Aa
Hep C and drinking
My sister has Hep C and rinks heavily. She seems to have "aged" quickly over the past few years. I am concerned her days are numbered. She gets confused easy, repeats herself, falls alot even when sober. Is this part of HepC?
What Jim said.
Us G2&3s tend not to have biopsies as our chance of cure is high. Yeh right. Because of our high SVR rate the need to use Biopsies as decision to treat tool is limited.
Biopsies can have complications and on rare occasions even death, and unless done properly can be inaccurate. This is probably why your Doc doesn’t want to do one.
My Doc estimated me at F2-F3 probably F2 and prior Tx and I was happy with that. I had also been drinking fairly heavily for 23+ years with HCV. My ALTs were higher than yours both times I treated. 200+ the first time and 140+ the second. Your ALT/AST ratio looks OK to me. My ASTs were around the same as yours 60 ish.
Now I am thinking of having a biopsy.
All the Best
CS
Us G2&3s tend not to have biopsies as our chance of cure is high. Yeh right. Because of our high SVR rate the need to use Biopsies as decision to treat tool is limited.
Biopsies can have complications and on rare occasions even death, and unless done properly can be inaccurate. This is probably why your Doc doesn’t want to do one.
My Doc estimated me at F2-F3 probably F2 and prior Tx and I was happy with that. I had also been drinking fairly heavily for 23+ years with HCV. My ALTs were higher than yours both times I treated. 200+ the first time and 140+ the second. Your ALT/AST ratio looks OK to me. My ASTs were around the same as yours 60 ish.
Now I am thinking of having a biopsy.
All the Best
CS
No, I had a very tough time. But given my sides (mutliple skin problems, GERD, chronic infections) during treatment, I don't think I would have been able to work even with standard treatment. One reason I say this is because things didn't get better when I went back to normal doses. Also, the side effect profile on double-dosing peg (first 12 weeks) isn't all that different from the normal protocol. The xtra riba, however, can bring about more severe anemia and that's why I recommended rescue drugs early on if needed.
A lot to think about... Thanks for the advice. I'll discuss a more aggressive approach with my doctor. I'm a big guy (over 220#) so I think an increase in dosages might be appropriate. Were you able to keep working on that aggressive treatment plan?
Probably should add that I also did high-dose ribavirn (HDR) for the first few weeks of treatment. HDR is above and beyond weight-based SOC. Just be warned that HDR has risks, mainly if you go too high, too soon, you could get very anemic and end up having to stop the riba or even treatment. I ended up in the ER around weeks 2-3 and had to stop riba for close to a week. Again, I went too high, too soon, for my body. To do it all over again, would have titered up the riba more gradually and started Procrit (epo) at the start of treatment. But that's hindsight and not everyone would have the hemoglobin drop (or reaction to the drop) that I did.
-- Jim
-- Jim
BTW all the above -- with the exception of riba pre-dosing -- are based on current studies and treatment protocols recommended on sites like Clinical Care Options. On a personal note, I did all of the above except pre-dosing the riba, and if I knew more about it prior to treatment, I would have asked my doctor to pre-dose. My doc told me the double-dosing alone would raise my odds around 10% for SVR. I was somewhere around stage 3 when I treated. Treated for 54 weeks. Been SVR for over a year. UND at week 6.
-- Jim
-- Jim
#1 in the list got clipped off.
(1) Double Dosing Peg for the first 12 weeks and/or until you become UND by sensitive viral load test.
(1) Double Dosing Peg for the first 12 weeks and/or until you become UND by sensitive viral load test.
Diet on treatment often turns out to be any food you can tolerate, which often is limited.
Given you're geno 1, stage 4, I'd consider an agressive treatment approach, including:
(2) Ribavirin on the high end of your weight range.
(3) Weekly CBCs to track WBC and Hemoglobin with the understanding that helper drugs (epo) will be used if necessary instead of reducing medications.
(4) Weekly sensitive viral load tests (50 IU/ml or less) starting from week 1, until UND. Then monthly after that.
(5) Pre-dosing ribavirin 2-3 weeks before your first Peg shot.
