its required Qualitative RNA HCV after treatment completed?

[shnawer]

Hello

I am 37 years old 4 years back I had completed my 6 month treatment of HCV. The doctors did Qualitative tests for 1 year after treatment and they said HCV will never become positive now. Two years back I took CBC and my LFT were fine. I have a relative who's HCV has returned back to her. Do I need to take qualitative tests every year? Or I just need only LFT tests for every year?


Thanks

[dontworry_behappy1]

Yes!  See what your doctor says at your appointment.  You don't have Hepatitis C anymore.  

Best To You

[shnawer]

I have taken a qualitative test and it says Not Detectable but LFT came high not sure whats wrong now. I have taken appointment with dr which would be after 15 days. Lets see what she says.

[FlGuy]

Has DD changed his name?

[Dee1956]

Thank you

[dontworry_behappy1]

Vertex posts a statement about the cure on the "incivek.com" website.  That's standing behind your product.  

DWBH

[mikesimon]

You said:

"...You say you're familiar with the study I've mentioned, then what would be your explanation of the chimpanzee infection after inoculation from an SVR patient?..."

I'm not sure which study you are referencing. I do not recall that in the Pham paper or in any of the information I've seen.
I'd appreciate if you would provide a link where I can review that article.

This article addresses PMBCs and it seems to refute your position.

"HCV Advocate Newsletter
August 2012 HCV Advocate


Cure: Really?
—Alan Franciscus, Editor-in-Chief

The word “cure” or “viral eradication” has always been hotly debated.  Study after study has shown that for most (>99%) the HCV virus is eradicated once someone has achieved a sustained virological response (SVR) or in those who spontaneously (naturally) clear the virus.  There is some evidence, however, that  the virus might still be in the body hiding out in so called reservoirs in organs and certain blood cells and that HCV could re-assert itself if a person becomes immunocompromised by an illness (i.e., cancer) or by taking immunosuppressive drugs (i.e., Enbrel).  

Two of the most common theories are that the virus could be lurking in the liver or in certain components of blood cells, such as peripheral blood mononuclear cells (PBMC)—this is the basic component of red blood cells that have one nucleus.  If there is a reservoir for a virus this is the type of cell in which a virus like hepatitis C could be “hiding out.”  A recently released journal paper reported on testing whether HCV can be found in PBMC’s and/or in the liver and more importantly if it is in a form that can replicate.    

The recently published study by K. Fujiwara and colleagues included 11 people who spontaneously cleared the virus, 48 people who achieved an SVR with HCV treatment, and two chimpanzees that had been inoculated with hepatitis C, but resolved acute infection.  First the authors proved that the hepatitis C virus could infect non-infected PBMC’s in a cell culture and that the virus was found to be in a form that could not replicate—this is a really important part of the study.  Next the researchers tested the PBMC’s of people who spontaneously cleared an acute infection and people who achieved an SVR.  The blood was checked for the hepatitis C virus using an HCV RNA test that had a lower level of detection of 2 IU/mL’s.  What they found was that while certain parts of the hepatitis C virus could be detected, it was not the entire virus and could not replicate.  Additionally, the chimpanzees’ blood was tested and in one chimpanzee that had died (not related to HCV) the organs were tested and no traces of the hepatitis C virus were found—this included blood cells and tissues as well as the liver of the dead chimpanzee.  

The authors concluded that, “Residual HCV was not detected in the plasma or PBMCs of any spontaneous or treatment-recovered subjects or in chimpanzee liver, suggesting that the classic pattern of recovery from HCV infection is generally equivalent to viral eradication.”

http://www.hcvadvocate.org/news/newsLetter/2012/advocate0812.html

Despite all of the recent evidence which suggests that SVR = complete eradication of any replicable virus I nevertheless allow for the possibility that some low level of the virus may remain after SVR and with improved technology we may be able to detect it someday. I do, however, think the word "cure" in this setting is a practical and accurate term insofar as SVR has been shown to be very durable. Early on I was anxious about taking steroids because of the articles I read. Now, I wasn't on massive doses but they were significant and I had no adverse reaction aside from a boost in my glucose level. Shortly after transplant I did undergo 2 or 3  intravenous bolus injection of Solu-Medrol - a gram in about 30 minutes. I admit that I would have some nervousness were I do undergo a treatment like that now. If I had to guess I'd guess I would be fine but I would not be really comfortable about it. So, I have that scintilla of doubt that I think a reasonable person would have given those circumstances. In the absence of anything as drastic as 1 gram of prednisone intravenously in 30 minutes I see no risk of relapse whatsoever and therefore I think SVR  really does mean "cured". But, that's semantics and purely academic. My reality is that I am virus free and have been for 10 years and I am confident that I will remain that way for the rest of my life...so, for me, I'm cured. I hope that you are too.

