Cured of Hepatitis C: Is There Potential to Infect Others?
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Those lucky enough to be cured of Hepatitis C have much to celebrate, but remain unsure of what being cured actually means. Does ‘cured’ of Hepatitis C mean that all viral particles are 100 percent absent forever, or does it mean the virus has gone into remission? More importantly, does being cured completely eliminate all chances of infecting others in the case of blood-to-blood contact?
In general, we are more comfortable living in a world of absolutes than acknowledging several shades of grey. Unfortunately, the potential for infectivity following a Hepatitis C cure lies somewhere in the grey category. It would be easy to assume that being cured of Hepatitis C totally removes any likelihood of being infectious, but experts’ opinions on this matter vary.
In order to be declared by a physician as ‘cured of Hepatitis C,’ the person’s viral load must be non-detectable six months after the completion of treatment. Known as achieving a sustained virologic response (SVR), this is the goal of Hepatitis C therapy. There are earlier indicators that treatment is going well, such as:
- Rapid virologic response – undetectable Hepatitis C RNA one month into treatment
- Early virologic response – undetectable Hepatitis C RNA three months into treatment
- End-of-treatment response – undetectable Hepatitis C RNA at the end of treatment
Even if any of these earlier results of undetectable Hepatitis C occur, physicians only consider the patient cured if the virus is undetectable at six months post treatment. Many physicians believe that once SVR is attained, the person is cured of Hepatitis C – meaning they no longer harbor the virus and therefore pose no threat of transmitting the infection.
A physician who claims that SVR is absolute is Lynn E. Taylor, MD, FACP, AAHIVS – an HIV specialist focusing on prevention and care of HIV/viral hepatitis co-infection. Taylor is an assistant professor of medicine in the division of infectious diseases at Brown University, and attending physician at the Miriam Hospital in Providence, Rhode Island. According to Dr. Taylor, “Once a person has cleared Hepatitis C, either through treatment leading to cure, or spontaneously (without medication), the infection is gone. There is no virus to spread. The person is not contagious.”
The rare instance of a person testing positive for Hepatitis C RNA after attaining SVR is typically attributed to re-infection. Especially for individuals who partake in high risk activities, such as intravenous drug use or receiving a tattoo with a used needle, re-infection is possible because Hepatitis C’s antibodies do not protect against future infection. However, there is some evidence that Hepatitis C can recur – even after six months of undetectable virus post treatment. Such a recurrence would mean that exposure to their blood could potentially be a route of infection for someone else.
Emergin research refutes Dr. Taylor’s position. According to a study published in a May 2009 issue of the journal Hepatology, research led by Tomasz I. Michalak of Memorial University of Newfoundland, Canada found that trace quantities of Hepatitis C persisting in the circulation for a long time after therapeutically induced resolution can remain infectious.
As published in the October 2013 edition of The Journal of Infectious Diseases, American researchers found that the reappearance of Hepatitis C RNA years after an SVR can be from relapse of the initial viral infection rather than re-infection from a different virus. According to one of the study’s authors, Theo Heller, MD, chief of the translational hepatology unit at the Liver Diseases Branch of the National Institute of Diabetes & Digestive & Kidney Diseases at the NIH, “In a few people, Hepatitis C has found a sanctuary site and can remain dormant for a length of time. This is important both biologically and clinically, even in the approaching era of direct-acting antivirals, where relapse may still be a problem. We already know it can and does occur.”
Careful evaluation of the information available shows that the medical community is torn on declaring SVR to be an absolute cure that renders the person no longer infectious. Before sighing in frustration, it is important to remember that the era of improved Hepatitis C therapy has just begun – and it will be many more years before we can eliminate many Hepatitis C uncertainties. In the meantime, Dr. Melissa Palmer, MD, author and internationally-renowned hepatologist suggests the following three scenarios for a return of Hepatitis C after SVR:
- The original diagnosis of being cured after therapy was incorrect due to either inaccurate blood testing or miscommunication.
- There has been a re-infection with a new strain of Hepatitis C.
- Truly relapsing after years of being virus-free must be reported to your physicians in order to alert other physicians.
A relapse of Hepatitis C after SVR is extremely rare, but not unheard of. Because of this possibility, those who have been cured of Hepatitis C are urged to take precautions so as not to accidentally expose anyone to their blood. Until more is known to eliminate this gaping grey area of infectivity, it is advised to err on the side of caution and assume that even those who have been cured may still spread Hepatitis C.
