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 BigPat - Is The Virus
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IS THE VIRUS GONE?
So you've gone through treatment and you still test negative 6 months later. Is the virus really gone? Can you stop worrying? Researchers in this recent study examined the blood of randomly chosen patients who once had hep C and had either resolved it spontaneously (5 patients) or through treatment (11 patients). They tested the peripheral blood mononuclear cells and in some cases, the monocyte-derived dendritic cells, using a very sensitive test (RT-PCR-NAH) and by real-time RT-PCR. Their results showed that HCV RNA was carried in the convalescent-phase sera and/or PBMC in all 16 individuals investigated. Also, HCV RNA negative strand were found in most of the blood tested. This suggests that the virus is multiplying, even in samples from patients who tested negative 5 years after treatment. The results suggest that HCV can remain in the blood and lymphoid cells at very low levels and an intermediate replicative form of the virus can remain in the body many years after the apparent resolution of the virus. Source: Pham TN, et al, J Virol. 2004 Jun;78(11):5867-74. Hepatitis C virus persistence after spontaneous or treatment-induced resolution hepatitis C. (courtesy of: Sept 2004 hepc.bull - Canada's Hepatitis C News Bulletin) Hepatitis C Virus Persistence after Spontaneous or Treatment-Induced Resolution of Hepatitis C (the above cited trial, complete) Persistence of Virus Following Successful TherapySustained viral response to hepatitis C therapy is defined as an undetectable serum HCV-RNA 6 months after stopping treatment, regardless of the therapy used. This definition has become the cornerstone of hepatitis C treatment because its attainment has a significant impact upon both the patient and the treating physician. An important study was presented by Radkowski and colleagues[9] during these meeting proceedings that places into question our definition of response. They evaluated for the presence of hepatitis C viral RNA in either stimulated lymphocytes, cultured macrophages, or posttreatment liver biopsy samples from 17 sustained viral responders to combination interferon and ribavirin therapy. HCV-RNA was detectable in the macrophages of 11 (65%) patients and in the lymphocytes of 7 (41%) patients. Three patients had HCV-RNA detectable in liver tissue. Overall, only 2 of the 17 (12%) sustained viral responders were negative for the presence of HCV-RNA in all analyzed specimens. These
findings are important because they bring into question the current
definition of sustained viral response. These findings need to be
further evaluated in larger series because the persistence of virus may
have significant implications on future disease progression, disease
activation, disease transmission, and the development or persistence of
hepatic fibrosis. ( 9. Radkowski M, Jablonski J, Wilkinson J, et al. Persistence of hepatitis C virus in patients successfully treated for chronic hepatitis C. Hepatology. 2004;40:180A. [Abstract #41]) Is There a Cure?
Jules Levine, from NATAP, is questioning
the reliability of the study in the Jan.
2005 issue of Hepatology, where HCV was
found in cells of some complete responders
several years later. There have been many
contradictory findings, even with testing 10
years after SVR. Levine has spoken with
doctors and researchers, who agree that they
have not seen relapse in their patients, and
some are questioning the PCR techniques
involved in that study. Levine says, “I think
the bottom line is--do we see relapse years
after SVR is achieved? And the answer appears
to be no.” Levine goes on to cite the following articles: http://www.natap.org/2004/HCV/083004_06.htm
http://www.natap.org/2004/AASLD/aasld_20.htm http://www.natap.org/2004/AASLD/aasld_31.htm http://www.natap.org/1999/aug/longtermhist81799.html http://www.natap.org/2003/Jan/010803_1.htm http://www.natap.org/2002/may/050902_2.htm http://www.natap.org/2004/HCV/112204_02.htm Marcellin P, et
al, Ann Intern Med 1997 Nov
Source: Jules Levin, NATAP - http://www.natap.org
15;127(10):875-81. Studies Showing that HCV is Not Persistent & SVR is Durable (source: http://www.hepcbc.ca/bulletin/Oct2005.pdf) # # # Questions or comments,
email this webhead: # # # # EOF - End-Of-File # |