(6) Extending treatment beyond 48 weeks if not UND by week 6.
Alternatively, consider enrolling in a Teleprevir trial for prior non-responders. Only problem here is that you might end up in a placebo or no-riba arm.
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You will probably need an enlightened and very up to date liver specialist (hepatologist) to get most of the above suggestions. Doubt if a gastro would go along -- or even be familiar -- with many of the suggestions, but you could always ask.
All the best,
-- Jim
Given you're geno 1, stage 4, I'd consider an agressive treatment approach, including:
(2) Ribavirin on the high end of your weight range.
(3) Weekly CBCs to track WBC and Hemoglobin with the understanding that helper drugs (epo) will be used if necessary instead of reducing medications.
(4) Weekly sensitive viral load tests (50 IU/ml or less) starting from week 1, until UND. Then monthly after that.
(5) Pre-dosing ribavirin 2-3 weeks before your first Peg shot.
(6) Extending treatment beyond 48 weeks if not UND by week 6.
Alternatively, consider enrolling in a Teleprevir trial for prior non-responders. Only problem here is that you might end up in a placebo or no-riba arm.
------------------------------------------------------------------------
You will probably need an enlightened and very up to date liver specialist (hepatologist) to get most of the above suggestions. Doubt if a gastro would go along -- or even be familiar -- with many of the suggestions, but you could always ask.
All the best,
-- Jim
Jim,
Thanks for all the great info you give the people coming here in search of answers. I found out less than two months ago that I have Hep C and my biopsy showed I have cirrhosis. Talk about a shocker, I didn't even feel sick. My only symptom was an itch over my entire body. My blood work shows many of the indicators (ALT 139, AST 126, AFP 93 ) but my INR count is normal at 1.24. After my dx, I read everything I could about cirrhosis and most of it was pretty depressing with a less than encouraging outlook. My hope of course is that I sucessfully treat and stop further damage and hopefully even reverse some of the fibrosis. Sounds like that is at least possible. I am not much of a drinker so stopping completely was easy. I start Pegasys/Copegus treatment next week. I hope all goes well and I beat the odds (my GI told me I only have a 30% chance of SVR due to being Genotype 1, over 40, and with cirrhosis). I've been told that the inteferon can help ease inflamation even without SVR. I am also on Ursodiol which can help decrease inflamation. My former doc put me on that to help with the itch. I have not been able to find much in the way of good information on how to feed a damaged liver. Any advice or websites on a diet that promotes liver health? Thanks.
Thanks for all the great info you give the people coming here in search of answers. I found out less than two months ago that I have Hep C and my biopsy showed I have cirrhosis. Talk about a shocker, I didn't even feel sick. My only symptom was an itch over my entire body. My blood work shows many of the indicators (ALT 139, AST 126, AFP 93 ) but my INR count is normal at 1.24. After my dx, I read everything I could about cirrhosis and most of it was pretty depressing with a less than encouraging outlook. My hope of course is that I sucessfully treat and stop further damage and hopefully even reverse some of the fibrosis. Sounds like that is at least possible. I am not much of a drinker so stopping completely was easy. I start Pegasys/Copegus treatment next week. I hope all goes well and I beat the odds (my GI told me I only have a 30% chance of SVR due to being Genotype 1, over 40, and with cirrhosis). I've been told that the inteferon can help ease inflamation even without SVR. I am also on Ursodiol which can help decrease inflamation. My former doc put me on that to help with the itch. I have not been able to find much in the way of good information on how to feed a damaged liver. Any advice or websites on a diet that promotes liver health? Thanks.
As to "who is right", no clear cut answer. From what I've read here and elsewhere, some very good liver specialists will make a diagnosis of liver damage (on an individual basis) often without biopsy. Others tend to biopsy almost everyone. Geno 1's tend to get biopsied more than geno 2's because often geno 2's are recommended to treat regardless of liver damage. I have no idea how 'good' your doctor is determining liver damage without biopsy. I'm sure expertise varies taking into account patients history, blood values including platelet count, size of spleen, ultrasounds, and physical examination. One compromise would be to find someone with a Fibroscan machine, although not yet readily available. There are also some blood markers like Fibrosure but they only seem accurate at the two extremes.
