine, great news! Thanks for the can
I will go search for this, I had never heard of it Thank you
@Viperine, great news! Thanks for the can
Great news on your PCR ! !
No can of worms opened .. the forum is all about discussing and support .. so no worries there ..
Best Results with your RA therapy ..
Cheers
No can of worms opened .. the forum is all about discussing and support .. so no worries there ..
Best Results with your RA therapy ..
Cheers
All,
Sorry for the can of worms. I just got my bloodwork back and I am still negative. Battle with RA begins but I'm still winning on the HepC front.
Thanks and good luck to all!!!
Sorry for the can of worms. I just got my bloodwork back and I am still negative. Battle with RA begins but I'm still winning on the HepC front.
Thanks and good luck to all!!!
I am sorry the virus is still present. I know it must be exceptionally difficult to be Hep C pos. after you think you have reached SVR.
I have learned a lot while on the forum and while treating (still treating). Your situation is interesting f, indeed, you were Undetectable in Feb. 2011, completed treatment 5/2011, were Undetectable in January 2012. I don't mean to appear rude, but are you certain about the Undetected result in Jan. 2012?
If you are interested in getting some input on your situation, treatment, what may have happened, etc. I would suggest that you start a new thread and entitle it something like, "Relapse or Reactivated Hep C Virus???"
If and when you post, please include as much data as possible:
Genotype and subtype if you know it
Biopsy results - stage of fibrosis
VL at start of Treatment in Dec. 2010
Date you started treatment
All of your viral load results during treatment and when they were taken (at 2 weeks, 4 weeks, 8 weeks, 12 weeks, etc.)
Date you completed treatment
All viral load results since completing treatment
How many times you have treated (was that the only treatment)
Complicating factors (diabetes, immune disorders, cirrhosis, etc.)
Age and length of time infected may be helpful too
If you would like some input from others, please post in a new thread with as much information as possible. I am sure some of the more knowledgeable forum members will respond (if you start a new thread). (They may not see your post in this thread.)
Best of luck.
I have learned a lot while on the forum and while treating (still treating). Your situation is interesting f, indeed, you were Undetectable in Feb. 2011, completed treatment 5/2011, were Undetectable in January 2012. I don't mean to appear rude, but are you certain about the Undetected result in Jan. 2012?
If you are interested in getting some input on your situation, treatment, what may have happened, etc. I would suggest that you start a new thread and entitle it something like, "Relapse or Reactivated Hep C Virus???"
If and when you post, please include as much data as possible:
Genotype and subtype if you know it
Biopsy results - stage of fibrosis
VL at start of Treatment in Dec. 2010
Date you started treatment
All of your viral load results during treatment and when they were taken (at 2 weeks, 4 weeks, 8 weeks, 12 weeks, etc.)
Date you completed treatment
All viral load results since completing treatment
How many times you have treated (was that the only treatment)
Complicating factors (diabetes, immune disorders, cirrhosis, etc.)
Age and length of time infected may be helpful too
If you would like some input from others, please post in a new thread with as much information as possible. I am sure some of the more knowledgeable forum members will respond (if you start a new thread). (They may not see your post in this thread.)
Best of luck.
Sorry to keep reposting. I think I'm type 2. My brain is so addled since the treatment that I can't even think straight on a good day. I'm still in shock, and will have to get out my paperwork and look at it and start over again from step one. Thanks for the reply, it helps me hang on.
I'm type 1, completed treatment 5/18/11 and do have cirrhosis, but never had a biopsy that I know of. The doctor said this week that the liver is still functioning pretty well, it sounded pretty good just a couple of days ago, that's one reason I was so shocked to get that news today. Just the thought of doing the treatment again, and not even having the appointment made yet to discuss it, is frightening. I had a comfortable home when I treated before and now I am in a noisy motel with no stores nearby and no one to even check in on me. Ugh! Not sure I will be able to pull it off here alone, especially with no car. My poor daughter doesn't know yet. I guess there's nothing to do but roll with the punches and hope for the best. But what a blow! I know I'm not the only one, though. Good luck to all.
ahhh, so you were undected during treatment. i'm sorry you relapsed, I know that's a hard pill to swollow.
when did you complete treatment? what genotype are you? what shape is your liver in (liver biopsy results). The good news is that there are many promising treatments on the horizon, there are a few people on here who have treated at least twice, some have treated more, one person has treated like 8 times.
SVR is only 80%, and that is even for type 1's now with the new treatment, but there are the other 20% who don't reache SVR, it's devestating, but there is hope...
when did you complete treatment? what genotype are you? what shape is your liver in (liver biopsy results). The good news is that there are many promising treatments on the horizon, there are a few people on here who have treated at least twice, some have treated more, one person has treated like 8 times.
SVR is only 80%, and that is even for type 1's now with the new treatment, but there are the other 20% who don't reache SVR, it's devestating, but there is hope...
