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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19686

  • GT2
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Hi Serg

I agree to respectively disagree with the likes of Roy M Poses about his extreme views on EBM.

There are always extremist views within any given profession and a tsunami of data on any given subject.

The trick is to separate the wheat from the chaff.

I wish you the best in deciding on the appropriate HCV treatment for your circumstances based on an acceptable degree of confidence according to your criteria.

GT2
1983: Hospitalised with Acute non-A, non-B Hepatitis after ICU blood transfusion 3mths earlier => HCV GT2
22/02/16: (pre-tmt) ALT 61, VL 2.48 IU/ml Hepascore 0.32 (F1/2), fatigue, brain fog, bloating (Treatment Naïve)
10/04/16: (Start tmt) Sofovir +DaclaHep (SOF + DCV) by Hetero Labs in India
09/05/16: ALT 34, VL: NOT Detected :cheer: :) , FBG 11.9 :huh:
17/6/16 FBG 5.7; PPBG (@14.22) 6.9 (@ 20.45) 7.1; BP 124/72
:) (Accu-Chek Mobile & Omron Auto BP Monitor) :)
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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19690

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www.openhealthnews.com/story/2015-01-18/...is-c-drug-treatments
Above was written in Jan of 2015
www.ncbi.nlm.nih.gov/pmc/articles/PMC415836/ This one was written in 2004. Got to disagree here.
Genotype 1A
ALT 473
AST 226
Virus Load 3,119,030
Results as of May-2016
5 week viral load/undetected as of 12/02/2016
Liver Biopsy Results from Feb 2013
Portal/Periportal chronic inflammation and mild interface hepatitis (Grade 2)
Focal Lobular chronic inflammation (Grade 1)
Portal/Periportal fibrosis (stage 1-2 trichrome and reticulin stains utilized)
Negative Iron stains.
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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19693

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Well, arguing about SVR as being a cure or not for HCV, reminded me the following joke from several years ago when the bird flu was a hot topic:

In a certain small village people were asked to sacrifice all of their chickens in order to prevent the spread of the bird flu.
Some did so, some did not. One of those people who did not sacrificed his chickens was asked:
-Q: "Why did not you sacrifice your chickens?"
-A: "Well, I was not sure (aka I have no solid evidence) whether the living creatures from my yard are really chickens, no veterinarian came to me to confirm me that it is really chickens"


Going back to the topic of cure or not, there are various debates that related to treating HCV, it is questionable to discuss about "cure" or SVR, because literally, "cure" implies that the virus is gone and the liver returns to the normal status (no fibrosis). As long as after reaching SVR the fibrosis is/will be reduced, but is not completely vanished, "cure" might be perhaps too much for some peope. So SVR seems to be a more accurate term.

No matter whether we talk about SVR or cure or whether some small HCV RNAs exists somewhere in small quantities, as long as there will be no more "destruction force" against the liver, I can live very fine with SVR12/SVR24,SVR48, or any other "N" number you put after SVR as long as N>=12 :).

Cheers,
RHF
In fiecare an HCV ucide peste 500000 oameni.Medicamentele generice pentru hepatita C functioneaza. Nu deveni statistica! Cauta pe Google “medicamente generice pentru hepatita C”.
HCV kills more than 500000 people every year. HCV generic drugs work. Don't become a statistic.
By sharing this Youtube video you might save someone’s life!
My TX: HEPCVIR-L[generic Harvoni]-India
SVR52 achieved
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Reduction of liver fibrosis without antiviral treatmen 6 years 2 months ago #19694

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Thanks RHF, excellent points that got me thinking about other diseases that are often considered curable or cured. So I googled the definition of "cure" and found the following. :lol: :lol: :lol:

“When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.”

― Lewis Carroll, Through the Looking Glass

G3a since '78 - Dx '12 - F4 (2xHCC)
24wk Tx - PEG/Riba/Dac 2013 relapsed
24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 - 22/06/17 UND
SRV12 - 27/07/17 UND
SVR24 - 26/10/17 UND
:cheer: :cheer: :cheer:
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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19695

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"The question is," said Alice, "whether you can make words mean so many different things."

"The question is," said Humpty Dumpty, "which is to be master—that's all."

