Relapsers after 6 months?

[Pinksmything]

I keep hearing that after 6 months UND/SVR we can consider ourselves cured so to speak.
has anyone relapsed after 6 months? Or heard of anyone?
It just seems so sad to me that we are seeing so many relapses.  I hear that its around 50% that are cured... so I shouldn't be so discouraged.  It's all so sad to me!  
My husband is making lots of plans for career changes after his treatment.  It's all a little scary as I know the odds/percentages.  
Janet

[willing]

yeah, I agree completely on the dangers of the "echo effect" - there's no substitute for tracking down the underlying data.  I ran into that recently in following up some reports of acute infection resolving spontaneously over an extended, two-year period. Turns out those reports all went back to a single '00 study that followed 15 Italian study volunteers and seems to be pretty much an outlier relative to  all other research in the area.

However, as I noted above, post-transplant hcv recurrence is not an area I'm familiar with (Mike will be a better source) and I don't know of either a good open-access review or a recent quantification of steroid-related impact on recurrence. Also, my access to journal content  is not working at the moment -  which might be a good thing given my recent obsession with hcv pubs.

Try googling for "+hcv +recurrence +steroid" - there seems to be no shortage of transplant-related material. Also, on pubmed, M Charlton  from Mayo has a series of reviews on the topic that are a good starting point for further searches:

"cumulative exposure to corticosteroids is associated with increased mortality, higher levels of HCV viremia and more severe histological recurrence."

Charlton M.
Hepatitis C infection in liver transplantation.
Am J Transplant. 2001 Sep;1(3):197-203. Review.
PMID: 12102252

BTW - recurrence here is in the context of post-transplant -  there's plenty of virus to recur and the patient's immune system is obviously not hcv-resistant (or they probably wouldn't have needed the transplant in the first place). I'm not at all sure any of this applies to post-SVR if that's   what you're skeptical about.

[mremeet]

Thanks for the info, but are links available to each of those references so I can read the entire text describing each event? (or if you have the text can you post it?) Or maybe a collation of the total number of documented cases where this has happened? Plus, are any of the reports referencing the same events? The reason I ask is because I've seen that before, especially in regards to the occult/persistence thing. A new "study" or report is published that references the same source data and voices similar conclusions, and then someone will read the new report and say "man these studies are piling up!" when it fact no new data has been presented, it's just another take on what the same set of data means (or in this case what the sparse anecdotal events mean).

[Deb_c430]

Thanks for all your thoughts, great info and great references>  At the time the steroids were given, my HCV was not the priorty keeping me alive was the first order of business. It was said to me not many come back from where I did, so the unraveling and fixing was a long slow process. But I got there and yes, I am now Tx again. I am on Infergen now and ribo.  Unfortunately my first PCR and viral load week 4 was not good.  Since then I have read in this forum about adding more fat to diet,
So working on that.
I guess for me the point of cause and effect of steroids is not always balanced, sometimes you have to have them,  but be aware they do cause damage.
merrybe
So agree there are some other much better options this days, apparently my adrenal was hemmoraged in the trauma of the accident, and I so agree that the small little gland and the liver need to be looked at together,  if the liver and hormones inter relate together,  the thyroid then why not the adrenal? It has much to do with energy.
I have read some articles on transplant and steroids,  an Uncle had a transplant NONE HCV, 5 years later he had a liver transplant, the cause of liver failure was steroids.  
Thanks again all
Deb

[willing]

deb - thanks for clarifying. If I understood, the steroids had been long discontinued by the time you reached your UND 6-month post tx test. Though they might have played a role in tx failure, it seems  you got to a successful SVR. It seems unlikely they played a part in the (unusual) relapse after that point, but who knows...Sorry about the disappointment and best wishes if you decide to re-tx

mremeet:  here's a couple of references

Henry SD, Metselaar HJ, Van Dijck J, Tilanus HW, Van Der Laan LJ
.Impact of steroids on hepatitis C virus replication in vivo and in vitro.Ann N Y Acad Sci. 2007 Sep;1110:439-47. PMID: 17911459
"Evidence suggests that steroid boluses used to treat acute rejection are associated with an increase in HCV viral load and the severity of recurrence. "

Immunosuppressive modifications in hepatitis C.
Current Opinion in Organ Transplantation. 6(4):327-330, December 2001.
Sheiner, Patricia A. MD
" High cumulative doses of steroids and treatment of rejection with steroid boluses appear to have the greatest impact on both rate of recurrence and severity of recurrence. "

and a medscape cme review:
"The known side effects of steroids -- including infectious risk, loss of bone density, diabetes, hypertension, hyperlipidemia, worsening of hepatitis C virus (HCV) infection recurrence, and growth retardation -- have led some centers to attempt to withdraw steroids very early in the posttransplant setting or to avoid them altogether.
"
http://www.medscape.com/viewarticle/510983

This is not area I've spent any time looking at. How to reduce/replace steroids seems to be an area of controversy - but a correlation between post-transplant use of steroids and hcv recurrence seems to be a recognized problem

[merryBe]

pinky
I wouldn't worry prematurely. Just make sure he stays 100 percent comliant with tx, eat your Riba with some healthy oils in the meal, but not much fiber.
All odds aside, we are all individuals. I would suggest he keep his dose as high as possible as long as possible, and also consider doing what HR discusses yesterday regarding gradual tapering of dosage at end of tx. the relaspe rate was smaller for those who tapered.
thread is called:
Hepatitis Researcher or Anyone one else with a good idea

deb,
20 years ago they came up with antiinflammatory immunosuppressants that worked better at controling rejection than did steroids. I know because I advocated for a friend, she had 2 rejections, and her hospital would not switch her to P35 which had a far better record at the transplant centers in Philly and UCLA...but the old school mind set had to be changed...it took years.

I don't know if there are nay correlaries for you here, as far as substances to help the adrenal shutdown. It's unlikely since you aren't fighting rejection but just to make normal needful amounts.
However, it brings up an interesting question, like how much help might these proteins be in joint health and other areas normally effected by adrenal insufficiency. It might be worth exploring.

However, the likelihood is your weaker gland was the one spared and it may have only been producing 10% of your output....so now this will just take it time to come up to double production duty...you can help this happen by not overstressing your system either with work, excess excersise or uneccesary running around, or with any chemical stimulants such as caffiene.

[mremeet]

When you say "In hcv liver transplant patients there is a well-documented correlation between viral resurgence and the administration of steroids as immunosuppressants to avoid rejection of the new organ" can you provide us with the totality of what this evidence is? I've heard of a few very rare isolated cases that basically amount to a precious few anecdotal examples of this (supposedly) happening. To me a "well documented correlation" rises to a level well beyond a very small number of anecdotal examples and leaves a bit more ambiguity than what you seem to be suggesting. But maybe there's more evidence of this sort of thing than I realize, and so if you wouldn't mind presenting it, please do so we can have a look at it. And please include all known "well documented" cases so we can see how many cases there are of this phenom. Thanks in advance...