-- Jim
-- Jim
Yes, the more recent thought and studies suggest both fibrosis and cirrhosis is often reversible, especially with SVRs. As to "alcoholic cirrhosis", indeed that may be a different animal, as sources like the following suggest it isn't reversible. Or, maybe they are just behind the research curve in terms of cirrhotic reversal, as was the case with similar thinking re Hep C only few years ago.
http://clevelandclinicmeded.com/diseasemanagement/gastro/ald/ald.htm
http://clevelandclinicmeded.com/diseasemanagement/gastro/ald/ald.htm
I think you are in a difficult situation. I suspect your sister has already been told that drinking and Hep C do not mix. This may not really be a Hep C issue.
I was in a relationship 10 years ago with a woman who drank and smoked through pregnancy. It was extremely difficult, as on the one hand, you want to stop the behaviour, but on the other hand, no matter what information you provide about how harmful the activitey, you do not have control. In the end I had to leave the situation, for my own sanity.
Unfortunately, for many, whether it be alcohol, drugs or similar, no amount of education will do the trick. Many use substances to avoid facing up to the issues in their lives. Hep C is another thing for some to avoid facing up to. There is only so much we can no matter how much we care about someone.
I would suggest that you try to be positive and encourage your sister. If you find your encouragement is resulting in resistance, or arguments, maybe it is better not to push. You may be better off spending your time with her as positively as you can by not bringing up the topic if she is not receptive too it.
I was in a relationship 10 years ago with a woman who drank and smoked through pregnancy. It was extremely difficult, as on the one hand, you want to stop the behaviour, but on the other hand, no matter what information you provide about how harmful the activitey, you do not have control. In the end I had to leave the situation, for my own sanity.
Unfortunately, for many, whether it be alcohol, drugs or similar, no amount of education will do the trick. Many use substances to avoid facing up to the issues in their lives. Hep C is another thing for some to avoid facing up to. There is only so much we can no matter how much we care about someone.
I would suggest that you try to be positive and encourage your sister. If you find your encouragement is resulting in resistance, or arguments, maybe it is better not to push. You may be better off spending your time with her as positively as you can by not bringing up the topic if she is not receptive too it.
Who is right here? This has been a question for my doctor..........She dosen't want to biopsy me prior to tx ...... says because I am geno 2b that there can be too many complications when the prognosis is so good for type 2 but I was a HEAVY drinker for 25 years and have probably HCV positive for 20 years she ESTAMATES me at stage 3 from bloodwork Albumin 4.2 but ALT as high as 113 currently 60 AST 46 Billirubin 0.9 total What gives?? I want to kno how much damage has occurred??? Thank you!
Who is right here? This has been a question for my doctor..........She dosen't want to biopsy me prior to tx ...... says because I am geno 2b that there can be too many complications when the prognosis is so good for type 2 but I was a HEAVY drinker for 25 years and have probably HCV positive for 20 years she ESTAMATES me at stage 3 from bloodwork Albumin 4.2 but ALT as high as 113 currently 60 AST 46 Billirubin 0.9 total What gives?? I want to kno how much damage has occurred??? Thank you!
Who is right here? This has been a question for my doctor..........She dosen't want to biopsy me prior to tx ...... says because I am geno 2b that there can be too many complications when the prognosis is so good for type 2 but I was a HEAVY drinker for 25 years and have probably HCV positive for 20 years she ESTAMATES me at stage 3 from bloodwork Albumin 4.2 but ALT as high as 113 currently 60 AST 46 Billirubin 0.9 total What gives?? I want to kno how much damage has occurred??? Thank you!
Jim
Your attempts to convince people that Fibrosis is reversible has not been in vain.
Comments that Fibrosis/Cirrhosis generally arent reversible are obtained from reputable sources.
I used to think that Fibrosis was reversible just not in everyone so kinda believe both.
