Re: Hep C

Posted By HFHSM.D.-DM on March 22, 1998 at 17:15:59:

In Reply to: Hep C posted by Shelley Ryan on March 14, 1998 at 11:25:20:








I was diagnosed one year ago with Hep C.  My liver biopsy showed no
damage and mild inflammation. My Alt's are statying in the high 80's.  My
GGT's are 435.  I also had an ERCP to make sure there was no blockage.
My symptoms are extreme fatigue and frequent migraines.  My doctor
feels that since my condition seems to mild that I should not start INF at
this time.  However I am hearing conflicting stories from other Hep C patients  where their doctors are saying to hit the Hep early and hard for
the best results.  I really need to know which approach is the best.  My
doctor told me the INF could cause more damage than good at this point.
One more question....these headaches are getting so frequent. I know the
medicince I take for them are not good for my liver.  I take fiorocet, and
sometimes firorocet with codeine when they get really bad.  I have also
started using Imetrex which works some of the time....right now I am into
day 3 of a really bad headache.  It has been suggested that the headaches are a result of toxins building up....that my liver is not filtering
properly.  Could this be the case?
Thank You so much for your help.
Shelley Ryan



_____
Dear Shelley Ryan:
I really appreciate your dilemna.   The decision on whether or not to take interferon is one of the most basic decisions patients with hepatitis C must make and I appreciate the opportunity to discuss it. To a large degree that decision is really up to you, the patient, and often there is no clear right or wrong answer.  I think you are seeing that in the conflicting information you are getting.    However, before you make the decision I think you should have a good understanding of the issues involved and a good, informative and trusting relationship with your physician.
One of the problems with interferon therapy is that it is not highly effective and in fact no more than 20% of patients can count on curing themselves of the hepatitis C virus with this medication.  Moreover, it is not a particularly easy medication to take.  Individuals have to inject themselves three times a weeks and there are lots of side effects that can make the drug unpleasant.  Patients develop fatigue, muscle aches, depression and irritability among other things.  Moreover, the current recommendations involve taking the drug for a year.  
On the flip side, there are arguments that can be made for trying interferon.  First of all a 15 to 20% chance of a cure is still significant .  Secondly, even though the drug can be unpleasant, we are able to monitor it so that it is rarely dangerous.  In addition, a lot of the side effects improve with time and most patients are able to work.  If  the drug becomes difficult to tolerate, you can simply stop it.  Finally it is true that interferon is less likely to work when the liver disease becomes more advanced.  While, I cannot comment specifically on your case, I find it fairly unlikely that interferon will make things worse.
Liver specialists understand the dilemna concerning the use of interferon.  Recently the US government sponsored a conference of Hepatologists from around the country to try to address some of these concerns (NIH Consensus Conference).  In a way, the Hepatologists at the conference suggested a compromise.  They suggested that if patients wanted to try interferon that they should receive three months and at the end of three months they should be tested for a response.  They suggested if patients were not responding at three months, that they stop the interferon.  They noted that if patients were responding, they should receive the full year of interferon but they would at least have the encouragement of knowing they were responding.  
I also appreciate your questions about your headaches.  Headaches would be an unusual symptom of hepatitis C and I tend not to think you headaches are a result of toxins building up that your liver cannot clear.  In fact, based on your description of your liver biopsy, it sounds like your liver should be working just fine.  I appreciate your concern about the use of fiorinal.  Fiorinal has acetaminophen (tylenol).  In large doses, acetaminophen can be bad for the liver especially if there is significant alcohol use.  Because you have hepatitis C, you would not want to take more than six fiorinal a day and you would probably want to do this for relatively short intervals.  
I hope this information is helpful to you.   It wold not be right for me to make specific recommendations to you without much more information and without meeting you.  If you anticipate being in Detroit, I would certainly invite you to see us.   At Henry Ford, we have an active group of liver specialists and we have enormous interest in and experience with hepatitis C.   I would encourage you to contact us at [phone].
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.