[authorsure_author_box]Related Articles
http://forums.webmd.com/3/hepatitis-exchange/forum/495, Eradicated Hep C Still Dangerous?, Melissa Palmer, MD, Retrieved July 4, 2014, WebMD, LLC, 2014.
http://jid.oxfordjournals.org/content/early/2013/10/14/infdis.jit541.abstract, Sequence Analysis of the Hepatitis C Virus in Relapse after Sustained Virological Response: Relapse or Reinfection?, Koji Hara, et al, Retrieved July 4, 2014, The Journal of Infectious Disease, October 2013.
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/HCV_Neg.pdf, HCV Negative: A Guide for Healthy Living without Hepatitis C, Lucinda K. Porter, RN, Retrieved July 3, 2014, Hepatitis C Support Project, 2014.
http://www.healio.com/infectious-disease/hepatitis-resource-center-2013/late-relapse-after-svr-may-not-be-new-hcv-infection, Late relapse after SVR may not be new HCV infection, Retrieved July 4, 2014, Healio, 2014.
http://www.hepatitis.va.gov/provider/guidelines/2012HCV-definitions-of-response.asp, Definitions of Response, Retrieved July 4, 2014, US Department of Veteran Affairs, 2014.
http://www.medicalnewstoday.com/releases/148905.php, Patients With Resolved Hepatitis C Likely Still Contagious According To Study, Retrieved July 3, 2014, MediLexicon International Limited, 2014.
http://www.ncbi.nlm.nih.gov/, Hepatitis C virus persisting after clinically apparent sustained virological response to antiviral therapy retains infectivity in vitro, MacParland SA, et al, Retrieved July 3, 2014, Hepatology, May 2009.
http://www.thebody.com/Forums/AIDS/Hepatitis/Q232318.html, Hep C Infectious if Someone has “cleared” the infection?, Lynn Taylor, MD, FACP, Retrieved July 3, 2014, The Body, 2014.
38 Comments
thank you for this informative up-to-date article, but you dropped the ball at the end. Your advice to prevent infecting someone else with blood possibly still harboring hep c virus is obvious, what about the infection route of unprotected sexual co-mingling of genital organ fluids? In other words, if advising for no blood contact, then this would need to include no unprotected sexual contact, correct?
Actually, HCV is not efficiently transmitted from sex. Its complicated, but in HIV negative folks, its exceedingly rare. In a 2010 article from Hepatology, the authors combined a variety of studies that looked at heterosexual transmission in serodiscordant couples: They found no increased risk of infection even after an estimated 750,000 combined vaginal and anal sex acts, the probability of transmission was less than 1 in 10 million! This is not to say it can’t happen, its just exceedingly low risk. The real risk factor for sexual transmission of HCV is HIV status: HIV positive people are are greater risk of sexual exposure than are HIV negative.
I can tell you, as a heterosexual who has never used needles in any way shape or form, but had a boyfriend that did, hep c can be transmitted through sex. That is 100% the only possible way I could hVe contracted it. I contracted it when I was 18 years old and a drug user, BUTnever had I ever used needles. They terrified me. I’ve never had a transfusion, never gotten tattoos or anything else that is deemed a possible risk. The only possible way I could have contracted this was through heterosexual sex, plain and simple.
also, I don’t have HiV or any others diseases; and by the way, I thankfully have been cured of hepC as a result of harvoni treatments. Just wanted to address the misconception that it can’t be contracted through sex. It can.
Not to pry, but did you do cocaine back then? I know that some studies have show HCV potentially can be spread through intranasal cocaine use (sharing a straw or other sniffing implement with an infected person). I was diagnosed when I tried to give blood right after I turned 17 (in the late ’90s). I had never done any sort of drugs (not even smoked pot), had never had any type of sex at that point, had no transfusions, nor had any tattoos– essentially no risk factors. And we never figured out how I got it. So it’s possible that you didn’t get it through sexual contact. Anyway, luckily my viral load was low to start and I responded to the year long interferon/ribavrin treatment in 1999/2000. Undetectable 6 mos, 12 months, 2 years, 5 years and 10 years out (last time I remember being tested). Anyway, I’m glad that your treatment was successful, too!
Depending on hoiw old you are you could have gotten it at a doctor’s or Dentist’s office. Back in the day they were’t always as careful and I think there was a time when they didn’t use diposable syringes
Like the dentist that deliberately infected one of his patients with HIV.
