SVR Eradicates HCV

[mremeet]

Not sure if this has already been posted, if so it bears repeating:

http://www.natap.org/2008/EASL/EASL_77.htm

"SVR Eradicates HCV

SUSTAINED VIROLOGICAL RESPONSE IS ASSOCIATED WITH ERADICATION OF HEPATITIS C VIRUS AND DECREASE IN ANTI-HCV TITER IN PATIENTS TREATED FOR CHRONIC HEPATITIS C

Reported by Jules Levin
43rd Annual Meeting of the European Association for the Study of the Liver April 23-27, 2008, Milan, Italy

M. Martinot-Peignoux1, S. Maylin1, N. Boyer2, A.C. Cardoso1, M.P. Ripault2, N. Giuily2, C. Castelnau2, M. Pouteau2, P. Bedossa3, P. Marcellin1,2 1 INSERM, U-773, Centre de Recherche Biomedicale Bichat-Beaujon CRB3 Hopital Beaujon, Clichy, 2 Service D'Hepatologie, Hopital Beaujon, Clichy, 3 Service D'Anatomie Pathologique, France

ABSTRACT

Background-Aim: Hepatitis C virus (HCV) eradication, in patients with chronic hepatitis C who achieve a sustained virological response (SVR), is still controversial. In this study performed in patients with chronic hepatitis C who achieved an SVR, HCV-RNA was measured in serum, peripheral blood mononuclear cells (PBMCs), liver and anti-HCV antibodies titers were assessed, during follow-up.

Methods: 278 patients with an SVR after treatment with IFN alpha-2b or PEG-IFN alpha-2b+ribavirin, were studied. HCV-RNA was tested: in serum for all the 278 patients every year and at the time of PBMCs or liver collection; in PBMCs in 71 patients 3.9±3.4 (0.5-10) years after treatment; in liver 38 patients 3.2±1.6 (1-5) years after treatment. HCV-RNA was detected with the VERSANT HCV-RNA Qualitative assay (TMA). In 142 patients HCV antibody titers were measured with the Axsym HCV 3.0 (Abbott), and with the third-generation HCV recombinant immunoblot assay (RIBA) (CHIRON RIBA HCV 3.0 SIA), before therapy and 4.7±2.2 (0.5 to 11) years after treatment. Liver histology was assessed in 92 patients with paired biopsies 1.4±1.9 (0 to 10) years.

Results:

Patients were followed up for a mean of 3.5±2.4 years (range, 0.5-17) years.

Serum HCV-RNA remained undetectable in all the patients (1050 samples).

None of the patients had detectable HCV RNA in the PBMCs or in liver.

The mean anti-HCV titers were 93±19 IU/ml and 45±21 IU/ml, before therapy and on the last serum sample available, respectively (p < 0001).

The most significant decrease was observed with anti-NS5 antibodies (p = 0.001); anti-c22 antibodies remained unchanged.

Normal serum ALT levels were maintained in 94%, fibrosis stage was improved in 57%, stable in 32%, deteriorated in 11% of the patients.

Regression of cirrhosis was observed in 7 of 10 patients.

Conclusion:

In our 278 patients with chronic hepatitis C and SVR, evaluated up to 17 years after treatment cessation, none demonstrated late relapse or the presence of HCV RNA in serum, PBMCs or liver.

HCV antibody titers showed a marked decrease. These results demonstrate a durable response to IFN alpha 2b or PEG-IFN alpha-2b+ribavirin and indicate that SVR is associated with HCV eradication and progressive decrease of anti-HCV."

[DoubleDose]

Don't worry, our flailing, and foaming brigade will find a way to dismiss your case and your highly experienced surgeon's opinion as not relevant.  Or they will just plain ignore the implications.  Far from obsessing over 'persistent' virus, as our colorful friend would claim, I am not on the forum day after day ranting and raving over everyone elses opinions and research comments.  I am pretty much living and enjoying life.

I continue to be interested in the significance of 'persistent' virus as demonstrated by now numerous studies, and even acknowledged by many researchers and growing numbers of hepatologists.  Not because I am obsessed, because in reality I think about it very infrequently, but sometimes when I come back to the forum and see long-winded, insult ridden, conjecture laden diatribes, I just can't resist throwing in my own two cents!  Whether I am right or wrong in my opinions on HCV, I can tell you one thing I am dead sure of, and right about:  some people make a complete farce of the concept 'intelligent discussion' regularly and repeatedly.  It doesn't do much to further the aims of the forum.  In my opinion it just promotes more antipathy and displeasure with reading the threads.  

This is why I don't like to spend much time or energy on these threads anymore.  If you have to wade through constant reams of personal insult, emotional venting, and ridiculous accusations....why bother?

