Hep C, Genotype 1b - liver biopsy is a must???

My mom has Hep C genotype 1b with viral load about in 500,000. it was in 200,000 but increased not long time ago. Also, her platlet count is low - 60,000. i was woundering if the liver biopsy is required for her to start the treatment. her regular doctor didnt want to do it because of the risk of bleeding. we are going to see 2 doctors on Monday and i heard that all of the Hep C docs require the biopsy... is it true?

Also:

- what kind of test will they want to do before they can start the treatment?

- How often and what kind of blood work is done when while on the treatment?

- how ofter do you see a doctor?

Thank you for your help!!!!

[James10500]

A liver biopsy is the best way to assess the liver.  Why wouldn't you want a complete picture of what is going on ?

Here is a link posted by copyman the other day.

http://hepatitiscresearchandnewsupdates.blogspot.com/2011/01/how-to-assess-liver-fibrosis-in-chronic.html

[HectorSF]

Welcome.

Your mother has a low platelet count. This can be an indication of advanced liver disease. I.E. cirrhosis of the liver. Did the doctor say anything about her low platelets? Does your mother have problems where if she starts to bleed it takes a while before the bleeding can be stopped?

“I was wondering if the liver biopsy is required for her to start the treatment”.
A biopsy is not required to begin treatment since there is nothing that can be done about any liver damage that has already happened. But many doctors will perform a biopsy so as to learn the extent of liver disease that has been caused by the virus. Also if it is thought that the patient has advanced liver disease, this is very important information to know, as the odds of successfully treating the virus is decreased and if the liver is very damaged, it can be risky to undergo treatment.

There are a couple of things that need to be done first.
Your mother should be seeing a gastroenterologist or hepatologist NOT a primary care doctor for treatment. This is especially true with your mother having a low platelet count. Treatment can lower platelets to dangerous levels if a person already has a low platelet and possible advanced liver disease, so she needs be monitored more closely by experienced specialists not a primary doctor.
Also there is a new treatment that may be available for HCV for patients this Summer who are genotype 1. This new treatment can increase the odds of successfully beating the virus. The current treatment, depending on each individual’s circumstance, has less then a 50% chance of working. Why would someone start treatment now instead of waiting 6 months or so when they will have to treat for almost a year to successfully be virus free? Has anyone mentioned this to your mother?

During treatment blood tests are performed on a regular basis to see if and how she is responding to treatment.

Best of luck to you both.
Hectorsf

[R Glass]

“ her regular doctor didnt want to do it because of the risk of bleeding.”  
Please explain.
Unless there is some other medical issue, I would insist on a Biopsy.
I hope your other Doctors are Hepatoligist or Gastro.
I have found most “regular doctors” know very little about HCV.  

[Bill1954]

Hi Natasha,

Your mom shouldn’t be concerned about viral load at this juncture; it’s all but irrelevant until she begins therapy; at that point, the amount of virus can be used to gauge how well she’s responding to the treatment drugs.

Her real concern at this point is low platelets; this is often an indication of advanced liver disease. Has her doctor suggested she has advanced to cirrhosis yet? Platelets at 60,000 might be too low for interferon therapy, as it can further reduce platelets in otherwise healthy patients; I think further investigation of blood labs are in order. If cirrhosis is present, a biopsy will probably provide little further value, and at an increased risk of bleeding and complications. Cirrhosis can be diagnosed without biopsy.

Good luck- let us know what the doctor offers-

-Bill

[Bill1954]

It looks like you’ve already gotten good thoughts above; my reply posted late.

Bill

[HectorSF]

Bill is always on point and a great resource of knowledge and wisdom. You can't do better in terms of guidance about hepatitis c IMHO.

; - )
Hectorsf

[Diane12855]

To answer you other questions... she will see the doctor or a nurse once a month unless there are problems during tx. lots of labs... at least once a month, a CBC is done every time along with liver panels, thyroid levels and viral loads done periodically. I have been having to go to the lab every 2 weeks for the past 3 months because my WBCs are very low... but not low enough for neupogen shots yet. I have 7 shots to go.

Diane

[pj1881]

Thats the same question I asked.. I had every excuse in the world why I thought it was uneccessary.

"Why stick a needle in my already sick liver!"
"What difference does it make, Im still gonna treat!"

Truth is, it was a really simple proceedure, didnt hurt at all.  Its more stressful than painful, and its over before you know it.  I thanked everyone in the room when it was over for making me comfortable.... Its really not that bad!