Cirrhosis treatment?

My mother is 82, has had Hepatitis C evidentally for many years, only known it for 2 years.  The doctors advised against treatment because of the side effects.  Now she has Cirrhosis of the Liver.  I don't know the proper terms, but her stomach is swollen and hard from fluid.  We went to a specialist today and suggested she take no treatment.  Because of her age he thought she would not have any trouble for 3 years.  My mother is mentally perfect, I know her age is against her.  Do you think it is better for her to enjoy her 3 years or is there a treatment that could help her?

[Mr Liver]

The fluid buildup is called ascites. In many cases it can be medically controlled. In others, draining of the excess fluid can be a regular occurrence. It is a sign of liver decompensation, but its appearance does not necessarily mean the liver is headed for immediate failure. I have had medically (and dietarily) controlled ascites for 5 years. I have known others with similar stories as mine.

Treatment takes a physical and mental toll on anyone who does it to varying degrees.  Those older than 65 tend to show an increased intolerance to therapy.   In addition, HCV treatment has shown it has the ability to cause decompensation in cirrhotics, and worsen the symptoms of those who are already decompensated.

Your mother's doctor has the information needed to make the most accurate prognosis. Assuming this accuracy, I don't believe treatment would pass the 'risk v reward' test for me. In my opinion, the only reason to treat is to hopefully increase the quality and length of your life. I don't think treatment would have a noticeable positive effect on either, and in fact, it could both ruin my QOL and potentially hasten my demise. So, I would enjoy the time that I had left if I was faced with the same choice.

As I just stated above, your mother's doctor is in the best position to advise her  We all want to help our loved ones make the best choices for themselves. If you feel that it is necessary, seek out a second professional opinion. I wish you both the best.

Regards,
Mr Liver

[deb k.]

Thank you for the information.  I guess my mother's condition is farther along than the doctor is letting us know.  He said he would sent her to a liver specialist, if we wanted.  However, he said he thought they would agree with him, not to do anything.  It's really hard to think there is nothing can be done to help her.  She, like most people with Hepatitis C, has no idea how she got it.  Do you think my sisters and I should be tested for Hepatitis C?

[orphanedhawk]

Deb:  I had ascites and it was cleared up with diuretics. I've kept it from reoccurring by limiting my salt intake. With attention to diet, your mother should be able to increase the comfort of her remaining years.  I would not have done the treatment if I was anywhere near her age. Good luck.

Mr. Liver: I am curious about your claim that tx can worsen symptoms of those with a decompensated liver, since that is what I have. My heptologist said that if I cleared the virus, then the scar tissue would begin to dissolve as the liver begins to regenerate.  
       Does tx help or hurt cirrhotic livers?

[Dominic777]

Maybe a liver specialist would agree with your Dr. about not treating. But he may also be able to medically control the swelling. I think Mr Liver gave you some good advice. And after my recent experience I would get at least 2 opinions...from hepatologists.

Dominic

[deb k.]

I think we will get another opinion from a liver specialist, certainly can't hurt anything!  

[zazza]

If there is any chance your mother had hepatitis C at the births of you and your sisters, you should get tested. 5% of the children to a mother with hep C at their births get it.

[Mr Liver]

Vertical transmission (mother-to-child) of HCV is an infrequent occurrence, but certainly not unheard of. The transmission rates I've seen suggest <5%.

Your doctor can perform a test to see if you have ever been exposed to HCV. It is a good idea for all people to be tested for HCV anyway, so I encourage you and your sibling to do so.

Because of the nature of HCV treatment, it is contraindicated  in many people for a variety of reasons.For many in these tx populations, inaction against the virus is the most advisable course to take.

I think in your case a second opinion from a specialist could be valuable for all concerned.

Again, wishing all the best.
Regards,
Mr Liver

[mikesimon]

Results of Combination Treatment With Pegylated Interferon and Ribavirin in Cirrhotic Patients With Hepatitis C Infection
7/13/2006      See: http://www.medscape.com/viewarticle/537740_1

This is from the discussion at the end of the artcle.

"In our patient group two deaths are directly attributable to the treatment. One patient decompensated and died. He developed liver failure with spontaneous bacterial peritonitis and variceal bleeding. He was an elderly Asian male with features of advanced disease ( Table 5 , patient 2). A second patient died following transplantation from primary graft non-function ( Table 5 , patient 9). She had no pretreatment features to identify a high risk for decompensation during antiviral treatment. In the other eight patients the severity of clinical decompensation varied, life threatening in some, whereas others managed to complete their treatment. Two patients required listing for transplantation following decompensation that only responded partially to treatment. Out of these 10 patients, four achieved SVR.

We have tried to identify parameters, which might identify the patient who is at high risk of decompensation during treatment. Risk factors for decompensation included age and low serum albumin. Neither ethnicity nor gender was identified as risk factors for decompensation in multiple regression analysis. However, decompensation was observed more frequently in Asian patients. Seven of 25 Asian patients (28%) decompensated compared with 3/33 Caucasian patients (9.1%) (Fischer's exact test, P =0.08). We have not been able to demonstrate a threshold age or baseline albumin value beyond which treatment should not be attempted. Clinically significant decompensation was not observed for patients aged less than 45 years. In general, patients with less severe baseline liver disease are more likely to achieve SVR, and older patients with more advanced liver disease appear more susceptible to serious complications during treatment. However some patients considered high risk achieved SVR without clinical decompensation, and some low risk patients suffered hepatic decompensation.

The relative chance of a patient to achieve SVR and their risk for decompensation may substantially influence the patients' and their doctors' decision to treat or not to treat."

Mike

[orphanedhawk]

Thanks!                   oh