Thank you. Any slight chance no matter how low it may be is still enough to possibly effect someone else’s life. Like yours and mine have been. Anyone with a spreadable disease should take all precautions to protect themselves from causing unwarrarented and unnecessary harm or changes to others. Everyone needs to practice safe sex and communicate honestly when there is any chance of effecting another persons way of life.
It is extremely rare to contract it trough sex. Before I discovered I had it, I usually had unprotected sex with my girlfriend for years. I was very concerned that I might have “given” it to her. Thank God all her blood tests always came back negative.
Dear Lindsey as an ex user I can assure you that there are other ways for a user to contract the virus.Many friends of mine,Heroin addicts never used needles but they got it by sniffing the stuff provided that they used the same rolled banknote which was blooded.So..
Ariel, my lay experience with HCV and in depth reading about this disease is that SVR along with normal heterosexual contact activity with otherwise healthy persons would not indicate “precautions” to prevent disease.
Personally, I’m a SVR patient and was intimate with a non- HCV partner not using “precautions” before and after cure. She is not positive for HCV.
Interesting, I have a SVR since May 2013. Was retested in April 2014; sustained SVR. Retest in June by GP. I had the virus since the time it was known as Hepatitis none A none B (1980). I married in 2000 and the wife has not contracted the virus to my knowledge. The treatment that I sustained a SVR was the Tri-treatment of Telaprevir, Peg-interferon and Ribavirin. I do have Cirrhosis now and I very am glad I have a SVR. I am under surveillance for Cirrhotic progression and Cancer. Recently, I was notified after a blood test that I tested positive for the Hepatitis C antibodies in one of the blood markers. I was told that this would be the case since I had the virus, but this would not affect my status of having a SVR. I have not read many articles that state the understanding of this “finding;” testing positive for Hepatitis C antibodies although having a SVR.
I just got done with the new medication Sovaldi I took it for 3 months with the pegInterferon & Ribavirin. A month into taken it I was non-detectable. I just had my labs done again and still no virus. I won’t say it was a cakewalk but to be honest it really wasn’t too bad. I know people who had to do the whole regime of the old meds that took a year and that was hell for them. I feel very grateful that my insurance paid for this very, very expensive drug. Good luck to anyone who is going through this or getting ready to. One last thought please don’t listen to all the hype of it being so painful cause I am here to tell you that at least in my case it wasn’t so.
Congrats, my Dr said not to make it sound trivial, but “anyone can do 12 weeks of interferon”. I have not made the jump yet, but again, CONGRATS.
Yes good advice not making it trivial but with that being said I am grateful I only had to do 3 months versus 1 year or even 6 months. It still had its really bad days but I got through it. thanks for the reply.
Congratulations for getting through it and getting to SVR. It is an accomplishment.
I can see where your doctor is coming from. When compared to 48 or even 72 weeks of hell.er.feeling like you have the flu.. 12 weeks is not as bad or as damaging. There is a newer drug coming out in the Fall that is supposed to be even easier. Thank God for that. I did 48 weeks of the “old” treatment, then 24 weeks with Incivek. A year after getting to SVR I was told I was cured. I hope they are right. I wish you the best.
I suspected I had something & started researching myself. My Dr. kept runnung yhe same test without considering anything else. Pretty much like holding a nail in 1 hand & hitting his hand with the hammer while looking elsewhere, wondering why he keot hitting his hand. Changed Dr.s & he got it right the first time. Refered to specialist & was really lucky to be in the first group to recieve Harvoni. 90 mg in combination with Sofosbuvir 400 mg. Felt better after a week with none of the most common side effects. Have a blood test coming up in March & Dr. appt. the following week. She has a positive outlook as my Hep C symptoms diminished quickly. I’m geno 1 A & my chances for cure using Harvoni are 100%.
I was one of the three per-trial patients for interferon, a prisoner was another and Ms. Judd the singer and I (at the time I worked in a hospital as a security Coordinator) I got through the horrific Throw-up every day, felt like a hangover side effects of Interferon in 2000. I had been told I had 6 months to live and no white blood cells. The patients that had worse diseases and injuries got me through this. There is always someone worse off then you as my belated Mom would say. It is worth you to do the Interferon and get it over with so you can go on and do what you were meant to do on this Earth.
What does it mean undetectable? is it undetectable in PCR test or HCV antibodies test negative or positive? If HCV (HCV antibodies) are negative please let me know……..i need it, i really need it.
