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What causes a relapse?

I noticed in some of the postings that people appear cured and then they relapse. Why? Is it not fully eradicated? Are they re-introduced to the virus? Are there risky behaviors involved such as drinking or drug use? Just wondering.
22 Responses
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4896357 tn?1360670904
Yep, not fully eradicated in most cases. (ttbomk)
Helpful - 0
163305 tn?1333668571
The tests do not go to no viral load, it simply says less than a given number. Hep C is teeny tiny and those who relapse usually were not completely free of the virus.
There is the possibility of reinfection but usually that is not the case.
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2059648 tn?1439766665
Relapse usual appears within the month after treatment end.  If Hepatitis C comes back shortly after end of treatment .....its with a vengeance.   It's not just a few copies of the Hepatitis C virus.  It thousands if not millions of copies.   These is why additional testing is done to confirm you are cured.
Testing is done a 12 weeks which is a good indicator you will be cured. 24
weeks is confirmation the test was accurate and you have been cured.

After being cured of Hepatitis C you can be reinfected.  Having the hepatitis C antibodies don't protect you from getting Hepatitis C.   So risky behavior
where Hepatitis C infection isn't a good choice after you've been cured of hepatitis C.

I hope this helps
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142841 tn?1201975052
People who relapse carry hidden reservoirs of virus somewhere within the body. Obviously, this virus is not detectable in the blood, and, presumably, not touched by the antiviral medications.  When treatment ends, and the suppressive action the meds cause tapers to zero, this hidden virus reemerges, and multiplies rapidly.  Note: I'm not an M.D., and this is just informed opinion.
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253566 tn?1219679699
Exactly!

I am not sure where others treated but I treated at the University of Pittsburgh Liver Center. I was not aware at the time but later learned that it is considered one of the best in the world... anyways, the nurses that cared for me NEVER used the word "cure" or "cured" but always "undetectable".

It was always explained to me that the blood test being used was NOT sensitive enough after treatment thus the undetectable. It was NEVER explained why a more sensitive test would not be created - maybe to give the big pharma the ability to suggest a "cure"!

I will go one point further than neptune above! I believe that all that have treated and reached undetectable *probably have a bit of HepC data left in them somewhere. The little bit that is left over is so small that our natural immune system is able to handle it *for most of us!
Helpful - 0
Avatar universal
I agree with Frank, but another problem is that some people may not be treated for a long enough period of time. For example, those with cirrhosis should treat longer than someone without it. When Sovaldi/Olysio was used before FDA approval the treatment time was 12 weeks but once the FDA approved it they recommended 24 weeks for those with cirrhosis but some had already completed treatment before this recommendation and some doctors refused to give their patients the extra 12 weeks. Now, with Harvoni and the Viekira Pak it looks like some doctors are still not treating a person for a long enough period.
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Avatar universal
I was one of the people with cirrhosis who only did S&O for 12 weeks but I was successful and have been declared "Cured"  by my IDS since I achieved SVR24. I was UD 4 weeks into treatment, at EOT, SVR 12 and finally SVR24 cured. My IDS is confident enough that I have been discharged and I am no longer a patient of her clinic.
Bucky
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2059648 tn?1439766665
Times are changing.   Most people can be cured of Hepatitis C.   And yes doctors now say "cured".      
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10175413 tn?1427170251
Hi Neotune...so interesting. I would like to see the data or the website that you found this info, really want to read it more in depth, please. I was under the impression that since blood runs through the whole body and hep is a blood borne disease it has no place to hide. Can you please tell me where these pockets are?
Thank you
Hope you are doing well
Deb
Helpful - 0
Avatar universal
Although, I've never been told that about the "pockets" and can see where Frank is coming from.  All it takes is a small speck of blood to harbor virus.., theorizing that...should it not be completely eradicated, that one cell could replicate.  Considering that when they test us, all they are testing is a sample of our blood and not every single drop of blood in our bodies.., it is conceivable that this is how it's possible for people to relapse.  This is why I'd not be comfortable with relying on only a 12 week post treatment undetectable result.  I'd definitely want to air on the side of caution and have it checked again a 6 mon. post treatment.  That's just me and I'm not a doctor.  But, look at what happens with a cancer patient.  The doctor will tell a patient, that they have been cured, they are cancer-free and then, boom the cancer crops up again in a couple of years. I'm not trying to be negative, just keeping my eyes open. And I admit, I have like barely any trust left for what doctors tell me anymore.  I am still of the opinion, though, that they are doing much better now, with getting people "undetectable for extended periods-.i.e. 'cured " than, they did 10+ years ago.  Susan400
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Avatar universal
My IDS told me early on that HCV doesn't hide like HIV. That is why DAAs can kill the virus.
Bucky
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142841 tn?1201975052
Not really sure where all that info comes from.  My doctor educated me on a lot of it.
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Avatar universal
Susan400, I totally agree with you.
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10175413 tn?1427170251
I can see how you would feel that way.
I'm astounded by the Dr's that still want to treat people with INF.  
I think some doctors need to be more educated about the virus instead of picking a Tx out of their hat, and this still happens.  You get people who have to treat multiple times, making them resistant or ineligible for certain drugs sometimes...... All the while creating more havoc in the treaters body......criminal
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142841 tn?1201975052
I think that it's possible that low level serum viremia causes some relapses (a decreasing number, as the test sensitivity improves.)  There are other possibilities, as mentioned in the following two papers (slightly dated, perhaps.)

