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Does UND Mean TOTAL ERADICATION?
Here's a noob question for you. 6 months post TX and UND, I've read, is what is considered "cured". So, UND means if there are virions present, there are so few of them that the tests are not sensitive enough to pick them up.
My question is, forgetting about UND for a moment, is EVERY LAST SINGLE VIRION REALLY GONE, or are there always a few hanging around but the immune system now keeps it in check since it was beaten back?
I can't seem to find anything about this online... comments appreciated.
My question is, forgetting about UND for a moment, is EVERY LAST SINGLE VIRION REALLY GONE, or are there always a few hanging around but the immune system now keeps it in check since it was beaten back?
I can't seem to find anything about this online... comments appreciated.
Great question. My Dr says that UND at 6 mos is CURED! Although since there is a VERY small population that becomes HCV-positive again after those 6 mos it makes me wonder. I know that doesn't help very much, but I'm not sure anyone really knows. However, if you are 6 mos UND, then 18 mos UND, then UND every year I have to assume it's gone.
Hello!
First of all, congrats on making SVR! Second...If you make it to 2 years post TX, the odds are less than 2% you will relapse. So, no there aren't any guarantees the dragon is completely dead, but a good test will be the first time after you are SVR that you get really sick from another illness. When your immune system gets severely weakened, it will be the best test to see if the Hep C tries to grow again. If it doesn't, your odds of being cured are very high. Good luck...((((((((HUGZ))))))))~MM
First of all, congrats on making SVR! Second...If you make it to 2 years post TX, the odds are less than 2% you will relapse. So, no there aren't any guarantees the dragon is completely dead, but a good test will be the first time after you are SVR that you get really sick from another illness. When your immune system gets severely weakened, it will be the best test to see if the Hep C tries to grow again. If it doesn't, your odds of being cured are very high. Good luck...((((((((HUGZ))))))))~MM
Hi Medic,
Thanks for the reply.
I didn't mean to imply that I'm SVR, actually, I was just diagnosed 2 months ago, and am waiting to see a specialist :-(
Just trying to learn all I can!
Thanks,
Robert
Thanks for the reply.
I didn't mean to imply that I'm SVR, actually, I was just diagnosed 2 months ago, and am waiting to see a specialist :-(
Just trying to learn all I can!
Thanks,
Robert
The more sensitive your test, the more confidence you have in your UND. And the longer you go UND after the end of treatment, the more likely it is that they are all gone. That's why there is a certain amount of confidence at a 12 week post treatment UND result and that six month wait period for that final test to determine SVR. That's the accepted time period to indicate a cure. If there were any hanging around they would replicate and they would become detectable eventually. So if you make it to six months post treatment and you are still UND, the thought is that there is no replication because there is nothing to replicate with.
"but a good test will be the first time after you are SVR that you get really sick from another illness. When your immune system gets severely weakened, it will be the best test to see if the Hep C tries to grow again. If it doesn't, your odds of being cured are very high."
MM,
Hmm, I've never read that or seen it documented before. Are there studies which support that?
Trinity
MM,
Hmm, I've never read that or seen it documented before. Are there studies which support that?
Trinity
I prefer to see undetectable 1 year post treatment before I say "cured" There have been some cases of late relapse within 1 year and, of course, the sensitivity of the tests have been questioned in some instances but, 1 year is extremely convincing.
There is talk about immunsuppressive drugs triggering a relapse or recurrence of HCV. It is rare and the very few cases I have seen involve heavy immune doses of suppression drugs and I believe cancer was also involved in most of those cases. I am immune suppressed due to my transplant and have been SVR since June 2004. I have never been detectable for HCV. I also had a bad motorcycle wreck in 2005 and God only knows what drugs they put into me the first week. I suffered extensive trauma but no HCV recurrence. My opinion is that SVR is very durable and 1 year post treatment is a more reliable test than 6 months post TX.
I am not saying that I don't think the 6 month test is almost always reliable because generally it is. I have seen relapse after 6 months though but not more than a year.
Mike
There is talk about immunsuppressive drugs triggering a relapse or recurrence of HCV. It is rare and the very few cases I have seen involve heavy immune doses of suppression drugs and I believe cancer was also involved in most of those cases. I am immune suppressed due to my transplant and have been SVR since June 2004. I have never been detectable for HCV. I also had a bad motorcycle wreck in 2005 and God only knows what drugs they put into me the first week. I suffered extensive trauma but no HCV recurrence. My opinion is that SVR is very durable and 1 year post treatment is a more reliable test than 6 months post TX.