Undetectable means under 200 virus equivalents per ml. This would apply to the HVC PCR quantitative test not the HEPC antibody test. If you’re this low, you’re generally considered clear. The antibody test would be a positive/negative result rather than “undetected”.
Hope this helps.
Its Means that its nondetectable in bloodstream
Mine was after 4 weeks of harvoni <15 uL/mL and BEFORE the treatment the count was 2.5 million uL/mL
I happen to be one of those people who has had a relapse after several years of testing”negative” and was deemed”cured”….a word I think shouldn’t even be mentioned for at latest 10 years into you testing beg for the virus. I was in one of the earlier (1998-2000) studies @ NIH and also did 8 months in a later study as well.
I first was told I was reinfected which turned out NOT to be true and was a misdiagnosis that had me questioning myself for over 2 years thinking about what type of risky behavior I or someone I had contact with had been involved in.
It turned out (when more testing was done on a blood sample taken during my first study in ’98) that I carry more than one genotype. I had first been found to have Geno 4. When the HCV reoccurred it showed Geno 1. It’s now been proven that I have both Genos 4 and 1
So currently half the time I test negatively and the rest of the time I test positive.
I’m one of those who Dr. Heller mentions in the article.
It’s frustrating because I don’t know if I will ever get rid of it m
Hep C is not the same as cancers and other diseases when it comes to remission/”cure”. Hepatitis C is in our blood until we die, we will have it, unless the new tx has proven after many years to put people in remission and keep them there. These drugs have been fast-tracked and not tested/studied as much as typical drugs. Even after being in remission, PLEASE get viral load and other tests every year or few years as doctor tells you. Good friend of mine was in remission 12 yrs., old treatment, but never got tested and died of liver cancer a month ago.
Please, a blood test every so often up against dying, is your choice.
Just because he had cancer 12 years later he still have been hep c free. Your chance of getting liver cancer after having hep c for some years is alot greater.
Because of the above final comment ,my husband who was cleared of hep.c. 18months ago has given the 6months undetectable and the 18months undettectable has now died and there has been a post mortem ,because he had been diagnosed with hep.c he is classed as high risk of infection and the undertakers will not allow me to see him in the chapel of rest. A beaurocratic piece of red tape so no-one can be sued. Once a leper always a leper. Disgusted that we went through the hell of the treatment ,to be still treated as if he was highly infectious.
I am so very sorry to hear of the death of your husband and they way you both are being treated now. So sorry. I believed my doctor after the first year of remaining SVR that it was gone. I do have to go back every year to be checked for liver cancer as there is a high prevalence of it for about 8 years after clearing but I can’t imagine what you are going through. In addition to everything else it is horrific.
If he is dead then everything living inside of him is dead unless he has HeLe cancer {tumours) these people are ignorant and clueless!
Does medicaid Pay for the hep c drug’s I to have been diagnosed with this disease of hepatitis c I will be going back to the doctor tomorrow I’ve been so depressed over this but it’s time to put my big girl Panties on now and face this Thanks Missy
Missy did you ever get your treatment from medicaid?
I was one of the approximately 20% that apparently self-cleared. I still don’t feel like I could cavalierly expose someone to my blood, but I wonder if that is different than someone cleared by medication.
Is this information still accurate? My doctor and multiple others have told me that if you spontaneously clear the virus that they are certain you are no longer infectious, putting it on their own career I believe he said. Which is it uncertain or not?
What about the people that spontaneously cleared Hep C?
Is it realy dat this medicine can cure hepatits…permanently
how i get cured
I hope you are right. I’m on a tablet at the moment, so I haven’t had a chance to check the author’s references. She very well could have pulled her “relapse” material from outdated studies. I’m 4 weeks into my Harvoni treatment and I’ve been trying to stay optimistic.
I really hope I am cured after this treatment, it would be a huge weight lifted off my shoulders. I got hep c several years ago from an ex, when we were doing drugs. I’ve since moved on from him and my past life, the only thing remaining was the hep c. I feel since I’ve had this disease, that it has prevented me from getting close to anyone again. I’ve stayed single because I’m fearful I could burden (infect) someone else. I just want to be cured and move on with my life.
Fellas i have a question , is it possible to have hep C for one year and still test negative antibody? just wondering because i had a needle prick used by hep C patient for over a year now and my body has changed so much that its obvious i have it my eyes and skin discolored though my LFT is still within range and ribcage pain when i stood straight for a while …… and am HIV negative so what do you guys think?
within me i know i have it right now my veins are so blue and transparent my skin has gone way lighter and normal