http://www.intmedpress.com/serveFile.cfm?sUID=690afbf7-b39b-4046-9eb8-0b456b16253d

http://www.sciencedaily.com/releases/2014/03/140313101708.htm
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Avatar universal

Good discussion, but opinions.... We all(incl some docs) have them.

Data please! Lots of really clear data. IMHO this is a canon convo, perhaps frightening to new or perspective treaters(and old) to just be bandied about.

If anyone has DATA on this, would you please share

Best,
Randy
Helpful - 0
142841 tn?1201975052
Sorry, I don't mean to mince words. The two papers are not "opinion."  These are peer-reviewed scholarly journals.  There may be genetic mutations that affect relapse rates. There is documentation about HCV virons present in various places in the body, not detectable by blood test.  Please...read them again. Not every aspect of this disease is completely explained by piles of "data."   I spent some time today looking for what is out there to explain why relapse happens.  I didn't find any long term, large studies.  I'll stick to what I said previously, there may be hidden reservoirs of virus in the body.  I'll add that there appears to be a genetic mutation associated with relapse, and I acknowledge that virus in the bloodstream below the limit of detection of the qualitative part of viral load tests remains a possibility.  OPINION: I think low level viremia is the least likely of these.  But, I could be wrong.
Helpful - 0
10175413 tn?1427170251

I think that "mutations" are a better explination than the mysterious "hidden pockets" of virus as there is really no place for the virus to hide as blood runs thru the entire body, which is what I was getting at earlier.....
Soon with less Tx cocktails and even more targeted meds even the mutations will no longer be able to hide from the "smart" meds.
Hoping for this sooner than later.
John Hopkins is already trying to perfect a vaccine to eradicate
this crap once and for all! What a great day it will be when we can shutdown all of these websites that will no longer be needed..I think it will come soon with the advances that have happened in just the past 3 or so yrs.
D
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683231 tn?1467323017
I treated with Sov Oly Mar 14 to Jun 14 12 weeks but a s a prior null responder with cirrhosis 24 weeks would now be the recommendation but I had finished tx long before that was changed. I was not a fortunate as Bucky when they did my 12 week post treatment viral load my virus was back at the same level as before treatment.

The test results say not detected the do not say no virus present My thinking is that a small amount of the virus is still present throughout the blood stream but in insufficient quantities to be detected. Not hiding just below the limits on the test to detect.

When the meds are removed it allows the virus to rebound. Virus are very good at reproducing it is what they do. So it a few are missed a miss is as good as a mile. Even just one virus particle remaining, if it is still viable and able to replicate, will go on to reproduce the virus rapidly to detectable levels.

At least that is my thinking but I work in a machine shop at night.
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10175413 tn?1427170251

This is why I love this community...we can discuss opinions whether we agree or not and still be supportive to one another.

We are all fighting the same enemy which IMHO is the glue that makes this site work.  People that have not had to treat will never understand our feelings, doubts and fears about takings these meds and what risks may be out there for each of us....I think we are all some really strong people with a lot of fight in us!  
KUDOS COMMUNITY & SUCCESSFUL Tx to all!

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Avatar universal
Let's also not forget about "Host Factors".  These are predetermined prior to Tx to establish priority as it relates to relapse.
Some of these include viral load, male gender, high BMI or being overweight, Tx naïve, cirrhotic or non to name a few.
We are not created equal and some of these while we can change, others are out of our control.  This spills over into other aspects of disease in our lives as well.
Unfortunately there is no guarantee that we will be in the majority and find ourselves cured, but the odds are looking mighty strong luckily for our immediate future.
.......Kim
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Avatar universal
After triple tx with incivek, I was an early responder and undetectable all through treatment. As a relapser, based upon my own known medical history I believe that the previous strategy of training the immune system to suppress the virus while slowing down the growth rate was in some cases ineffective due to prevalence of fatty and/or scar tissue. This type of tissue may have reduced blood flow or be resistant to absorption of the medications at a cellular level, thereby preventing the immune response from stopping all proliferation.
I believe that the new medications will be much more effective now that they not only prevent proliferation but actively kill the virus.
Length of treatment is only significant under this protocol to assure that sufficient absorption has occurred in all tissue. When the last virion is killed, you are indeed cured, and cannot relapse, only be reinfected from an outside source.
Prior relapse is clinically significant in determining length of treatment as it demonstrates that there are factors present affecting either the absorption of the meds or the mutation rate of the virions.
My theory, anyway.
Helpful - 0
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