Treatment of Hepatitus(hepatitis) C

[Pegy]

  I was diagnosed with chronic Hepatitus (hepatitis) C two years ago when I developed jaundice and edema. I don't know the origin or how long I have had it. I am currently doing quite well, experiencing fairly constant discomfort on the right side and pretty significant exhaustion, but little swelling or discoloration. I am under the care of a doctor at Emory University Hospital in Atlanta.  He tells me that I am not a candidate for any treatment protocol (such as interferon) because of my bloodwork, but I am not clear on why,exactly. I would very much appreciate any further clarification you can give on various treatment options and how I can be sure I am receiving the care I need to have the best possible chance of recovery from this disease or, if that is not possible, at least the longest and best life with it.
  My latest bloodwork shows:  CHEM 18: All results within normal range. Glucose 96, Urea Nitrogen (BUN)10, Creatinine 0.6, Sodium 138, Potassium 5.0, Chloride 106, Carbon Dioxide 26, Calcium 9.4, Phosphorus, Inorganic 3.4, Protein, Total 6.9, Albumim 4.2, Bilirubin, Total 1.2, Alkaline Phosphatase 67, LDH, Total 125, AST(SGOT) 28, Uric Acid 4.2, Triglycerides 48, Cholesterol, Total 142
  CBC:  White Blood Cell Count 4.2, Red Blood Cell Count 3.64, Hemoglobin 12.2, Hematocrit 34.1, MCV 93.6, MCH 33.6, MCHC 35.8, RDW 14.1, Platelet Count 94, Absolute Neutrophils 2478, Neutrophils 59.0, Absolute Lymphocytes 1336, Lymphocytes 31.8, Absolute Monocytes 286, Monocytes 6.8, Absolute Eosinophils 84, Eosinophils 2.0, Absolute Basophils 17, Basophils 0.4.
  Any assistance you can give is greatly appreciated.  I really feel quite under-educated about this condition.
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Dear Peggy,
Before I answer your question, allow me to briefly explain the effects of chronic infection with Hepatitis C.  Hepatitis C (HCV) is a chronic viral infection which primarily effects the liver. It can also effect other organs such as kidneys, skin and nerves. Chronic infection can lead to liver damage. A  minority of patients have livers that are shrunken and scarred. This stage is called cirrhosis of the liver. Once cirrhosis occurs it is irreversible. Some patients have signs and symptoms indicating the liver disease.  These include jaundice, swelling of the feet, swelling of the abdomen, confusion, bleeding from the gastrointestinal tract, tremors etc In the long term some patients are at risk for developing cancer of the liver.
Drug therapies utilizing interferon work by boosting the patient's immunity so that the body can destroy the virus. Since the virus lives inside liver cells there is some associated destruction of liver cells. Therefore only those patients who have an adequate reserve of liver cells and liver function can tolerate this therapy.
Now, let me try to answer your question. You may not be a candidate for interferon based regimen due to any one or more of the following reasons-
1) It is possible that you may have borderline liver function. I suspect this because you've had episodes of jaundice, edema and fatigue. However, I cannot be sure. Only your doctor who knows your medical history can tell you that for sure.  Often a liver biopsy is done to assess the extent of liver damage.
2) For any interferon-based regimen to work there needs to be evidence of liver inflammation assessed by elevation of the liver tests. You have not given me the levels of the SGPT but your SGOT appears to be normal. If your SGPT were also normal then you would not be a candidate for treatment since there is a very high chance of failure of treatment. Currently, patients with chronic hepatitis C who have normal levels of SGPT are not treated with interferon.
3) One of the side effects of interferon therapy is a decrease in the platelet count. Platelets help in clotting and stopping bleeding. If there is a severe reduction in platelet count there is a risk for bleeding. The normal platelet count is 150,000/ml to 400,000/ml. Your platelet count is 94,000/ml. Since your platelet count is already low you may be at high risk for developing a bleeding complication if treated with interferon.
I am  concerned  that you are having fairly constant right upper quadrant discomfort. Cirrhosis of the liver usually does not cause right upper quadrant discomfort. I am not sure what is going on, but I would strongly recommend that you bring this problem to your doctor's attention.
This information is presented for educational purposes only.  Always ask specific questions to your personal physician
HFHSM.D.-sg
*keywords: hepatitis C, interferon
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