When is infection considered chronic?
I've been reading the posts for a while, and would like to ask a question.
I'm 61 years old and positive for anti-HCV and anti-HBV. I was treated
for a bad case of Hep B in the early 1970's. They had not identified
HCV at that time.
My questions arose upon reading the following in a recent digest:
"The Third National Health and Nutrition Examination Survey (NHANES
III), conducted between 1988 and 1994, indicated that 1.8% of people
in the United States had been infected with hepatitis C virus (HCV),
70% of whom had chronic infection."
What determines the difference between "infected" and "chronic?"
Also, I wonder how often I should have ALT tested, and how far off the
normal range it needs to be before I get concerned.
I have had my current PCP for over a year. I told him I tested
positive for both Hep B & C a couple years ago, and that I got B from
IV drug use 35 years ago, but he doesn't think anything in particular
needs to be done about that. He is an internal medicine specialist
with my Humana Medicare HMO.
Any guidance you might provide would be appreciated.
Pam in San Antonio, Texas
- Hey Pam,
I'm in Grand Prairie, Texas, (the DFW area). Howdy neighbor! :)
I too have HBV and HCV.
First, if your doc says you need do nothing for the HBV, then the HBV isn't chronic. There are other tests that will tell you if you are chronic and you need to have them all, because it can be chronic in more ways than one.
Technically, to be chronic is to be ill, to feel the effects basically.
With HBV, you can have the antibodies and not be sick. The body fends it off like it would the flu or a cold, leaving the antibodies which tells us that it had been fought off, but does NOT tell us if it's "active" or "inactive" (which doctors usually use "chronic" for "active" and "not chronic" for "inactive". I know, it's not techy med stuff, but you get the picture I think). About 80% of the people who contract HBV fight it off and do not go chronic.
To determine whether your HBV is chronic, more tests must be done. You can look these up on the internet. I can't remember them all, but like the surface antigen (I think it's HBsAG, something like that) in my body is negative, therefore, not chronic. There are other antigens to test for.
However, with Hep C, it's a different story. 80% of the people who contract HCV go "chronic" or "active", that is, the body tries to fight it off and kill all the virus, but it can't, the virus mutates and replicates too fast for the body to keep up. So while we may have the antibodies, which says that we have fought (and probably are fighting) the virus, it does not tell us whether the virus is still around in the body.
A PCR test will tell you if the virus is active and how much of the virus is in the blood. It is measured either in the millions for one kind of test, in the thousands for another, so don't equate the two different measurements. I don't understand them except that they measure differently, one in "copies" and one in some kind of "standard units". Others here can explain that better than I can and it's online.
Once a PCR test is done and it's found to be active, it still doesn't tell you a thing about how your liver is doing nor how badly or long a person has had HCV.
A liver biopsy is the most reliable way to determine how damaged (or not) the liver actually is. It's accurate within about 20% (or rather the tech or gastro who analyzes it is :).
Nothing indicates whether you will get symptoms or side effects from the HCV. People with cirrhosis might not have any symptoms (until end stage of course) and people just beginning with the disease might have a multitude of side effects. My sides are fibromyalgia and chronic fatigue mostly, with a dash of migraines, occasional depression, and forgetfulness (we usually call brain fog).
Most sides can be treated or helped in some way. Usually taking good care of your body, especially your liver, is what most of us do as a common sense thing. Rest, low stress, excercise, eating well, etc. are the best basic things you can do for your body in any situation.
ALT/AST do tell us how stressed the liver is, but that can be caused by different things as well. I don't worry about my liver enzymes until they get near or past 100 because I take a lot of meds for different things, but mine stay pretty normal most of the time. Medication, stress, etc can also elevate enzymes. If your enzymes shoot up, or keep climbing over time, then I'd definitely see what could be done. (Course, I'm not a doc, it's just what I'd do.)
Sometimes "infected" and "chronic" are used interchangeably. Like I have a sinus infection, that means it's active right now, same with HCV. Very few people actually "kick" the virus, meaning they get infected (the virus enters their body), but the body fights it off and it's not "active" after that, meaning most of the virus is dead (we can always have a little bit of it or anything like cancer floating around in our body but it would be so low that the body keeps it under control and it's no big deal).
When an infection lasts longer than the normal time to be sick, say a common cold (why do they use that word "common"?) lasts about 2 weeks. If it hangs on for weeks and weeks, then it's probably a sinus infection or something like that and isn't gonna go away on it's own most likely. Then it could become seasonal sinusitis and the person is treating the thing every spring and fall (that's me LOL) for years and years.
When HCV lasts longer than, what is it, 6 months? (I'm trying to remember exactly so don't quote me.) Then it's called "chronic" whether the person actually feels sick or not. The virus is "active" in the body and the body cannot kill it fast enough to get it all.
The problem with HCV is that most people can't get rid of all the active virus and so we become chronic. They used to think that non A non B (now HCV) was only active when a person was sick, and dormant otherwise, but current thinking is that it's damaging our body when active (positive PCR) whether we feelt he results or not.
Sorry, that looks like a lot of stuff, but I hope it makes some sense. I'm paraphrasing a lot. Your gastroenterologist or Hep C specialist can tell you best about the details. Not all PCP's are up to date on current thinking. Knowledge on HCV changes quite rapidly with all the research going on and what I know today is probably even old hat now because I don't read as much of the research as I used to when I first learned about mine in '89.
Oh, and one last thing. I'd advise keeping a copy of all your tests. It's a good backup and as you learn about stuff, you'll understand the tests more. A doctor is just one person, they need all the help they can get :).
Have you determined your genotype?
Nice to meet you :)
Grand Prairie, TX
[Non-text portions of this message have been removed]
- Hi Pam,
Welcome! Alley seems to have answered much better than I could have.
I will reiterate one thing. If I were you, I'd get a referral to a GI or Hep C physician and have a liver biopsy done. Then you'll have a better understanding of where you are physically and what can be done about it.
I seem to be in a sort of stasis at this point. While I still have active HCV, my liver is regenerating on it's own steam. So, in order to keep that regeration going, I'm avoiding any more treatment. No point in stopping the blessing God gave me by shutting down my immune system.
>From: daxaeon <aeondax@...>
>Sent: May 21, 2006 4:04 PM
>Subject: [GIWorld-Hepatitis] When is infection considered chronic?
>I've been reading the posts for a while, and would like to ask a question.
>I'm 61 years old and positive for anti-HCV and anti-HBV. I was treated
>for a bad case of Hep B in the early 1970's. They had not identified
>HCV at that time.
>My questions arose upon reading the following in a recent digest:
>"The Third National Health and Nutrition Examination Survey (NHANES
>III), conducted between 1988 and 1994, indicated that 1.8% of people
>in the United States had been infected with hepatitis C virus (HCV),
>70% of whom had chronic infection."
>What determines the difference between "infected" and "chronic?"
>Also, I wonder how often I should have ALT tested, and how far off the
>normal range it needs to be before I get concerned.
>I have had my current PCP for over a year. I told him I tested
>positive for both Hep B & C a couple years ago, and that I got B from
>IV drug use 35 years ago, but he doesn't think anything in particular
>needs to be done about that. He is an internal medicine specialist
>with my Humana Medicare HMO.
>Any guidance you might provide would be appreciated.
>Pam in San Antonio, Texas
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