I am not saying that I don't think the 6 month test is almost always reliable because generally it is. I have seen relapse after 6 months though but not more than a year.
Mike
Her is part of a report from Jules Levin
EASL, April 11-15, 2007
Barcelona, Spain
Mark Swain from Canada looked at the durability of Sustained Viral Responses with Pegasys based therapy. 5 years after achieving SVR 99% of patients maintained undetectable HCV viral load, Swain called these patients cured. Swain reported 5 year followup on 997 treatment-naïve patients who achieved an SVR who received Pegasys monotherapy (3 studies) or Pegasys + ribavirin (6 studies) in one of 9 studies. This included 163 patients who received Pegasys monotherapy, 741 who received Pegasys plus ribavirin combination therapy, and 93 HCV/HIV coinfected patients who received Pegasys with or without ribavirin. Achievement of an SVR was defined as undetectable HCV RNA (50 IU/mL) at 24 weeks after completing treatment. Annual testing was performed for 5 years for HCV RNA in serum with the COBAS AMPLICOR HCV test v2.0 (limit of detection 50 IU/mL). Overall 99.2% of patients who achieved an SVR remained HCV RNA undetectable at a mean of 4.1 (0.4-7) years follow-up. Of note, this high rate of durability was the same regardless of whether patients received monotherapy (98.8%), combination therapy (99.2%), combination therapy with normal ALT (100% n=75), or were coinfected (98.9%). He combined the results of whether you received mono- or combination for the coinfected patients. 8 patients (0.8%) who achieved an SVR became HCV RNA-positive a mean 2 (1.1-2.9) years after completing therapy, and Swain said "it is currently unclear whether patients who became HCV RNA detectable during follow-up experienced re-infection, rather than virological relapse. Regrading the 8 patients with detectable HCV RNA, Swain showed characteristics of these patients and "there appear to be no common risk factors associated with detectability of HCV RNA during follow-up". None of the 8 had cirrhosis; 5 had 48 weeks therapy & 3 had 24 weeks therapy. Several received monotherapy with peg, several received 800 mg RBV and several received 1000/1200 mg RBV. Most of the 8 were Caucasian.
so to conclude over 99 % after five years and it does not matter how you treated ie old mono or combo etc, this is good info as all the subjects had the same tests to detect viral load as opposed to varing assay sensitivity
EASL, April 11-15, 2007
Barcelona, Spain
Mark Swain from Canada looked at the durability of Sustained Viral Responses with Pegasys based therapy. 5 years after achieving SVR 99% of patients maintained undetectable HCV viral load, Swain called these patients cured. Swain reported 5 year followup on 997 treatment-naïve patients who achieved an SVR who received Pegasys monotherapy (3 studies) or Pegasys + ribavirin (6 studies) in one of 9 studies. This included 163 patients who received Pegasys monotherapy, 741 who received Pegasys plus ribavirin combination therapy, and 93 HCV/HIV coinfected patients who received Pegasys with or without ribavirin. Achievement of an SVR was defined as undetectable HCV RNA (50 IU/mL) at 24 weeks after completing treatment. Annual testing was performed for 5 years for HCV RNA in serum with the COBAS AMPLICOR HCV test v2.0 (limit of detection 50 IU/mL). Overall 99.2% of patients who achieved an SVR remained HCV RNA undetectable at a mean of 4.1 (0.4-7) years follow-up. Of note, this high rate of durability was the same regardless of whether patients received monotherapy (98.8%), combination therapy (99.2%), combination therapy with normal ALT (100% n=75), or were coinfected (98.9%). He combined the results of whether you received mono- or combination for the coinfected patients. 8 patients (0.8%) who achieved an SVR became HCV RNA-positive a mean 2 (1.1-2.9) years after completing therapy, and Swain said "it is currently unclear whether patients who became HCV RNA detectable during follow-up experienced re-infection, rather than virological relapse. Regrading the 8 patients with detectable HCV RNA, Swain showed characteristics of these patients and "there appear to be no common risk factors associated with detectability of HCV RNA during follow-up". None of the 8 had cirrhosis; 5 had 48 weeks therapy & 3 had 24 weeks therapy. Several received monotherapy with peg, several received 800 mg RBV and several received 1000/1200 mg RBV. Most of the 8 were Caucasian.
so to conclude over 99 % after five years and it does not matter how you treated ie old mono or combo etc, this is good info as all the subjects had the same tests to detect viral load as opposed to varing assay sensitivity
'When your immune system gets severely weakened, it will be the best test to see if the Hep C tries to grow again.'
