Re: Hepatitis C

Posted By HFHSM.D.-DM on July 25, 1998 at 17:09:21:

In Reply to: Hepatitis C  posted by John C. on July 22, 1998 at 17:51:20:






I am a 48yo male who has been diagnosed with Hepatitis C.  This was initially discovered when I had my gall bladder removed in Jan 98., and the surgeon discovered what appeared to be (and in fact was) cirosis of the liver.  This was confirmed by biopsy.
My doctor is recommending interferon therapy with the hope that it would retard, if not remove the hepatitis.  But, in view of the fact that I already have cronic (chronic) hepatitis C complicated by the cirosis, I am wondering if I would not just be wasting my time and money.  My wife is very strongly urging me to go ahead with it, but I would like another opinion.
Thank you.



  
Dear John C:
Your question is very complicated but it gives us an opportunity to discuss some of the complexities of treating individuals with hepatitis C.  You were diagnosed recently with hepatitis C and found to have cirrhosis on liver biopsy and you want to know if you should consider interferon.  You also imply that you might be paying for the medication yourself which is potentially a problem because it is very expensive.  The decision to use interferon is a decision you and you wife will have to make but what I can try to do is give you some information.  
First of all, well make some assumptions.  Lets assume that your liver disease is due to hepatitis C and that you do indeed have cirrhosis.  Lets also assume that you are a candidate for interferon.  This means that your platelet and white count are high enough to tolerate the therapy and that you dont have signs of decompensated liver disease or other contraindications.  Lets also assume that you are otherwise pretty healthy.  
Here are some considerations.  The likelihood of your being cured with interferon is less than 10%. There is a new form of therapy for hepatitis C using the combination of interferon and ribavirin (a pill) and this appears to be more effective than interferon alone but no one can say exactly what your chance of being cured is with the new therapy.  It is possible that interferon or the combination of interferon and ribavirin will slow your liver disease even if it doesnt cure you, but nobody knows if this is the case.  The government and hepatologists (liver specialists) are very interested in doing a study to see if treatment prevents the progression of liver disease in patients who are not cured but nobody at this time knows if this is the case.
Both interferon and the combination therapy have significant side effects that can be difficult to tolerate.  They include fatigue, flu-like symptoms and depression.  However, the symptoms typically get better with time, they can be treated and if worse comes to worse, the therapy can just be stopped.  Moreover, the treatment can be monitored so that it is usually safe even if it is unpleasant.  Both interferon and the combination therapy are expensive.  Interferon costs thousands of dollars and the combination therapy is even more expensive.  
Well now you have a lot to think about and no one else can tell you what to do.  There is no right answer.  At Henry Ford, we typically offer cirrhotic patients interferon unless it is contraindicated or inappropriate.  Most but not all patients consider it.  I note, however, that most of my patients have a prescription plan.  If you have to pay for the drug, it can be an even more difficult decision.   Sometimes, however, we can arrange for drug manufacturers to provide the drug for free on a compassionate basis.
I hope this information is helpful to you. If you have additional questions or concerns, I invite you to contact us at Henry Ford.  Our direct phone number is  [phone].   I would also encourage you to visit us at Henry Ford.  We have an active group of liver specialists and we have enormous interest in and experience with hepatitis C.  
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.