Humpty appears in Lewis Carroll's Through the Looking-Glass (1872), where he discusses semantics and pragmatics with Alice

:)
1983: Hospitalised with Acute non-A, non-B Hepatitis after ICU blood transfusion 3mths earlier => HCV GT2
22/02/16: (pre-tmt) ALT 61, VL 2.48 IU/ml Hepascore 0.32 (F1/2), fatigue, brain fog, bloating (Treatment Naïve)
10/04/16: (Start tmt) Sofovir +DaclaHep (SOF + DCV) by Hetero Labs in India
09/05/16: ALT 34, VL: NOT Detected :cheer: :) , FBG 11.9 :huh:
17/6/16 FBG 5.7; PPBG (@14.22) 6.9 (@ 20.45) 7.1; BP 124/72
:) (Accu-Chek Mobile & Omron Auto BP Monitor) :)

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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19701

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Hi, Gaj!

I am glad to see that you as a F4 are considering starting treatment this year though, that is not a decision that should be put off indefinitely.

Thanks. Yes, agree, it seems, for me, it is better try to undergo modern treatment with compensated F4.
Probably infected in 1977
2005 - diagnosed with HCV 1b, compensated F4, 15 mln viral load, ALT 320
2005-2006 - PegIFN/rib 48 weeks treatment, relapse
2016 - compensated F4, MELD 8-9, ALT 100-160
2018 - compensated F4, MELD 8, ALT 91

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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19702

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Hi GT2!

I agree to respectively disagree with the likes of Roy M Poses about his extreme views on EBM.

I dont think that he has unusual "extreme" EBM views... His views looks like "standard" (but yes, strict) EBM views for me. Something like this: "New medication must prove its effectiveness in properly done randomized trials.If not, then we cannot be 100% sure whether benefits outweigh harm or not, whether drug do more good than harm or not." According to EBM metodology, lacking of properly done randomized trials leads to uncertainty about effectiveness of drug.

Rather, HCV infection looks like extreme example of "slow progressing" condition. Such "slow" character of HCV infection seriosly complicates performing of randomized trials (which required according to EBM).

Really, Roy M Poses is not against HCV treatment "at all" in current situation, in his blog he wrote that treatment should be individualized.

I wish you the best in deciding on the appropriate HCV treatment for your circumstances based on an acceptable degree of confidence according to your criteria.

Thank you. I wish you to achieve SVR with your therapy.
Probably infected in 1977
2005 - diagnosed with HCV 1b, compensated F4, 15 mln viral load, ALT 320
2005-2006 - PegIFN/rib 48 weeks treatment, relapse
2016 - compensated F4, MELD 8-9, ALT 100-160
2018 - compensated F4, MELD 8, ALT 91
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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19703

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Hi, rohcvfighter!

"cure" implies that the virus is gone and the liver returns to the normal status (no fibrosis).

Yes, often "cure" implies that the virus is gone completely. But normal status of liver is "no cirrhosis". Liver fibrosis itself is not a disease, and many healthy people have liver fibrosis without history of having hepatitis virus. Really, we cannot be completely sure that "virus is gone completely", because we cannot exclude possibility of "occult" hepatitis, which is not detected by current conventional PCR blood test.

No matter whether we talk about SVR or cure or whether some small HCV RNAs exists somewhere in small quantities, as long as there will be no more "destruction force" against the liver, I can live very fine with SVR12/SVR24,SVR48

"Occult" hepatitis due to small quantities of HCV RNAs is not well-studied - hence, we cannot be completely sure that such possible kind of hepatitis is not a "destructive force"... Also, damaging of liver, caused by HCV, does not depends on viral load. We may have low viral load (for example, 200 copies per ml) and fast fibrosis progression, or we may have 10 millions per ml and no fibrosis progression during many years. Hence, if we will have, for example, 0.5 copies per ml after SVR, which are not detected by current conventional PCR test - we cannot 100% confidently predict possibility/rate of fibrosis progression. In anyway, SVR looks like a good prognostic sign and i wish you to achieve SVR with your therapy!
Probably infected in 1977
2005 - diagnosed with HCV 1b, compensated F4, 15 mln viral load, ALT 320
2005-2006 - PegIFN/rib 48 weeks treatment, relapse
2016 - compensated F4, MELD 8-9, ALT 100-160
2018 - compensated F4, MELD 8, ALT 91

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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19704