This does happen unfortunately. It happened to one of my best friends. She was UND for about 8 years. She has RA and is on Enbrel to treat it. (Enbrel suppresses the immune system so the RA doesn't attack the joints). She suspected the Enbrel caused the hep C to reappear. I just had a serious conversation with her to quit drinking and see her doctor about the status of the Hep C. She's fearful the doctor will make her treat again. I told her the doctor can't make her do anything, and she may want to watch the new drugs. She went through the 48 weeks of SOC to get her SVR. She had done another tx before that with the 3x a week ifn and had to stop that one. I saw her while she was tx ing and remember how bad it was for her. She was there for me when I did my round last year. I know this is extremely rare but it does happen.
This does happen unfortunately. It happened to one of my best friends. She was UND for about 8 years. She has RA and is on Enbrel to treat it. (Enbrel suppresses the immune system so the RA doesn't attack the joints). She suspected the Enbrel caused the hep C to reappear. I just had a serious conversation with her to quit drinking and see her doctor about the status of the Hep C. She's fearful the doctor will make her treat again. I told her the doctor can't make her do anything, and she may want to watch the new drugs. She went through the 48 weeks of SOC to get her SVR. She had done another tx before that with the 3x a week ifn and had to stop that one. I saw her while she was tx ing and remember how bad it was for her. She was there for me when I did my round last year. I know this is extremely rare but it does happen.
I have heard that in extremely rare cases relapse can possibly occur with heavy steroid use or the use of some drugs that might cause immunosuppression but getting really sick with an illness and that being a test to see if the virus comes back is suspect to me. People become ill all the time with things like bacterial meningitis, staphs or streps, leukemia, E Coli just to name a few that make a person extremely ill and weaken the immune system but there is no documentation that says relapse is caused by those illnesses or any illness. I've just never read anything that stated Hepc will manifest itself again if someone becomes seriously ill and the immune system is compromised.
Trinity
Trinity
I don't think you understood my post. I believe the Enbrel (immunosuppression drug) caused the relapse in my friend. It was one of those catch 22 situations, do you let the pain from Rheumatoid arthritis cripple you or do you take something (Enbrel in this case) to relieve it and risk the virus coming back. It wasn't a total shocker to her when I mentioned the possibility of the immunosuppression drug causing it. She hasn't been seriously ill since tx back in 2002.
Annie
I understood your post just fine. I did not understand MM's statement that if you get really sick from another illness which implies any illness as I stated by random examples and the immunue system is severly weakened it is a test to see if the virus will return.
Trinity
I understood your post just fine. I did not understand MM's statement that if you get really sick from another illness which implies any illness as I stated by random examples and the immunue system is severly weakened it is a test to see if the virus will return.
Trinity
Hi Trinity!
Sorry about my slow response...I was trying to find the stats that support my statement. (Still working on it...) This theory was initially from patterns of "viral uprisings" when a person has had other chronic virus-based illnesses like herpes, shingles (herpes zoster/chicken pox virus), malaria, and a few bacterial ones as well. There is a correlation between the hep C viral load climbing when one's immune system is weakened because, when a person's body is stressed from fighting an infection (or other body -stressing agent like drug use, alcoholism, severe lack of sleep, poor nutrition, etc.) the Hep C gains a foothold, increasing its replication rate and damages the liver. Studies are under way to prove this is a key factor in why some people can have it for 20-30 years and suffer little damage, while others have it for 5 years and require a transplant. So, this goes back to my statement...Once the Hep C treatment is completely purged from your fat cells (usually about 6 months, but longer for others), and your immune system is tested by severe stress from an illness (like pneumonia, surgery that makes you bed-bound for more than 4 days, etc.) and you remain SVR afterward, then it is reasonable to assume the Hep C is gone for good...~MM
Sorry about my slow response...I was trying to find the stats that support my statement. (Still working on it...) This theory was initially from patterns of "viral uprisings" when a person has had other chronic virus-based illnesses like herpes, shingles (herpes zoster/chicken pox virus), malaria, and a few bacterial ones as well. There is a correlation between the hep C viral load climbing when one's immune system is weakened because, when a person's body is stressed from fighting an infection (or other body -stressing agent like drug use, alcoholism, severe lack of sleep, poor nutrition, etc.) the Hep C gains a foothold, increasing its replication rate and damages the liver. Studies are under way to prove this is a key factor in why some people can have it for 20-30 years and suffer little damage, while others have it for 5 years and require a transplant. So, this goes back to my statement...Once the Hep C treatment is completely purged from your fat cells (usually about 6 months, but longer for others), and your immune system is tested by severe stress from an illness (like pneumonia, surgery that makes you bed-bound for more than 4 days, etc.) and you remain SVR afterward, then it is reasonable to assume the Hep C is gone for good...~MM
Dang. I was interrupted and didn't finish what I was saying about relapsing viruses. ..When a person with shingles, or herpes, (or sometimes even cancer) when their immune systems become stressed, they have an outbreak...The theory forming about Hep C relapse after treatment is similar involving a stressed immune system "test"...~MM
I do understand the basis of what you are saying but as I said my research has never indicated a severe illness after SVR may contribute to relapse. When SVR occurs and a sensitive PCR indicates no presence of virus it would imply there is nothing to replicate after the SVR has become durable as in 12 months but it's been my experience with this disease nothing is etched is stone regardless of what the print may say.
