SVR Durability / Transient HCV Detected

[mikesimon]

From: Sustained Virological Response to Pegylated Interferon and Ribavirin is Maintained during Long-term Follow-up of Chronic Hepatitis C Patients
http://www.medscape.com/viewarticle/716305

"......In our study, we identified a small proportion of SVR patients with transiently positive serum HCV-RNA. In fact, we observed that 8% of the patients who had obtained an SVR to PEG-IFN and ribavirin therapy showed transiently positive serum HCV-RNA when the virological determinations were carried out in a consistent fashion (i.e. every 6 months) and for an adequate period of time (i.e. up to 7 years). In fact, among the 18 patients with transiently positive serum HCV-RNA, four (22%), six (33%) and eight (45%) patients had a positive result after 1, 2 and between 3 and 4.5 years of follow-up respectively. Apart from being heavier and with a greater BMI, these patients had no significantly different characteristics as compared to the 211 patients with persistently negative serum HCV-RNA. Noteworthy, in all these patients, transient positivity of serum HCV-RNA was immediately followed by a negative virological result. As our study was carried out in the clinical practice, we used a commercial assay with an HCV-RNA detection limit of 50 IU/mL and therefore a possible contamination of samples in the laboratory during performance of the PCR for HCV amplification cannot be completely ruled out and we did not perform HCV-RNA sequencing in these subjects. Although previous studies have clearly shown that residual HCV-RNA can be detected in the sera and liver of patients with treatment-induced or spontaneous HCV clearance up to 8 years after apparent resolution of infection,[16, 17]  the interpretation of this unexpected result can be speculative at best for reasons of the above-mentioned limitations. However, our results are surprisingly similar to those obtained in a smaller cohort of patients who obtained an SVR after standard IFN and ribavirin treatment (97% of the study population) who were studied by George et al.,[11]  who found a rate of transient positivity of serum HCV-RNA similar to ours (i.e. 6%) using a very sensitive assay such as transcription-mediated amplification (TMA, detection limit 5.3 IU/mL) and evaluating serum HCV-RNA annually, although their positive samples tested negative using an assay with a detection limit of 29 IU/mL.

Although other studies have demonstrated that in patients with chronic hepatitis C, weight loss is accompanied by both biochemical and histological improvement and have identified high BMI as a parameter independently associated with lack of SVR,[18, 19] there are no published studies showing that weight loss is able to improve the SVR rate and that high BMI is associated with transient resurfacing of HCV. Nevertheless, the interaction between lipids homeostasis and HCV is quite complex, and HCV itself circulates, in vivo, as heterogeneous particles among which are globular particles rich in triacylglycerols that contain HCV-RNA.[20] Whether fat and lipid particles may act as a 'sanctuary' for HCV is not known, and at least during our follow-up, none of the patients who showed transiently positive HCV-RNA had overt clinical disease progression. In our cohort, the lack of paired biopsies did not allow us to draw firm conclusions regarding fibrosis progression; nevertheless our results clearly underscore that longer follow-up periods are actually needed to evaluate whether patients with these characteristics might have a different outcome.

In conclusion, we have observed that in patients with chronic hepatitis C treated with PEG-IFN and ribavirin, the durability of SVR exceeds 99% for up to 7 years of follow-up. Although 'late' virological relapse may occur in less than 1% of the patients, this phenomenon is mainly confined within 1 year after assessment of the SVR. Clinical outcome of patients who obtain SVR is excellent, although patients with cirrhosis are still at risk of hepatocelluar carcinoma despite HCV-RNA negativization and therefore need adequate surveillance."

Mike

[justme53]

At my last appt. two weeks ago, we talked about what to expect post tx and she began to schedule US, endoscopy and MRI for down the road. I really thought if I cleared that my HCC chances would lessen. No such luck with cirrhosis. I was so bummed. She said they'd lessen with an SVR not disappear. I asked at what point do you start calculating and was told at a cirrhosis dx, which would be 2008 for me. Gives me all the more incentive to keep the weight off I've lost and keep exercising whatever the outcome of tx.

Pam

[Trish77]

nygirl:  "(I do remember the day when docs said that treatment kept us safe from HCC - now it appears the other way around :( "

"Clinical outcome of patients who obtain SVR is excellent, although patients with cirrhosis are still at risk of hepatocelluar carcinoma despite HCV-RNA negativization and therefore need adequate surveillance."

Successful treatment DOES keep you safe from HCC if you're earlier stage liver damage and it keeps you from progressing any further.  That's at least something.  I won't ever have to concern myself with HCC according to my doc, thanks to an SVR at Grade 1.  So depends where you're at when you get that SVR, I do believe.

Trish

[scratchinghead]

Glad I recently lost all that I can lose on Weight Watchers and spinners class. Still waiting for the *3rd Ingredient* to get approved before I do treatment.

[nygirl7]

Sure is a lot of important information in this isn't there?
High BMI hi bad fats is a negative for real.......at least until the one year mark then it appears we are OK afterwards.

Which is what most of us oldies still believe no matter what the fancy pants docs changed it to anyway......just nice to KNOW for sure!

(I do remember the day when docs said that treatment kept us safe from HCC - now it appears the other way around :(