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Two new articles: Extrahepatic Manifestations Part 2,

Here are two additional articles worth reading for those who may be interested in the topics.  The first is a Part 2 follow up to the article that I posted last week on Extrahepatic Manifestations of HCV:


The second article discusses the current state-of-art regarding Tailoring HCV Therapy, for optimal response...but most of the discussion relates to the use of RVR  (4 week PCR status) for making decisions about therapy.


Also please use this thread to discuss any ongoing questions from the past week regarding the above issues, late relapse, persistent virus, extended treatment, or any other 'hot' topic of discussion from the past week.

I hope all our members are doing well, and keeping in touch.  If you have a question or a concern, you will find diverse, well- thought-out responses here.  It is up to you to absorb them all, and come up with your own ideas and strategies.  Hopefully a great deal of current, relevant information will be made available by our long term forum veterans, that will assist in making better decisions, or just asking your doctor the right questions.

34 Responses
Avatar universal
My brain won't allow me to contribute in this discussion but I would like to post this link.

92903 tn?1309908311
Yesterday we touched on a related topic. My hepatologist believes patients continue to fight the virus after the withdrawal of combo therapy. Reflecting on his statements, I guess he didn't imply everyone would still be fighting it after stopping tx, but certainly he views it as a reallity for at least some, if not all patients.

In my particular case, he advised me to avoid cortizone injection until several months post tx, because he felt the suppression of the immune response could be a risk during this critical period.

I think this is pretty interesting. I believe most of us perceive complete erradication of the virus as the end-point of tx, but I think his take is that tx is actually more training the imune system as opposed to erradicating the virus.

I think this position is reasonably aligned with the blood test Jim described that measured presence of a particular T cell at end-of-treatment in order to predict relapse.

119874 tn?1189759429
Thanks for the articles and the laughs.

Goof, do you know what T cell measure Jim mentioned.  I want to be ready at the end of treatment to ask for all the right tests.  I didn't know enough at the beginning to get all the tests that I should've.

Suggestions (other than the obvious stuff like liver function, CBC, thyroid)?  Thanks.

92903 tn?1309908311
I probably should have been more clear. As I recall it's something available only in a couple research labs. In any case, it's not available to us :(

My point though was that that the test looks at the state of the immune system at EOT to forecast SVR ....
Avatar universal
LMAO, you know id love it. And they think i'm crazy.
Avatar universal
you're right. i laughed out loud. thanks.
Avatar universal
I think Jim recommends a TMA test that can test for as few as 5 copies of the virus.  There was an article here about it:


The increased sensitivity of the TMA found viral copies in 12% or so of patients who were deemed undetectable by other labs but were likely to relapse. They are looking for MRV - minimal residual viremia.  Another abbreviation to worry about.  

I guess that if you find MRV you renew your script for the combo ASAP or you are SOL.
119874 tn?1189759429
Big story in the news today.  All networks and major papers.  ABout how the FDA doesn't follow up on the long-term safety of drugs once they're approved (and we know the drug companies don't follow up).

Apparently, the drugs that get follow up are often the ones where the public (users) organize to complain about their side effects.  Hope I don't see all you guys at an anti FDA rally in DC in a few years.

Fight the sides!
Power to the people!
Yada yada yada!

Avatar universal
Algernon says: Big story in the news today... ABout how the FDA doesn't follow up on the long-term safety of drugs once they're approved (and we know the drug companies don't follow up).
Where is the "news" part ?
Avatar universal
Sorry if I mislead on the TMA.  It did begin with "T."  I just can't keep up with Jim - moving on to T cell measurements - what's next, connecting the dots on the riba rash to reveal a hidden yes or no on SVR?
Avatar universal
or replaying doctor's office voice mails backwards?
Avatar universal
OK. I read the two articles but I don't see either of them supporting or not supporting the position Goofy's doctor takes. They're more about viral persistence after SVR with the suggestion that if the virus persists it may reactivate. My hepatologists reaction to viral persistence is that these are incomplete, often non-replicating viruses that have not yet shown any clinical significance in terms of relapse. The relapse stats do seem to be the smoking gun here and bear him out. Again, why aren't we seeing more relapses after 1 year in SVR's -- and I'm not talking about very isolated cases. After all, it's not like our treatment population is the youngest of young or the healthiest of healthy. Just some thoughts.

-- Jim
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