Mike

[copyman]

I agree with mikesimon. Leading Hepatologist are using the word cured because they have seen HCV patients that SVR'd 10+ years out and still no viral load.

A member that use to stop by this forum and a leading hepatitis researcher used the word cured several times. He invented the test that goes down to <2 virons. He once said  "if someone shows no viral load using a sensitive test like this then consider yourself "cured"

[willbb]

Thanks for the posting of these very detailed and informative studies backing up what most informed members here are already aware of,however always good as a refresher.

Best  to you Mike

Will

[medic54]

I am happy for you success. And surely relapse is very rare but documented in many studies (I am not going to spent hours goggling references to prove that point). You say you're familiar with the study I've mentioned, then what would be your explanation of the chimpanzee infection after inoculation from an SVR patient? Again, not trying to grind an ax or demean SVR (it has truly changed my life for the better), but the more I studied virology and HCV in particular during these last couple of years, and the more I learned how much my gasto doc didn't know... Well, I think knowledge is very important and possibilities should always be considered when studies back them up. What benefit would it be in establishing the importance of OCI? Awareness might lead to avoidance of relapse or inflection among other things. To me, that's just common sense progression but it sure has stirred up a hornets nest on this forum so I'm done.

[mikesimon]

Oh I forgot;

Then what about those previous SVR patients that relapse after immune depression (HIV, radiation therapy, transplant induced suppression)... while not common,  there are still many cases


I can think of maybe 2 cases and I believe they were cancer patients.
You say there are many cases. Show me those many cases cause I haven't seen them and I have been looking constantly for a long time.

[mikesimon]

I've been studying Occult Hepatitis C for 10 years. I know a little about it.

And what would your prominent doc's have to say about the cases of HCV/SVR that relapse one or two years later (all new infections I suppose).

How many can you document?

Then what about those previous SVR patients that relapse after immune depression (HIV, radiation therapy, transplant induced suppression)... while not common,  there are still many cases

I am a liver transplant recipient and I have been SVR since 2004. I am on tacrolimus and have supplemented with prednisone on occasion and I just tested undetectable in June 2013. I do not know of one true SVR who  relapsed and I know several on immunosuppressive drugs due to transplant.

I've done my own research and I have researched in-depth. I read the Tran/Pham papers at least 8 years ago when they were fresh.

You have some vocabulary and some vague references to studies but you don't have any real experts and you don't have any real documentation showing relapse after SVR.

You say: "I would suggest to anyone requiring immunosuppression (transplant or cancer pts) have their physician research..."

Well, I do require immunosuppression and I am SVR and I have been since 2004. And I did plenty of research and I disagree with you and so do the top notch hepatologists. S, I'll just go along naively and continue to live HCV free.

[medic54]

I stand by what I said. All you have to do is google HCV SVR OIC or hcv svr relapse...ignore the popular pages and read the long winded studies. The results and documentation is all there. Including the long standing critical test- the ability to infect the non infected (researchgate.net/publication/41011938 Occult hepatitis/file/ncbi.nlm.nih.gov/pubmed/21699630  this testing involved SVR patients of many years and they were able to extract evidence of not only HCV particles but of replication from either circulating blood, plasma or the lymph system over serial draws (serial draws are required as the levels are so low at times/days that not even NAAA testing can detect it)... but 100% of svr subjects did prove positive by NAAA. Also, the lymph fluid or plasma (forget which) was injected into chimpanzees who then displayed elevated liver enzymes consistent with new onset HCV. And what would your prominent doc's have to say about the cases of HCV/SVR that relapse one or two years later (all new infections I suppose). Then what about those previous SVR patients that relapse after immune depression (HIV, radiation therapy, transplant induced suppression)... while not common,  there are still many cases... a 'dead' or virus does not cause disease (hence the use of 'killed virus' vaccinations). Not saying SVR is not a huge positive step in ones health, it does certainly seem in practical terms a 'cure' of active disease. But blind faith in someone's word (whoever it is) is very naïve and I would suggest to anyone requiring immunosuppression (transplant or cancer pts) have their physician research (AND do some of your own!) which treatments/doses are/are not most associated to OCI relapse. I am SVR and have no incentive to demean it but OCI has proven in studies to be what it is. Why when so many virus infections dubbed resolved are in reality in suppression, do we not consider this possibility with HCV? Well studies are proving it factual now... in spite of prominent talking points.

