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Advice Required
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Advice Required

Hi Everyone:

I am writing this on behalf of my mother. She is 62years old, is 5ft 2 inches tall and weighs 58kg.

In 2005, we discovered she had Hep C. She was treated with interferon+ribavirin. Although, I don't remember exactly but she had type 1 genotype most likely. The virus was undetectable within 3 months. However, she completed 48 weeks of therapy.

My mother had issues with depression and anxiety in the past. In 2011, we tested her for Hep C randomly and turned out it was positive again. She had some scarring on liver but doctors suggested that it wasn't that bad. They decided to put her under 48 weeks of ribavirin and interferon therapy with higher dose. The virus was cleared by 5th month. She attained SVR at 6 months after treatment. Her Haemoglobin dropped much rapidly this time around and doctor prescribed blood transfusions for last 6 shots. One of the blood transfusion went bad and she had a "blood reaction/ septic shock" due to negligence of nurse. Consequently, we couldn't complete last 4 shots as septic shock was pretty bad and she ended up in ICU. Since then, she has recovered very well. Her haemoglobin and liver functions are well. Since then, she gets tested for hep C and liver ultra-sound every 6 months.

Last month, after almost 2.5 years of undetected viral load. We found out her Hep C was positive again. Doctor also noticed two small bubbles on her liver but thinks they are benign. She is now in USA for next 5 months to spend vacations with her sister. However, doctor requested her to perform an ultra sound test around mid-trip and send them his way so he could keep an eye. Doctor believes her medical tests suggest that her liver is in good shape and there is no need for knee jerk reaction. We could opt for Solvadi in future (easily available in Pakistan) and even gain access Harvoni (it will be available in next 6 months to a year in Pakistan).

My mother's latest results:
AFP: <4.86 (less than 5 normal)
Haemoglobin: 15.5
Anti HCV: 6.81 (cutt-off rate 1.0)

LFT tests:
Total Bilirubin: 0.43 mg/dl (normal upto 1.0)
ALT: 27 U/L (normal range 10 - 35 )
AST:18 U/L (normal 10 - 35 )
Alkaline Phosphate: 82 U/L (35 - 104 normal)
GGT: 57 (5 - 35 normal)
Total Protein: 7.32 g/dl (5.5 - 8 normal)
Albumin: 4.59 (3.5 - 5.5 normal)
Globulin: 2.73 (2 - 3.5 normal)
A/G ratio: 1.68

*normal refers to normal range
My mother is very discipled about diet and medicine. She is in good health and follows her daily routines. Would you guys suggest me to persuade the doctor into going with Solvadi and turning the virus negative once again or should we wait for some years and then opt for Harvoni as my mother simply hates those interferon injections.

I would really appreciate you advice.
Tags: hep c, Liver
13 Comments Post a Comment
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2059648_tn?1422055945
You are not sure of her Genotype?  Pakistan has a high occurrence of Genotype 3a.   What exactly is your mothers viral load?   Treatment and duration depends on knowing this information.   Yes the doctors are watching these places on her liver for change.    That's expected.

Your really need to find out the stage and grade of your mothers liver, her genotype and viral load.   Can you get and provide that information?


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Avatar_f_tn
I have a feeling that your mom never was really clear of the virus with her interferon treatments. The fact that they treated her for 48 weeks likely means she is genotype 1. Her lab work is wonderful and her doctor says her liver is in good shape. How is he making the determination about the histology of her liver? Has she had a biopsy? Why are you mentioning itnterferon with sovaldi? Will Olysio be available in Pakistan. It will likely be a better to treat your mom with Sovaldi and Olysio as long as she doesn't have cirrhosis and is genotype 1. If in fact the doctor is correct about her level of liver disease, waiting a year for Harvoni would probably give her the best chance of clearing the virus once and for all. I think you need to chat with the doctor and find out how he knows the liver is in great shape. The lab work does not always give a good indication all by itself.