Fortunately that theory hasn't applied to those co-infected who have SVR'd and remained virus free. One would think the immune system would be very stressed with the presence of HIV.
Trinity
Fortunately that theory hasn't applied to those co-infected who have SVR'd and remained virus free. One would think the immune system would be very stressed with the presence of HIV.
Trinity
Hi Trinity,
I have to agree with you...There are many factors for relapse that are being considered/studied...The most consistent ones we know are genotype, co-infection, age, compliance to treatment, lifestyle, and early response to treatment...I was only stating this as theory that is being researched, expressing if the virus is really gone, a continued SVR after significant stressor on the immune system is reassuring because, if the Hep C was occult, a weakened immune system would provide a chance for it to replicate and regain a foothold...~MM
I have to agree with you...There are many factors for relapse that are being considered/studied...The most consistent ones we know are genotype, co-infection, age, compliance to treatment, lifestyle, and early response to treatment...I was only stating this as theory that is being researched, expressing if the virus is really gone, a continued SVR after significant stressor on the immune system is reassuring because, if the Hep C was occult, a weakened immune system would provide a chance for it to replicate and regain a foothold...~MM
I apologize Robert for never addressing your question.
I am not convinced that SVR means total eradication. I guess it could be completely eradicated but if I had to bet I would bet "no" the virus would still be detectable if we had a sensitive enough test.
Mike
I am not convinced that SVR means total eradication. I guess it could be completely eradicated but if I had to bet I would bet "no" the virus would still be detectable if we had a sensitive enough test.
Mike
"I am not convinced that SVR means total eradication. I guess it could be completely eradicated but if I had to bet I would bet "no" the virus would still be detectable if we had a sensitive enough test. "
So, your contention is that SVR is a condition where the immune system dominates the virus completely, but there are always a few still present.
It'd be interesting to see if anyone has studied this scientifically somehow.
Guess it doesn't really matter though, as long as it's contained, the damage ends, and the healing begins.
EXCELLENT!
So, your contention is that SVR is a condition where the immune system dominates the virus completely, but there are always a few still present.
It'd be interesting to see if anyone has studied this scientifically somehow.
Guess it doesn't really matter though, as long as it's contained, the damage ends, and the healing begins.
EXCELLENT!
it only takes one viron to exist to breed , therefore gone means gone svr is cure its gone.
There are many articles on "occult HCV' or "persistent HCV".
You can view some of these articles/abstracts on the health page site which deal with this issue.
It is a controversial topic but I believe that most people who've read much about it do not easily dismiss the possibility that some viral presence may survive post SVR (or post spontaneous clearance according to some articles).
Here is the link:
http://www.medhelp.org/health_pages/Hepatitis/Detection-of-occult-hepatitis-C-and-hepatitis-B-virus-infections-from-peripheral-blood-mononuclear-cells/show/54?cid=64
Mike
You can view some of these articles/abstracts on the health page site which deal with this issue.
It is a controversial topic but I believe that most people who've read much about it do not easily dismiss the possibility that some viral presence may survive post SVR (or post spontaneous clearance according to some articles).
Here is the link:
http://www.medhelp.org/health_pages/Hepatitis/Detection-of-occult-hepatitis-C-and-hepatitis-B-virus-infections-from-peripheral-blood-mononuclear-cells/show/54?cid=64
Mike
Are there any sites available that can be read for free? I followed this link:
And every single article I clicked on took me to a "pay-per-view" site. At $20 - $35 per article, no way would I pay to read this.