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1983: Hospitalised with Acute non-A, non-B Hepatitis after ICU blood transfusion 3mths earlier => HCV GT2
22/02/16: (pre-tmt) ALT 61, VL 2.48 IU/ml Hepascore 0.32 (F1/2), fatigue, brain fog, bloating (Treatment Naïve)
10/04/16: (Start tmt) Sofovir +DaclaHep (SOF + DCV) by Hetero Labs in India
09/05/16: ALT 34, VL: NOT Detected :cheer: :) , FBG 11.9 :huh:
17/6/16 FBG 5.7; PPBG (@14.22) 6.9 (@ 20.45) 7.1; BP 124/72
:) (Accu-Chek Mobile & Omron Auto BP Monitor) :)
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Last edit: by GT2. Reason: Semantics

Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19706

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:)

If i correctly understand, it may be possible another interesting thing with semantics. If majority of HCV-infected people will not develop cirrhosis and complications of cirrhosis, extrahepatic manifestations during lifetime without treatment - then, HCV infection is not a "disease" for these majority of people. Hence, really, they are "healthy" people, despite they are infected. The "treatment", for many people, really, is "prophylaxis" of "diseases" (cirrhosis/extrahepatic manifestation) in a "healthy" person.
Probably infected in 1977
2005 - diagnosed with HCV 1b, compensated F4, 15 mln viral load, ALT 320
2005-2006 - PegIFN/rib 48 weeks treatment, relapse
2016 - compensated F4, MELD 8-9, ALT 100-160
2018 - compensated F4, MELD 8, ALT 91

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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19707

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No.

- Hepatitis C is the disease.

- Cirrhosis/extrahepatitic manifestations are symptoms.

- it is possible to have a disease without displaying obvious symptoms.

I'm sorry but if you believe otherwise it is not semantics but misunderstanding.
G3a since '78 - Dx '12 - F4 (2xHCC)
24wk Tx - PEG/Riba/Dac 2013 relapsed
24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 - 22/06/17 UND
SRV12 - 27/07/17 UND
SVR24 - 26/10/17 UND
:cheer: :cheer: :cheer:
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Last edit: by Gaj.

Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19708

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I disagree. If i correctly understand, term "disease" implies, that there are symptoms of disease or these symptoms will definitely occur in future. If there are no symptoms and symptoms will not occur in future, during lifetime - what is the reason to define this situation as a "disease"?
Probably infected in 1977
2005 - diagnosed with HCV 1b, compensated F4, 15 mln viral load, ALT 320
2005-2006 - PegIFN/rib 48 weeks treatment, relapse
2016 - compensated F4, MELD 8-9, ALT 100-160
2018 - compensated F4, MELD 8, ALT 91

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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19709

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P.S. I agree with your statements - "cirrhosis/extrahepatitic manifestations are symptoms", and "it is possible to have a disease without displaying obvious symptoms".
Probably infected in 1977
2005 - diagnosed with HCV 1b, compensated F4, 15 mln viral load, ALT 320
2005-2006 - PegIFN/rib 48 weeks treatment, relapse
2016 - compensated F4, MELD 8-9, ALT 100-160
2018 - compensated F4, MELD 8, ALT 91

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Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19710

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Symptoms such as cirrhosis, etc. are subjective indications or signs of disease. They may or may not be present now or in the future and may or may not be due to a particular disease.

On the other hand a disease such as HCV can be defined by objective means such as a PCR test.
G3a since '78 - Dx '12 - F4 (2xHCC)
24wk Tx - PEG/Riba/Dac 2013 relapsed
24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 - 22/06/17 UND
SRV12 - 27/07/17 UND
SVR24 - 26/10/17 UND
:cheer: :cheer: :cheer:
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Last edit: by Gaj.

Reduction of liver fibrosis without antiviral treatment 6 years 2 months ago #19711

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I can be positive with TTW or hepatitis G viruses by PCR test, for example. But this does not mean that i have a "disease", because such viruses will not cause symptoms for me (like cirrhosis). Analogically, if HCV will not cause symptoms for me - what is the reason to define such situation as a "disease"? Of course, for such proportion of patients, who will develop cirrhosis/extrahepatic manifestations during lifetime - HCV is a disease. But many infected people will not develop symptoms.
Probably infected in 1977
2005 - diagnosed with HCV 1b, compensated F4, 15 mln viral load, ALT 320
2005-2006 - PegIFN/rib 48 weeks treatment, relapse
2016 - compensated F4, MELD 8-9, ALT 100-160
2018 - compensated F4, MELD 8, ALT 91

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