HCV and steroid injections

My youngest son is getting ready to start Lumbar epidural steroid injections. He has HCV but not sure of the type and viral load. He sees  gastro dr. next month for further evaluation. Are these injections safe for HCV patients?

[mremeet]

I'm not a doctor, just a former HCV patient (SVR for 5 years now). As far as I know, generally speaking, IV steroidal meds are not what you want to take if you're chronically infected with HCV. But a local steroid like what you're describing probably will be ok as long as your doctor agrees. To my knowlege, short term usage of localized steroidal injections and topical creams do not effect the long term course or outcome of HCV disease.

I used steroidal creams for rash during my HCV treatment, AND I took large amounts of oral corticosteroids (prednisone) AND I even received an IV jolt of Solumedrol, a power steroidal med used in the ER for dangerous allergic reactions (bee stings etc). This all happened during my treatment, which really worried me at the time because these drugs are immunosuppressants  and can counteract the effect of the antiviral drugs I was on at the time. Happily, my worries were misplaced; I was cured after treatment and remain so today.

From memory, oral and IV corticosteroids are known to increase HCV viral load, but I'm almost sure this is a temporary thing and when the drugs wear off the VL usually drops down to where it was afterwards. It's prolonged steroid use you have to really look out for (which can especially be a problem for transplant recipients who are also HCV+ and require immunosuppressive anti-rejection drugs). And like I said, localized creams and shots are not nearly as potentially harmful as IV or oral corticosteroids.

Aside from that, is there any reason your son hasn't pursued treatment to become cured? The new drugs out make successful treatment a lot more likely and in less time than just a few years ago. Good luck either way.  

[ceanothus]

Hi Mike,
I'm also not a doctor, but a HCV patient with cirrhosis, who also has had numerous joint problems over the years. I've always been told by my doctors that injections of steroids into the joints or the epidural space (I've had both) are not a risk for my liver. They've told me that very little of the steroid gets out of the local injection site and into general circulation. I hope the epidural injections help his back pain, and I really hope he gets on track to learning a lot more about his HCV infection and the condition of his liver, as well as treatment options. Best wishes!

[Mike194962]

He had his first injection today and asked the dr. ahead of time if it would be harmful to his condition. The dr. said it was ok. He may or may not need more injections. Has to follow up in a few weeks to see where the pain level is. His primary dr. referred him to a gastro dr. to help him deal with the HCV. That's why he hasn't started treatment for that yet. He couldn't get in till July. I'm not very familiar with the protocol of treatment so am trying to research all I can so we can help him in any way possible. Any and all info and advice is appreciated. Thanks.

[Mike194962]

Thank you for your reply. He was told the same thing you were. We're staying positive. One day at a time.

[pooh55811]

I know you do not yet know which Genotype your son has. If he has Genotype 2 or 3 and he treats now, he will probably treat with Interferon and Ribavirin.

If he has Genotype 1 (the most common Genotype in the US), he will do the triple medication regimen. It is a very good idea to read as much as possible and to learn as much as possible about Hepatitis C. This will help immensely when speaking with doctors about Hep C. Plus, the more a person knows, the easier it is to keep a handle on the fear and anxiety concerning/relating to the disease.

The treatment for Genotype 1 is the triple medication treatment (Interferon, Ribaviron, and a protease inhibitor, either Incivek or Victrelis).

The following link will take you to an article that outlines the Practice Guidelines.

http://www.aasld.org/practiceguidelines/Documents/2011UpdateGenotype1HCVbyAASLD24641.pdf?cf03388EF1=E5A7752C!MjA0MDE1OTQ3OmNvcnByYWRpdXNzc286cZ2RPVB2sBQtej+2reuHeQ==

And here is an excellent article about the treatment of Genotype 1. It is several pages so just keep pressing "next":

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%201.aspx

I hope you will keep coming back to the forum. This forum has some of the best information on it. This forum also has some very, very knowledgeable people who will respond to posted questions. The forum is also very supportive, and we all need that when we are dealing with Hep C.  

I wish you both the best.

[ceanothus]

There is also a very good article here with all the general background info on HCV. It makes a great starting point. It's at http://www.medhelp.org/health_pages/Hepatitis/A-Guide-to-Understanding-Hepatitis-C-2006-/show/180?cid=64. Best wishes!

[Mike194962]

Thank you ceanothus and pooh55811. Will def read this material.