Viral Load and SVR

[gypsyjoey]

Hi y'all!

A friend of mine and I were talking about being SVR, me for 8-months now and her for 10-years.  She said that someone told her she has always still had a viral load but is testing SVR because the viral load is under the level that the test checks for.  I'm thinking Bull-****.  If she has had any level of viral load over the past 10-years, wouldn't you think that it would have come back by now?  I don't want to figure, I want to know; for her, for me, for all of us.

Input please.

Joey

[RobertBeWell]

Heh, the first sentence in my previous post was supposed to say "There are THREE tests."

Robert

[RobertBeWell]

There are tests. The most sensitive is TMA (Transcription-mediated amplification) and can detect virus down to as little as 5-10 IU/mL.

Here is an excellent little paper for us non-scientists that explains each test in a very easy to understand manner.

http://www.hcvadvocate.org/hepatitis/Basics/BASICS_Viralload.pdf

Take Care,

Robert

[newleaf09]

You either believe that it can stick around undetected or you don't.  I don't think researchers can totally prove one way or another.  There was a post a little while back by mikesimon that I liked.  I want to be a believer that the virus is totally gone, so I liked the link to study results that he put in his post.  It was a study of transplant patients (not liver; some other organ like kidney maybe) which involved former HCV patients who had SVR'd and they very seriously looked at these people's tissues and found absolutely no HCV.  Maybe mike will re-post his link.  

[nygirl7]

Joey

If the virus stays under detection levels (if there is even any possibly left somehow) but you stay healthy, and your liver is getting better and you are SVR (people do NOT just lose it after a few years - once you are over six months or a year it is not coming back even if it *were to be there somewhere hiding*  ( I don't personally believe so but...)

Who cares? As long as you are healthy and don't 'have' the disease anymore you are fine right?  Remember we will always carry the antibodies.......so it's sort of like having the virus in a way but a virus that is dead (which is not literal I'm just trying to make a point) and can't do anything - they don't bother me at all, so if there are three floating around in my big toe? Who cares, they aren't affecting me so it's all good!  (I mean that in the happy way of course :)

[gypsyjoey]

Yes Bill,

This is very helpful and easy to understand.  Of course it fuels the question button in my head to want exact and unequivocal answers that say "no virus."  What I think I'm hearing is that no such answer can be provided at this time...Right?
Joey

[Bill1954]

Hi Joey--

I think maybe what she’s really trying to say is that she wouldn’t *know* if low level viremia is present; our tests have limits of detection, and don’t provide quantitative information below that limit.

For instance, a test might have a lower limit of detection of say, 50 IU/mL. The test will probably also have language included that says, ‘HCV RNA not detected to <50 IU/mL. No, she *shouldn’t * have *any* virus in her blood; however, that can’t be fully demonstrated with current technology.

SVR is determined by absence of *detectable* virus six months post treatment; beyond that, who knows for certain? There is emerging study on the concept of long term persistent infection/occult HCV; some of that has been cataloged here:

http://www.medhelp.org/health_pages/Hepatitis/No-evidence-of-occult-hepatitis-C-virus-HCV-infection-in-serum-of-HCV-antibody-positive-HCV-RNA-negative-kidney-transplant-patients/show/54?cid=64

Importantly, this probably has little clinical relevance; the durability of SVR has been demonstrated now for years, and this probably has more relevance in terms of research.

Does that help answer your question?

Bill