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What Do You Think About This Scary Study?

Study: Patients With Resolved Hepatitis C Likely Still Contagious


Patients with chronic hepatitis C that has been resolved through therapy or immune response may still be able to infect others with the virus. That finding is from a new study in the May issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD). The article is also available online at Wiley Interscience (www.interscience.wiley.com).



About 170 million people worldwide are infected with hepatitis C virus, which can progress to chronic hepatitis, cirrhosis and even liver cancer. In some individuals, the infection seems to resolve, either spontaneously from the efforts of the immune system, or after treatment with interferon and ribavirin.



Patients who achieve a sustained viral response show no clinical or biochemical evidence of liver disease and standard tests can no longer detect the virus in their blood. However, more sensitive research tests are finding that such patients often still have miniscule amounts of the virus in their bodies. No one knows if these trace remainders are infectious.



Researchers led by Tomasz I. Michalak of Memorial University of Newfoundland, Canada examined this question using a system that allows for propagation of HCV in human T cells in vitro.



They began with nine patients with HCV who had achieved a sustained viral response that persisted for at least two years after treatment. HCV RNA was detectable in their blood only with the more sensitive tests.



The researchers set up twelve cultures of lymphoid cells from healthy donors, and exposed them to plasma or to supernatants of cultured circulating lymphoid cells from the HCV patients. Eleven of the cell cultures became HCV RNA positive. Furthermore, HCV from three of the nine patients was able to establish active HCV replication in the cultures.



“These findings provide in vitro evidence that trace quantities of HCV persisting in the circulation for a long time after therapeutically induced resolution of CHC can remain infectious,” the authors report.



Interestingly, HCV replication in the T cells was prevented after neutralization of the virus, and by treatment with interferon.



This study is the first to investigate the infectivity of HCV traces that remain when the infection is occult. It agrees with previous animal studies of the same question.  



“Our present findings reveal that HCV circulating in some individuals with resolved hepatitis C is capable of inducing productive infection in vitro at doses of 20 to 50 copies,” the authors conclude. “This can be interpreted as a strong indication of potential virus infectivity in vivo.”



Article: “Hepatitis C Virus Persisting at Low Levels after Clinically Apparent Sustained Virological Reponse to Antiviral Therapy Retains Its Infectivity in Vitro.” MacParland, Sonya A.; Pham, Tram N.Q.; Guy, Clifford S.; Michalak, Tomasz I. Hepatology; May 2009.



77 Responses
179856 tn?1333550962
I've never really understood occult virus so I still don't understand how you can pass on something you no longer have but if the idea is that the interferon trains our immune systems to keep fighting any virus that might be left down to undetectible levels and it's not really GONE I still can't understand how someone could infect somebody else...unless they weren't at undetectible levels of "1" and it's that "1" that does it.

I've never heard of anyone who is SVR infecting anyone else before but all of this type stuff is WAY over my head anyway.  I'm not too worried about it myself as I'm not going to be IVDu'ing with anybody and I think that's the only way you could get pass it on anyway.
Avatar universal
I'm with you, nygirl. If I were undetected I wouldn't worry about it either. I also have never heard of anyone infecting someone else when they are SVR (which I consider cured). I think that maybe there may be a very very small amount of virus left in some SVR people....not enough to be infective, or counted in the bloodstream,  unless something happened that drove their immune systems so low the virus was able to overcome them.
Avatar universal
What do I think?  I hate to see it but it exists and we may not be able to deny it's existence.  We will have to be very careful of the way that we..... laymen....both interpret or attempt to re-communicate this evidence.  I think that we will be far more likely to come to a possibly false conclusion of the ramifications of this study than a virolgist.

I think one question that it poses if to how communicable the virus is post SVR.  I don't think it attempts to convey an answer to us and so I hope that we don't "fly off the handle" at this and can continue for the present time to obsess about the swine flu.  ; )

Many of us will be able to do what we have always done; maintain a safe and normal lifestyle without fear of transmission.  Might it be unsafe to share a needle with a past HCV positive but currently SVR person?  It appears that we might want to re-think that.  : )  I think normal day to day situations might remain unchanged.

best,
Willy
626749 tn?1256519302
Hey JennyPenny

Could you please post a link to this study.
Went to
www.interscience.wiley.com
as in your first post and could not find it.

apache

Avatar universal
I think to able to infect someone after one aquires SVR .you would have to injesct a full syringe of blood into the other person to catch it....if the virus is occult and is in muniscle amounts...i think it would be very hard to transmit.....like nygirl says....you would proberly have to on a 2 week shooting gallery bindge of partying to get it...im happy if i get SVR...i dont care waht they say...if my damage is stopped ....i doubt ill be spreading the C
717272 tn?1277594380
I think "in vitro" is the key to understanding this.  They can make it infectious in a test tube.  Not the same thing as a human system.

I asked my doctor (an HCV researcher) about the virus re-activating about a month ago.  He said: The genome (the genetic material) of the virus remains in the liver.  It is unable to replicate (reproduce) because the treatment left behind a much stronger immune system (interferon induces killer T cell production).

IF you were to suppress your immune system (say with meds for one of the autoimmune diseases like lupus or rheumatoid arthritis or immunosuppressants for a transplant) it would be possible for the virus genome to begin replicating again.  I saw a study that suggested cured HCV patients wait at least 6 months before using such drugs.  I think I will just avoid everything like that until I am in dire need and hopefully by then they will have the whole business better figured out (kinder HCV treatment, more specifically targeted immunosuppressants).

I think we all know to exclude our livers from donor organs we may give some day.  I don't intend to worry about it all.  I've already changed my life this much and don't think I'll have much trouble refusing unneccessary prescriptions in the future.  It would be a good idea to mention past HCV infection to your other doctors so, hopefully, they will not prescribe immunosuppressive drugs to you for cassual reasons.
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