Thanks
Robert
And every single article I clicked on took me to a "pay-per-view" site. At $20 - $35 per article, no way would I pay to read this.
Thanks
Robert
UND does not mean Total Eradication.
SVR is when the virus is still undetectable 6 months after completing TX.
SVR is when the virus is still undetectable 6 months after completing TX.
So, your contention is that SVR is a condition where the immune system dominates the virus completely, but there are always a few still present. "
I believe that since there is so much contention and so many different camps of thought on this one - this is why we do the 'extra' months of treatment after we are SVR. In this way we train our immune system to take care of any leftovers that just might be swimming around in our bodies that beat that UND. This also might be the reason for post tx 'false positives' as happened to me (was positive at 63 on week 4 but then every test for the next three years down to 2 was negative. It might be that my immune system almost dropped the ball but came back roaring in to keep them under bay)
Since nobody is positive either way it's best to just assume it could happen but I've never seen anyone on this forum "loose their SVR" in the five + years Ive been here. And we are talking about many, many people during those years. So IF it does happen it is extremely rare.
I believe that since there is so much contention and so many different camps of thought on this one - this is why we do the 'extra' months of treatment after we are SVR. In this way we train our immune system to take care of any leftovers that just might be swimming around in our bodies that beat that UND. This also might be the reason for post tx 'false positives' as happened to me (was positive at 63 on week 4 but then every test for the next three years down to 2 was negative. It might be that my immune system almost dropped the ball but came back roaring in to keep them under bay)
Since nobody is positive either way it's best to just assume it could happen but I've never seen anyone on this forum "loose their SVR" in the five + years Ive been here. And we are talking about many, many people during those years. So IF it does happen it is extremely rare.
Hi Robert,
Check out the site for Janis and friends. She and an amalgam of others formed this site specifically for people with Hep C -both the newly diagnosed, and those in end stage liver failure. Since you are newly diagnosed and probably still freaking out a little, I can ofer you a few words of comfort and advice...
First, this is a disease of DECADES and rarely does it mean you only have months to live. Most people who remain infected with it die of something else before they die of the Hep C.
Second, do as you are doing...Educate yourself and ask questions -no question is too unimportant. If you decide to pursue treatment, prepare yourself beforehand. Get a hepatologist if possible (they usually know WAY more than GI Drs). A liver biopsy is suggested to know how much damage your liver has endured. Learn to read you blood labs so you know if they are trending to critical levels during treatment. Prepare yourself mentally -make sure you are surrounded with a good support group who will tolerate your crabbiness, pity parties, and sleeping 20 hrs a day. Prepare financially. You may not be able to work (or drive!) after a few months into treatment. Get anything that can cause problems fixed (or stabilized) like teeth, mental health issues, and underlying medical problems. -I had to get my gallbladder out before I started...I hope this helps...Also, a forum I found helpful for live chatting with experienced heppers was in Delphi forums. This is where Janis and friends originates from...Good luck in your quest! If you decide to go through treatment, I will lend you my Hep C dragon-slaying sword! Death to all dragons!!!!!!HA!!! ;) ~Melinda
Check out the site for Janis and friends. She and an amalgam of others formed this site specifically for people with Hep C -both the newly diagnosed, and those in end stage liver failure. Since you are newly diagnosed and probably still freaking out a little, I can ofer you a few words of comfort and advice...
First, this is a disease of DECADES and rarely does it mean you only have months to live. Most people who remain infected with it die of something else before they die of the Hep C.
Second, do as you are doing...Educate yourself and ask questions -no question is too unimportant. If you decide to pursue treatment, prepare yourself beforehand. Get a hepatologist if possible (they usually know WAY more than GI Drs). A liver biopsy is suggested to know how much damage your liver has endured. Learn to read you blood labs so you know if they are trending to critical levels during treatment. Prepare yourself mentally -make sure you are surrounded with a good support group who will tolerate your crabbiness, pity parties, and sleeping 20 hrs a day. Prepare financially. You may not be able to work (or drive!) after a few months into treatment. Get anything that can cause problems fixed (or stabilized) like teeth, mental health issues, and underlying medical problems. -I had to get my gallbladder out before I started...I hope this helps...Also, a forum I found helpful for live chatting with experienced heppers was in Delphi forums. This is where Janis and friends originates from...Good luck in your quest! If you decide to go through treatment, I will lend you my Hep C dragon-slaying sword! Death to all dragons!!!!!!HA!!! ;) ~Melinda
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