Hep C Discussion Forum

I didn't want to "read" that online Wiley stuff, but didn't have the common sense to stay away. I used those quotation marks because when you don't understand more than 30% of words in any given sentence, it's probably not what youre doing. But I did get the bit about the virus still being detectable after nine years in most guinea pigs. That made me sad until I read Pablo's take on it. And  yes, once a zap was added I knew Dave's tin foil hat, Jimmy's  I'll take that thanks and look here's what it goes with stuff and Tig's wry commentary would all come rolling in. 

Predictable = funny = safe.

What would we do without you all? 

Syd 

Good thing you live by the sea.

LOL, I knew that with ZAP in the picture it wouldn't take long for Jimmy to chime in.

Zap would be a great name for it though. Ads would say "Zap the Dragon" ... as a big bolt of lightning strikes the beast.

... don't know about you but I'm wearin' my tinfoil hat if I take it.

D

Tig56 wrote:

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That ZAP stuff, that's the ticket! At least we have a name for it when it's developed... 

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 Copyright Infringement!

Zap! has been around since 1968.

That ZAP stuff, that's the ticket! At least we have a name for it when it's developed... 

Based on the article:

"This continuous presence of HCV RNA could explain the phenomenon of relatively common persistence of humoral and cellular immunity for many years after supposed viral clearance and could present a potential risk for transmission or infection reactivation."

It would then be dependent on how long active virus can remain hidden. Does SVR ever mean complete absence of HCV RNA? If we're to believe the research, then no, it doesn't. I do think that the longer an individual maintains SVR, the likelihood of relapse (reactivation) remains low (<.5%). At least that's the anecdotal evidence I keep reading about. We haven't witnessed the number of successes we are now. So I think in the decade or two to come, we'll have the opportunity to collect the data that will provide the answer. By then, treatment will have improved so much, this will probably be a mute point. I don't think we're far off now.

In the meantime, like Pablo, I'm not going to worry about it

Interesting read indeed.

I must profess I find the whole topic confusing despite having read widely around the issues and having had it explained to me by doctors.

Why do a small percentage of people relapse after treatment when nearly everybody becomes UND at some point during DAA treatment?  

The most cogent theory is that small amounts of HCV persist below the cut-point and that UND is not no viral RNA present but, moreover, a small amount of RNA may still exist below the cut-off.   But then, confusingly, we get the scenario wherein a small percentage of people who are not UND at the end of treatment go on the achieve SVR.  The thinking being that the remaining RNA are mutations without the ability to replicate properly and die off over time.  But then we also know that that relapses are caused by resistance associated variations.  So it seems that some mutations can replicate and others not.

Then you have the issue that only 65% of people improve their fibrosis score after achieving SVR with the remaining 35% being split fairly evenly between no improvement and a worsening of fibrosis. Surely one would expect nearly everyone to improve after SVR?  Is it the case that, as per the linked paper below, that some viral RNA persists in some people's livers and therefore they don't improve despite their plasma being UND?

My brain begins to hurt when I think about these things!  I think the bottom line is that the science isn't fully understood around this yet.  So I am going to keep things simple:

-95% of people achieve SVR with DAAs;

-for the 5% of so who don't achieve SVR then a second, or even third, round of treatment with a different combo of DAAs for a longer period will work;

- the majority majority of people who achieve SVR will improve in terms of fibrosis;

- I'm going to take charge of the things that I can to keep my liver in good nick, e.g. not drinking alcohol;

- I will leave the speculation around what UND really means and whether the virus persists in a low grade form to the scientists, and not worry myself unduly about things I have no control over; for I know my own mind and I can work myself into a tizzy about such matters.

Amen.

Pablo

Skewed,

Interesting (from 2005), but still .... good topic. Would have to search to see what else is "out there" on this topic (with the new daa's) and not just this one (from the old interferon days as you noted). Found persisting, 9 years! - interesting.

Mallani made mention of this (being in lymphocytes) and kind of on the side, another further conversation ensued about any possibility of fluctuating VL's coinciding/corresponding with with lymphocytes numbers. (See - "General Discussion - RE: Lymphocytes? (like Mallani said)!?".

 C.