I don't know all of the terms and so forth, but I was undetected in Feb. 11 and up until my last visit with that doc, which was this past January. I just found out from tests done this week that it has returned. I had blood work done in Feb. and March with no word of any problems.
it looks like you started treatment on 12/1/10. When did you end treatment? Did you treat for 24 or 48 weeks? Being undected for year and being SVR for a year are two different things.
You don't reach SVR until 6 months of being undetected after the end of treatment.
People do occasionally relapse at 6 months post treatment, it happened to my boyfriend...he treated for 6 months, was undected at 4 weeks of treatment all the way until the end of treatment, at 6 months post treatment he was detected again, never reached SVR.
So were you SVR for a year, or is your year of beinging undected including your treatment time?
You don't reach SVR until 6 months of being undetected after the end of treatment.
People do occasionally relapse at 6 months post treatment, it happened to my boyfriend...he treated for 6 months, was undected at 4 weeks of treatment all the way until the end of treatment, at 6 months post treatment he was detected again, never reached SVR.
So were you SVR for a year, or is your year of beinging undected including your treatment time?
I was undetected for over a year, and now I get word that it's back and high numbers. I hate to ruin anyone's day but just two minutes before I got that phone call I was reading comments to an article about it and thinking to myself that HepC was "curable" in some people. Well, la de freakin da. I've been having swelling in feet and legs, but my liver function tests looked good as recently as a few weeks ago. I don't understand all of this, I'm still struggling with after effects of treatment, and to top it off, I'm living in a motel with no spending money or a vehicle. Should I even bother to deal with any of this? What a loser! I've been trying to get an apartment so I can reunite with my teenage daughter, who is anxious about getting into college next year, and I thought I was making some progress, inch by inch. Not happening!
Thanks Copyman - I could not sleep well and did a ton of reading. The good news I was unable to find any documentation where the virus has been dormant for many years reactivates. The bad news is the RA drugs are immunosuppresants which could make it difficult for my immune system to keep Hep C at bay.
I will get on the RA forum and come back to this forum if Hep C plays a part other than my GI & RA Dr.s working it out.
I appreciate you taking time to respond to me.
I will get on the RA forum and come back to this forum if Hep C plays a part other than my GI & RA Dr.s working it out.
I appreciate you taking time to respond to me.
I would look more to the RA drugs causing a reaction and the swelling. RA drugs are very harsh, especially on the liver.The swelling may be your body telling you it doesn't like them. Best of luck
Thanks Aaron,
This is what I was hoping I would hear. I'm "up" for a new struggle but did not think I had the heart for another round of treament followed by RA treatment. Thanks for putting a little peace back in my heart.
This is what I was hoping I would hear. I'm "up" for a new struggle but did not think I had the heart for another round of treament followed by RA treatment. Thanks for putting a little peace back in my heart.
I see your a member since 2007 .. sorry your back here asking questions
Never heard of anyone having this occurrence .. but I don't work in this field .
Hard data (peer reviewed published studies) in this area you suggest .. re-activation is not high on the list of scientific endeavors .. what you suggest is called "occult hep c" ... it has pretty much been discounted over time ..
http://www.ncbi.nlm.nih.gov/pubmed/21892969
"True occult hepatitis C virus does not exist in our cohort. Residual viremia at the EOT stage merely reflects a difference in viral kinetics in various compartments that remains a target of immune response even after the end of antiviral therapy and is eventually cleared out at the sustained viral response (SVR)."
We all have our belief's .. I know that the anti bodies will exist in our blood , we will always test positive for hep c ... if we are lucky and SVR ... not the virus after an extended period of time ..
Get a PCR & put your concerns to rest ....
Thanks for the response Aaron –very much appreciated!!!
I understand what you are saying but Hep C is a virus and no virus can be totally cured (not being negative but this is a fact). I cannot go for an aggressive treatment on RA "IF" the virus is back. My RA Dr. will immediately consult my GI, should the need arise. I am curious if anyone has ever had their virus "reactivate" after years lying dormant. It would be akin to chicken pox and shingles
I understand what you are saying but Hep C is a virus and no virus can be totally cured (not being negative but this is a fact). I cannot go for an aggressive treatment on RA "IF" the virus is back. My RA Dr. will immediately consult my GI, should the need arise. I am curious if anyone has ever had their virus "reactivate" after years lying dormant. It would be akin to chicken pox and shingles
V ,
If you were Und 1 year after the end of your treatment .. the chance of the virus coming back is slim to none ..
It might be prudent to have a PCR test done .. that's the only way to know for sure what's going on if anything & then you will have a lab report to show the doc and begin treating your RA problem ..
I would not regard the RA's diagnosis of so called "reactivation" as relevant as the doc is not a GI/Hepa or hcv specialist ...
If you were Und 1 year after the end of your treatment .. the chance of the virus coming back is slim to none ..
It might be prudent to have a PCR test done .. that's the only way to know for sure what's going on if anything & then you will have a lab report to show the doc and begin treating your RA problem ..
I would not regard the RA's diagnosis of so called "reactivation" as relevant as the doc is not a GI/Hepa or hcv specialist ...
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
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.