I really do appreciate that there are a few cooler and calmer heads here that can digest and wade through the garbage, and manage to maintain a very mature, respectful, and objective demeanor.  (I am not including myself in this comment)

One final thought regarding 'viral persistence', I will say again that I agree with the 'durability of SVR' consensus opinion, and the 'repair of damage' potential for SVR, and even the concept of 'virtual, or effective' viral disappearance'......my concerns with the possibility of, and growing evidence of persistent replicating virus have more to do with the possible effects of keeping a virus in 'remission' by our immune systems (if that indeed is what is taking place), and the long term possibilities of 'reservoir virus' slowly causing changes in the functing of our CNS, or brains.  Much of the study on those who 'spontaneously recover' from acute HCV infection shows that the great majority of these people continue to demonstrate typical HCV extrahepatic symptoms, decades after the 'spontaneous resolution' of their initial infection.  The scientist in me really needs to fully understand why this happens, and whether it has to do with 'viral persistence', and related issues.  

We do know that 'occult HCV' (different than persistent virus) is becoming found more frequently in a number of people, and this alone also indicates viral behavior contrary to current explanation.  The doctors and researchers don't really understand how any of this happens...but apparently they should call Mremeet and get some solid answers to their concerns.  They will be very gratified to know that we have such a prescient specialist in our midst!

Have a great week guys (and gals), and remember to ENJOY!

DoubleDose

[jmjm530]

As to your surgeon seeing "a higher than average incidence of acute cellular rejection in (SVR)  patients -- yes, it could be the immune system still over-primed by the interferon from SOC per this paper here:

http://www3.interscience.wiley.com/journal/109085972/abstract

[jmjm530]

It's hard to say what to make of that, or what was picked up, especially because when you were asked a year or so ago some specifics of that test you replied that you had failed to ask the surgeon and btw my "renown expert" believes once the virus is gone it's gone for all practical purposes. In any event, sure glad that whatever that single test showed, you're back to UND. Of course, one explanation is that with all the sensitive testing you get that one every blue moon is bound to be a false positive, and frankly that's why I don't test any more :)

-- Jim

[mikesimon]

I just figured it out - the biopsy showed HCV because of contamination.
Of course!
Mike

[mikesimon]

I have been undetectable since April 2003 and I stopped treatment in June 2004. I have tested every month since I became undetectable with Heptimax test < 5 IU/ml.
I have a biopsy report from June 3rd 2006 which shows a low VL HCV.
I go to a very well known and respected transplant canter and the chief pathologist is a world renown expert.
How do you explain that? Misread biopsy perhaps? Wrong PRCs every single month for 2 years - one just 2 weeks before and one  10 days after my biopsy and both were undetectable. Maybe we transplant recipient SVRs are unique and just happen to show HCV on biopsy.
I know I was very surprised when I learned of the biopsy results.
But, my surgeon wasn't the least bit surprised - he's seen this stuff before because he sees a lot of biopsies - even SVR biopsies. How many SVRs do you know who've undergone a liver biopsy post clearance?
By the way, my surgeon says that he has had SVR patients who showed no sign of HCV anywhere with any test and you know what he said? He said he sees a higher than average incidence of acute cellular rejection in these patients. Must be immune system related somehow.
Mike

[mremeet]

Don't worry jim, I can handle the viral persistence club as it adjoins the back patting DD/willing/mikesimon clique. And although there may be some saucy words exchanged here, make no mistake - bringing up these incredibly obvious, plain as the nose on your face issues is absolutely salient, pertinent, applicable, within scope, exactly on target and exactly on topic. Nothing ad hom about it mikesimon. And for you of all people to be the ad hom policeman around here is a joke anyway. If you don't like what I have to say, feel extremely free to SKIP IT, bub.

I just find it amusing how there are a couple of self appointed experts around here on viral persistence who have begun to carry themselves as if "the argument's over", or as in DD's case constantly coloring himself as the noble, besieged, objective and scientific inquirer who just "wants to get to the truth" but is constantly unfairly attacked and dismissed by a moblike horde of doubting idiots. I usually skip over these persistence threads because I really don't care that much about it. I don't obsess over it like DD and a few others do. I don't have a file catalog with every study done on it that just happens to agree with my preconceived notion that it's already true (leaving out reports like the one on this thread's heading). And I don't sit around just waiting for another thread that even remotely pertains to the subject to come around so I can weigh in with my "expertise" on the matter (often scaring newbies with the concept that you're "never really cured").

So just this once I thought I'd probe into this issue using some common sense inquiry and very basic observations with "the experts" and see if they could teach me something I didn't already know. Well, big surprise - isn't it funny how they really don't know much about it at all? They don't have any answers to these perfectly reasonable questions, but yet they're still "the experts", with the implied swagger that the argument's over when it comes to viral persistence. Unless there's someone else out there reading this that knows a lot more than you guys do about this subject, sure sounds like the argument's FAR from over to me.

So in the meantime guys, stay away from those cooties. Except DD of course, he won't be able to - but at least give it the 'ole college try?? ;-)