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Gastroenterology (Expert Forum)
To Treat or Not Treat
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
To Treat or Not Treat
by JRS, May 31, 2004 12:00AM
I have been diagnosed with Hepatitus (hepatitis) C. Extremely elevated ALT/AST's 295/150. Type 1a genotype and 2,000,000 viral load. I am 54. Discovered HVC during a doctor's visit for check up. Probably had it for 25 to 30 years based on either intraveneous drug use in 1973 or a transfusion in early 80's. I have had a liver biopsy and my doctor indicated minimal liver damage which is good news I guess. I used to drink alcahol (alcohol) moderately before I was diagnosed and now abstain.
My doctor gave me three choices for management of the disease:
1. First choice: Have the combo interferon/pegesyas treatment for one year. Negative side of this is the possible adverse side affects. Also he indicated the interferon treatments available would have less than 40/50% chance of being affective at eradicating the virus because of length of time I've had it. He said If I could not handle knowing I have the disease without trying to rid myself of it than try the treatments.
2. Second choice: Lose weight (15/20 lbs), completely abstain from alcahol (alcohol), monitor with blood tests every 6 months. I am generally in good health and don't smoke. I amd not overweight (5'-9" 175 lb's) in appearance and have good muscle tone for my age but ultrasound showed fatty deposits around liver and pancreas. I do exercise (probably not enough), eat well and am taking recommended supplements for liver health. He says any amount of weight loss where fat will be eliminated supposedly will improve my condition. Also, my doctor says by holding off the treatments available today for a couple of years there will likely be treatments available in the near future with less side affects and offer better results for my condition and length of time I've had the Hep C.
3. Third choice is to try the interferon treatment and see how I react. Continue it if I can tolerate it or discontinue if I can't. I am a business owner and would be devestated finacially if I were to be incapacitated.
I had no recognizable symtoms before being diagnosed. Now I am blaming every ache or pain I get as probably the Hep C. I am on Wellbutrin perscribed by my general practitioner for depression. He is reluctant to take me off of them because of the Hep C and other factors.
My Hep C doctor also has me scheduled for a colonoscopy soon. I had one three years ago where a couple of polyps were removed. Why would he want a colonoscopy and is it related to the Hep C?
Finally, do you think I am getting adequate advice? I do, but want to be sure.
I am sorry for such a long story. I hope you can educate me more.
My doctor gave me three choices for management of the disease:
1. First choice: Have the combo interferon/pegesyas treatment for one year. Negative side of this is the possible adverse side affects. Also he indicated the interferon treatments available would have less than 40/50% chance of being affective at eradicating the virus because of length of time I've had it. He said If I could not handle knowing I have the disease without trying to rid myself of it than try the treatments.
2. Second choice: Lose weight (15/20 lbs), completely abstain from alcahol (alcohol), monitor with blood tests every 6 months. I am generally in good health and don't smoke. I amd not overweight (5'-9" 175 lb's) in appearance and have good muscle tone for my age but ultrasound showed fatty deposits around liver and pancreas. I do exercise (probably not enough), eat well and am taking recommended supplements for liver health. He says any amount of weight loss where fat will be eliminated supposedly will improve my condition. Also, my doctor says by holding off the treatments available today for a couple of years there will likely be treatments available in the near future with less side affects and offer better results for my condition and length of time I've had the Hep C.
3. Third choice is to try the interferon treatment and see how I react. Continue it if I can tolerate it or discontinue if I can't. I am a business owner and would be devestated finacially if I were to be incapacitated.
I had no recognizable symtoms before being diagnosed. Now I am blaming every ache or pain I get as probably the Hep C. I am on Wellbutrin perscribed by my general practitioner for depression. He is reluctant to take me off of them because of the Hep C and other factors.
My Hep C doctor also has me scheduled for a colonoscopy soon. I had one three years ago where a couple of polyps were removed. Why would he want a colonoscopy and is it related to the Hep C?
Finally, do you think I am getting adequate advice? I do, but want to be sure.
I am sorry for such a long story. I hope you can educate me more.
Doctor's Answer
by Kevin Pho, MD, Jun 02, 2004 12:00AM
, Jun 02, 2004 12:00AM
There are no absolute answers to this problem. I believe your physician has outlined reasonable options. As a general rule, patients who are considered for treatment should have histologic and virologic evidence of chronic infection (ie, HCV RNA detectable in serum) and an elevated serum ALT. This is clearly your case. It would not be unreasonable to consider therapy.
Patients with viral genotype 1 respond less well to interferon alone or in combination with ribavirin than those with genotypes 2 or 3. Similar to HCV RNA levels, the viral genotype may be important for guiding the duration of therapy. Again, as your physician has mentioned, the genotype would reduce the chance the therapy has to be effective.
If it were up to me, I would suggest option 1. You may consider another GI opinion if you are not comfortable with these suggestions.
Regarding the colonoscopy, to my knowledge this may due to routine screening that should be done in all adults over the age of 50.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Bibliography:
Chopra. Treatment of chronic hepatitis C virus infection: Recommendations. UptoDate, 2004.
Patients with viral genotype 1 respond less well to interferon alone or in combination with ribavirin than those with genotypes 2 or 3. Similar to HCV RNA levels, the viral genotype may be important for guiding the duration of therapy. Again, as your physician has mentioned, the genotype would reduce the chance the therapy has to be effective.
If it were up to me, I would suggest option 1. You may consider another GI opinion if you are not comfortable with these suggestions.
Regarding the colonoscopy, to my knowledge this may due to routine screening that should be done in all adults over the age of 50.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Bibliography:
Chopra. Treatment of chronic hepatitis C virus infection: Recommendations. UptoDate, 2004.
