Treatment Questions § MORE!!!

[hcin200111]

Hello. I am 47 years old and I'm assuming I contracted HEP C from a blood transfusion in 1978 due to a miscarriage. So I would have had HEP C for 27 years without any symptoms that I am aware of. I found out about 6 months ago from a routine blood test. Needless to say, I went through all the emotions, of course, first which was denial, fear, anger, etc. Now I'm ready to really try and figure out what I need to do. I had all tests so far, EXCEPT biopsy which I'm trying to decide if I should.

I am genotype 1b with viral load over 2 million IU or 5.4 million copies/ml; which on some charts is medium and some charts is high, which is it medium or high? My blood tests are all normal from ALT 28, AST 24 to CBC w/white blood cell count, billirubin, alkaline phosphate, AFP, etc. Also had ultrasound of liver, kidneys, spleen, aorta (ultrasound of abodomen) which is also unremarkable (meaning no abnormalities from what they can see from ultrasound anyway). Can they see if I have cirrohsis? Fibrosis? Can you tell from ultrasound and/or blood tests?

Since all blood tests, ultrasound, etc are normal, do I need a biopsy YET? And if I do have a biopsy w/zero to mild damage do I treat? And if I have ALOT of damage should I treat and what are chances of responding to treatment w/my genotype and viral load? and which treatment is best?

Also, anyone w/1b genotype and high viral load...can you tell me about response, what treatment you did, sides, and results? I'm 1b w/viral load, which I got two ways 5.4 million copies or 2.2 million IU's. Thanks in advance for your information.

[Kevin Pho, MD]

To answer your questions:
1) Cirrhosis is diagnosed via a biopsy.  It can only be implied with an imaging test.

2) A liver biopsy is not necessary for the diagnosis of HCV. However, most patients undergo liver biopsy prior to treatment of chronic HCV infection to determine stage and prognosis.  

3) The decision to treat patients with chronic hepatitis C infection is based upon several factors, including the natural history and stage of the disease and the efficacy and adverse effects related to therapy. As a general rule, patients who are considered for treatment should have histologic (i.e. via biopsy) and virologic evidence of chronic infection (ie, HCV RNA detectable in serum) and an elevated serum ALT.

Currently, most patients are treated with a combination of medications known as pegylated interferon and ribavirin.  You may want to discuss these options with your physician.

I would suggest visiting our Hepatitis forum for more patient support.  

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.

Thanks,
Kevin, M.D.

Bibliography:
Chopra.  Diagnostic approach to hepatitis C virus infection.  UptoDate, 2004.

[Caroline5]

You should have a biopsy as it is the only way to tell for sure if there has been liver damage. If you have little or no damage and you've had this disease for many years, you can decide to wait for treatments to get better/easier.