[can-do-man]

If we dump all the "experts" that calls it a "cure" we would be looking at mainly GP's for treatment. Wouldn't that be scary?

[mikesimon]

"One thing is certain- no clinician should ever tell a patient he will never have to worry about his HCV again or is cured...."

You probably ought to inform the preeminent hepatologists in the world of that because the vast majority of them say that HCV is curable.

Here's just one "naive" hepatologist:

"....Course Description
Leading hepatologist and hepatitis C expert Gregory Everson, M.D. provides state-of-the-science information in Curing Hepatitis C -- a new book that outlines the latest treatment protocols that offer the outcome of complete cure from this disease.

In a breakthrough publication, leading hepatologist and hepatitis C expert Gregory Everson, M.D. provides state-of-the-science information to guide patients through the diagnosis and treatment of hepatitis C. Until recently, hepatitis C was considered incurable. Curing Hepatitis C: Current and Future Options for Treatment outlines the new treatment protocols that offer the outcome of complete cure from this disease...."

ABOUT THE AUTHOR
Gregory T. Everson, M.D., F.A.C.P., one of the country's leading hepatologists, is a Professor of Medicine and Director of Hepatology at the University of Colorado School of Medicine. Dr. Everson is a distinguished Fellow of the American College of Physicians and the American Gastroenterology Association.

Here's another:

For more on this rapidly changing landscape, we turned to Dr. Donald M. Jensen, director of the Center for Liver Diseases at University of Chicago Medicine and a noted hepatitis C researcher, with more than 100 peer-reviewed articles .

"Q: So this is good time to be a hepatitis C researcher?

A: Definitely. Before, we'd say a patient had a "sustained response." Now, we're comfortable with the "cure" word.

Here at the U. of C., we have initiated HCV CURE for patients who have been successfully cured of their hepatitis C in order for them to "pay it forward." We met a couple weeks ago with almost 40 patients and their family members to celebrate their cure status. They are being asked to help support patients now undergoing HCV treatment as well as advocating publicly for increased awareness and testing. To my knowledge, this is the first such organization ... in the U.S. I think that such a group of highly motivated — and thankful — individuals could play an important role by providing their individual stories and success."

http://articles.chicagotribune.com/2013-01-30/health/ct-x-0130-expert-jensen-20130130_1_boceprevir-hcv-new-drugs

I could go on and on and on but I'll stop here.

[medic54]

Ask your doc about Occult HCV, if the terms new to him/her.. get another doc.

[medic54]

In my opinion, you propose an interesting question and one clinicians can not accurately answer at this time (though it doesn't seem to stop most of them). One thing is certain- no clinician should ever tell a patient he will never have to worry about his HCV again or is cured. When compared to most known viral disease, HCV is still in a relatively early research stage. Many virus's lie in active dormancy in various tissue or in active suppression within the immune system. It would be quite naïve to think this not possible for HCV just because a blood test is unable to detect it down to 10 IU. Additionally- ask anyone over the age of 60 how many 'medical truths' have been proven 'untrue' in their lifetime.

[shnawer]

Genotype is 3b

[dustbear]

Hi there. My hepatologist said to get tested yearly for 5 years after completing tx. I have Hep C, 1A and halfway through tx.

[Dee1956]

Hello I am 16 months post tx and was told last month that I am considered cured.  I hope that is true and that there is no chance of the HCV coming back.  I was a genotype 1A and consider myself very lucky to have gotten to SVR
I hope someone will answer your question as well.
If there is concern for it coming back I would get the Qual test every year.
In my case, ly LFT's did not indicate how sick my liver was

Best of luck to you...Dee

[dontworry_behappy1]

What was your genotype? This will help others answer your question.

DWBH