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."

[moahunter]

If it is gone in a meaningful way, why is this research important? Why are some researchers saying it is completely eradicated, and other researches stating otherwise? It is either gone, or it isn't. Some think it is, some think it isn't. I'm inclined to "think" it is gone, and the arguments above I think, on balance, support that view, particularly as it matches peoples experiences. IMO the odds are that this is a research / testing issue rather than a medical misunderstanding about some mysterious property of Hep C that may or may not exist, whereby Hep C can change such that it is not Hep C, or whereby our bodies are magically stronger at containing after treatment. In saying that, I might be wrong, but for me, I'm happy with the eradication research which is a highly plausible and compelling hypothesis, and find the thread an interesting read - not disturbing at all.

[mikesimon]

I think we all - or the vast majority anyway - agree that SVR means it's gone in a "meaningful" way. I cannot speak for DD on this point but when I see normalized liver enzymes, undetectable viral load and improved histology that sure looks meaningful to me. And durability is a big plus too. But, that really wasn't what I thought this thread was about.
Mike

[mikesimon]

I would likes to see where willing resorted to an ad hominem argument with you or anyone else for that matter. Me? I can believe that about me easily but willing? I haven't seen it ever from him. Mike

[jmjm530]

BTW my take (and my liver specialists), as expressed before, is when the virus is gone, it's gone -- at least in a *meaningful* way. And until whatever it is that some researchers repor they see under a microscope/centrifuge are given some clinical signficance, I'm not going to lose much sleep over it. Yes, in the words of "Mre", the "cooties" are all around us, so as long as they leave me alone...

[jmjm530]

I must admit that I'm enjoying a bit of the ad hominem directed at both Willing and DD, as both have directed some at me in the past on this same topic, and same with you my friend, on other topics --  so I guess you all were losing your arguments with me? LOL.  Ad hominem aside, I think good non-ad hominem points have been made on both sides. Job well done, fellows.  One of the better discussions on the issue to date, so thank you to the participants.

-- Jim

[mikesimon]

Am I the only one who sees one side drifting more and more into the "argumentum ad hominem"? It's really becoming more and more predictable and more humorous too - arms flailing wildly in the air.
I'm not certain about this SVR issue by any means and I wonder how someone can appear to be so sure about this. But I do have an opinion about see who is winning the argument here - it's willing with his hands down, sitting calmly amidst the tempestuous sea of desperate insult and innuendo swirling around him .
Mike