My husband been called back after ultrasound

[any_wonder2]

We live in the UK and my husband is Hep Genotype 1 untreated. He was infected some 20 or more years ago has no symptoms to date. He had a biopsy in 2000 which showed mild fibrosis only (& he takes drugs for asthma each day). His blood results from 2008 continued to show some increase in transaminases (ALT90 and ASD 40) but were otherwise normal. He was going to have a biopsy done 2 years ago but it was cancelled at last minute as they found two small lesions and decided it was too risky. He had an ultrasound done in April 2009 and we thought the results were all fine. But today (July 09) I had a call from his specialist and they now say they have found a new lesion and they are calling him in for a MRI.
I'm 31 weeks pregnant and getting very worried about his health....What should we be looking out for? What markers etc? Am I right to start panicking? I want his to start treatment ASAP but he keeps putting it off. Was meant to start last year but was put off as I was pregnant then (but our son was stillborn...) and this time I'm pregnant again and am getting very worried and stressed. We also have a 3 year old and my husband works full time. Am I right in thinmking he would need the longer treatment due to genotype 1?
I'm not even sure what advice I'm after but I felt I need to contact a group and 'talk' it through....
Thanks

[Bill1954]

You are asking all the right questions. Yes; there is definitely a link between liver cancer type lesions (HepataCellular Carcinoma [HCC]) and Hep C; but no correlation if the lesions in question are hemangiomas, to my knowledge. Most doctors use either imaging or a biochemical marker called AFP (Alpha FetoProtien) or both to monitor for liver cancer; mine uses both at six months intervals. I don’t believe there is any *extra* risk for developing primary liver cancer until fibrosis stage 3/4 is reached; that is, not any more risk than the general population. If your husband is considered <stage 3, I don’t think there’s any appreciable risk of HCC development.

Remember that enzymes such as ALT/AST are dynamic and can very from day to day; slight elevations don’t provide much of a clue as to direction of inflammation, etc.

If the protease inhibitor drugs include the use of interferon and ribavirin, in other words, as an adjunct; I don’t believe the virus will become more ‘virulent’ if the initial treatment fails. This is one of the reasons that interferon is being included in the PI trials; interferon is supposed to mop up any mutant virus that is spun off from the PI’s that might be resistant. I think that is what you’re driving at; if not, I’ll try again :o).

Try to push for additional biopsy or Fibroscan; there really is no other reliable way to assess damage and treatment urgency other than speculation.

Best to you both,

Bill

[any_wonder2]

Thank you for all the advice. We're going to call the Dr and get more info on his bloods etc as we are not really given enough info.
There has been a slight increase in his transaminases - ALT is now 90 and ASD is 41. He has no stigmata of chronic liver disease and no enlargement.
So there is no link between lesions and Hep C? Or is it more correct to say no link between hemangiomas and Hep C? If it was liver cancer wouldn't some markers of shown up in his bloods?
If he opts for treatment now rather than wait for better drugs for GT-1 in 2011 then what is the risk factor in the virus becoming more viralant if the treatment fails? (I thik this is the case for PL inhibitors?), The annoying thing is that we don;t know what stage his scarring is at. He should have had a fibroscan last time but the machine wasn't available.

[Bill1954]

The most common lesions found on a liver are ‘hemangiomas’; they are unrelated to HCV, and generally don’t cause any harm. Intervention usually isn’t necessary unless there is pain or if they cause some type of blockage of bile ducts, etc. Typically, ones HCV status won’t affect the production of these benign ‘blood tumors’.

Many people adopt the ‘watch and wait’ approach that your husband is taking. There are new drugs in late phase clinical trials that promise to increase the efficacy of interferon treatment for GT-1 patients from approximately 45% to 70%, and possibly reduce duration from 48 weeks to 24 weeks dependent on initial response.

The flip side of this philosophy is that HCV is generally more responsive to medication when lower levels of fibrosis are present, and the disease hasn’t progressed to cirrhosis. Ongoing monitoring of the patients condition is essential, and biopsy should be performed at least every 3 to 5 years to assess disease advancement.

To view member’s previous posts, you can click on their name to go to their home page. Once there, you’ll find a list of posts. Click on ‘all posts’ and a history of their previous posts should appear. Or, you can use the ‘search this forum’ bar near the top of the page to search for specific topics of interest.

Good luck to you and your husband as you go forward,

Bill

[any_wonder2]

Thanks for the replies.

Franke566 - how do I go about seeing your other posts?

We have waited as he was stage 1 (mild fibrosis) and seemed stable and due to being genotype 1 his specialist thought he could wait for some of the new treatments...But if new lesions appearing then I guess we can't wait until 2011.

[HCA]

He has been recalled in order to determine the nature of the 'lesion'.It is probably nothing but has to be checked.
Hepatitis C is a slowly progressive disease and should be treated-it wont resolve on it's own.
There are new treatments for genotype 1 which will be out 2011-we don't yet know the length of treatment required.

[franke566]

Please read some of my posts about waiting too long.  No. Do not panic. Not good for you or the baby you carry. Your Hubby needs to visit this forum and learn from others who are going thru and have gone thru this and foremost do what the specialist says!  If in doubt get a second opinion if you can.  Waiting will not, I repeat, will not make it go away!  Mike JmJm please help-you guys have the savvy to tell this lady in lamens terms whatthis ignorant fisherman can't.  any_wonder 2, take nice slow breaths and stay calm-you have nothing to fear but fear itself.  I'll be praying for you. franke566