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Medical Forum / Diseases and Disorders / Hepatitis / October 2007"Normal" Strangeness...
I'm a few days from 5 months into Tx. Q#1: I think I damn well know the answer but is it normal to feel "normal" in pulses between long stretches of strangeness? Q#2: Also I went to this link http://www.hepatitisdoctor.com/ provided in someone's post here and I read that 1a's have a c.30% chance of relapse even with SVR at 12 weeks so how "true" is that? ~ Alex >I'm a few days from 5 months into Tx. > [quoted text clipped - 6 lines] > >~ Alex "Normal" being relative to a prevailing sense of being hammered into a small lump of flesh? Sure - you can have good hours, good days, even good weeks if you're lucky. But there is no "SVR at 12 weeks". SVR means "sustained viral response" - the key word is "sustained". SVR is only applicable a minimum of six months *after completion of therapy* and if viral load tests at that time do not detect any virions. With the current standard treatment, g1s need an average of 48 weeks to have a decent chance of obtaining SVR. And "decent" is still under 50%... fwiw: RVR - "Rapid Viral Response" - which usually means clearing the virus *from the bloodstream* roughly 4 weeks after beginning therapy. Associated with "super responders", this is the gold ring wrt the odds of SVR. EVR - "Early Viral Response" - usually means a significant (at least two log) drop in viral load within 12 weeks of beginning therapy. Finally, NR: "non-responder" - means the level of viral load drop under treatment is not substantial enough to have a reasonable chance of SVR. That would be under 2log drop by the end of the 12th week. Cheers /greyhackles > SVR means "sustained viral response" - the key word is "sustained". SVR is > only applicable a minimum of six months *after completion of therapy* and if [quoted text clipped - 15 lines] > treatment is not substantial enough to have a reasonable chance of SVR. That > would be under 2log drop by the end of the 12th week. Yep, just what I meant to say... uh... sure. Thanks for the correction!! Wish ya could improve the odds........... >> SVR means "sustained viral response" - the key word is "sustained". SVR is >> only applicable a minimum of six months *after completion of therapy* and if [quoted text clipped - 21 lines] > >Wish ya could improve the odds........... Don't we all. Unfortunately, to this point, the best that could be done is to close the gap between "testing clear" and failing to achieve SVR, by redefining the "testing clear" part. It occurred to me this morning that what you were probably asking was something to the effect of "if the patient is clear at 12 weeks how can he still relapse after completing treatment?" And that's a good question. The problem is in testing for "free-floating" virions in the blood stream while the location of the viral replication "factories" is in the liver. Considering all the products of the IFN-stimulated immune system are in the blood stream, it isn't unreasonable to expect said blood will appear "cleaner" than the infected liver tissue might. But we don't do routine biopsies to do viral load testing - for obvious safety reasons. Hence there is that disconnect between test procedures and the actual state of infection. VL tests are thus reduced to "inference", which is rarely 100% accurate, leaving plenty of room to appear "clear" even while some viral replication factories remain. Something Dr. Cecil speculates on might be a major contributor to this uncertainty: it seems to have a relationship to the level of liver damage present. Perhaps the virus can "hide" in the scar tissue, being less vascularized than normal liver structure which in turn makes it less likely that the immune system components floating along in the blood stream can come in contact. The same techniques that have been used to declare that there is an "occult HCV infection" syndrome in a few studies ought to be tested to see if there is a clinical use to help break down that level of disconnect between the currently used VL test techniques and the actual state of infection. I haven't looked into these techniques - which often claim to have found virions within PBMCs (peripheral blood mononuclear cells) while standard VL tests show "clear" - though I've often wondered what exactly is being tested in a "normal" VL test if it misses virions in PBMCs. Clearly they don't put whole blood into a Cuisinart and test the resulting goo ;-) Cheers /greyhackles > But we don't do routine biopsies to do viral load testing - for obvious safety > reasons. Hence there is that disconnect between test procedures and the > actual state of infection. VL tests are thus reduced to "inference", which is > rarely 100% accurate, leaving plenty of room to appear "clear" even while some > viral replication factories remain. > Clearly they don't put > whole blood into a Cuisinart and test the resulting goo ;-) Thanks again for your ever-wise yet humorus advice and information!! Gonna print this out and take it to my next TxTeam visit... |
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