I wish your mom the best and I hope she gets a treatment that cures her forever.
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2059648_tn?1422055945
Overall, genotype 3a was the predominant genotype with a rate of 55.10%, followed by genotype 1a, 3b and mixed genotype with a rate of 10.25%, 8.20%, and 5.08%, respectively; and genotypes 4, 5 and 6 were rare. Genotype 3 occurred predominately in all the provinces of Pakistan. Second more frequently genotype was genotype 1 in Punjab province and untypeable genotypes in Sindh, Khyber Pakhtunkhwa and Balochistan provinces.

http://www.ncbi.nlm.nih.gov/pubmed/21902822
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Avatar_f_tn
Yes, but geno 3 is treated for six months all over the world. This gentleman's mother was treated for 48 weeks.
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2059648_tn?1422055945
Its questionable what the poster genotype is.  The gentleman's mother has had blood transfusions during treatment in a country that is plagued with un checked blood supply unlike the United States.   She could have more than
one genotype.  Without knowing the facts its hard to answer.  Sure she could have Genotype 1.  But she could also have genotype 3.

_______________________________

In Pakistan more than 10 million people are living with Hepatitis C virus (HCV), with high morbidity and mortality. This article reviews the prevalence, genotypes and factors associated with HCV infection in the Pakistani population. A literature search was performed by using the keywords; HCV prevalence, genotypes and risk factors in a Pakistani population, in Pubmed, PakMediNet and Google scholar. Ninety-one different studies dating from 1994 to May 2009 were included in this study, and weighted mean and standard error of each population group was calculated. Percentage prevalence of HCV was 4.95% ± 0.53% in the general adult population, 1.72% ± 0.24% in the pediatric population and 3.64% ± 0.31% in a young population applying for recruitment, whereas a very high 57% ± 17.7% prevalence was observed in injecting drug users and 48.67% ± 1.75% in a multi-transfused population. Most prevalent genotype of HCV was 3a. HCV prevalence was moderate in the general population but very high in injecting drug users and multi-transfused populations. This data suggests that the major contributing factors towards increased HCV prevalence include unchecked blood transfusions and reuse of injection syringes. Awareness programs are required to decrease the future burden of HCV in the Pakistani population.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789216/

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Avatar_f_tn
So you think she is being reinfected?? Good point.
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683231_tn?1427182107
You posted Anti HCV test result that appears to be an antibody test and not a HCV RNA by PCR the test for the virus itself.

Anyone who has been infected with hep c will forever test positive for Hep c antibodies. There would be no point in performing an antibody test only a HCV RNA by PCR or other similar test looking for the presence of the virus would show that she does not have hep c.

For her and anyone else who has ever had hep c the antibody test is meaningless.

Has she been tested for the virus not just the antibodies? What is her viral load?
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2059648_tn?1422055945
Yes we are trying to find out if she has a viral load.  If she has a genotype she has hepatitis c.  The information is incomplete.  
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10638747_tn?1427534352
Good catch flyinlynn. Right on.

BUT this boggles the mind---> "In Pakistan more than 10 million people are living with Hepatitis C virus (HCV), "
~
I suppose they are basing the liver condition on the ALT and AST. The numbers are in range.
The Hemoglobin looks very good to me. I would like to have 15.5 but post cured I hover around 12.9 and that's great for me.

Post more info: Genotype, viral load and Liver status.
I think it could be what Lynn said. Antibodies?
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6708370_tn?1418197421
This is the first time I have ever heard of anyone relapsing 2.5 years after reaching SVR

Especially because most people who treat are hyper-vigilant about situations that might not be safe. Does Pakistan still use tainted blood for transfusions?

I guess we will be better able to help once we know the answers to the questions that KOKO and Flyin have posed
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Avatar_f_tn
I don't agree. While there is no record of a viral load test in the post, the language used sounds very much like PCR was done. He claims she was undetected which sounds like a PCR, not an antibody test. As you state, the antibody would not clear up or go undetected during treatment. Much more info needed to help this man.
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2059648_tn?1422055945
You understands references like cleared and SVR.  These are terms related to viral loads.   Based on the information provided there is no way of knowing if his mother has hepatitis C or not.  A PCR  (viral  load test)  is needed to  confirm if Hepatitis C is present.  

Hope this advice is helpful.
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2059648_tn?1422055945
Also, if your mother has Hepatitis C it's important that you confirm her Genotype.  Treatment depends on what genotype she has.  Genotype type
3 progresses faster than genotype 1.   Most of the people who have hepatitis C in Pakistan have Genotype 3.  You also can be infected with more than one
Hepatitis C Genotype.  
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