The following comes from http://www.liverfoundation.org/education/info/alcohol/
“The damage from cirrhosis is not reversible. “Ok its about alcoholic hepatitis but cirrhosis is cirrhosis
I have come across similar statements on several sites about both Fibrosis and Cirrhosis
The following comes from An appraisal of the histopathological assessment of liver fibrosis http://gut.bmj.com/cgi/content/full/55/4/569. This article primarily discusses the usefulness of biopsys
Previously, it was thought that liver fibrosis and end stage liver disease (cirrhosis) were irreversible, and therefore crude determinations of liver fibrosis were acceptable because the therapeutic impact of this assessment was relatively minor. Recent work suggests that liver fibrosis may be modified by treatment1–4
The concept of Fibrosis reversal is relatively recent and probably stated with HepC Tx but now covers most if not all Liver diseases if the cause of the damage is removed.
Articles such as
Is liver fibrosis reversible? http://gut.bmj.com/cgi/content/full/46/4/443 Discuss this in some detail.
The following article won me over http://www.natap.org/2007/DDW/DDW_23.htm
Especially as it seems to be using data from the Hadziyannis pegasys study. I happen to know a bit about this study as it’s the only International RCT that compares 24 weeks v 48 weeks ever done. Its the reason why G2s and 3s do 24 weeks, even though it wasn’t published when the NIH 2002 consensus statement recommended 24 weeks.
All this has raised as many questions as it has answered such as how accurate biopsies are and whether complete reversal happens over time.
My Liver is a lot more remarkable than I gave it credit for. It has a hell of an ability to repair itself.
Anyway thanks for helping to change my views.
CS
Your attempts to convince people that Fibrosis is reversible has not been in vain.
Comments that Fibrosis/Cirrhosis generally arent reversible are obtained from reputable sources.
I used to think that Fibrosis was reversible just not in everyone so kinda believe both.
The following comes from http://www.liverfoundation.org/education/info/alcohol/
“The damage from cirrhosis is not reversible. “Ok its about alcoholic hepatitis but cirrhosis is cirrhosis
I have come across similar statements on several sites about both Fibrosis and Cirrhosis
The following comes from An appraisal of the histopathological assessment of liver fibrosis http://gut.bmj.com/cgi/content/full/55/4/569. This article primarily discusses the usefulness of biopsys
Previously, it was thought that liver fibrosis and end stage liver disease (cirrhosis) were irreversible, and therefore crude determinations of liver fibrosis were acceptable because the therapeutic impact of this assessment was relatively minor. Recent work suggests that liver fibrosis may be modified by treatment1–4
The concept of Fibrosis reversal is relatively recent and probably stated with HepC Tx but now covers most if not all Liver diseases if the cause of the damage is removed.
Articles such as
Is liver fibrosis reversible? http://gut.bmj.com/cgi/content/full/46/4/443 Discuss this in some detail.
The following article won me over http://www.natap.org/2007/DDW/DDW_23.htm
Especially as it seems to be using data from the Hadziyannis pegasys study. I happen to know a bit about this study as it’s the only International RCT that compares 24 weeks v 48 weeks ever done. Its the reason why G2s and 3s do 24 weeks, even though it wasn’t published when the NIH 2002 consensus statement recommended 24 weeks.
All this has raised as many questions as it has answered such as how accurate biopsies are and whether complete reversal happens over time.
My Liver is a lot more remarkable than I gave it credit for. It has a hell of an ability to repair itself.
Anyway thanks for helping to change my views.
CS
Recent studies[4] showing reversal of cirrhosis when HCV is eradicated by antiviral combination chemotherapy suggest that this is a population in whom antiviral therapy will be valuable.
http://www.medscape.com/viewarticle/434537
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http://www.medscape.com/viewarticle/434537
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GO: If allowed to progress to stage 4 (cirrhosis), the damage generally is considered to be irreversible with hepatocellular carcinoma (HCC) being the eventual expectation.
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You've posted this numerous times, and I've tried to correct the statment every time I catch it. Either you've been missing my posts, or disagree and aren't responding. If you disagree and have some recent studies to support your position, please post. Bottom line is that cirrhosis can reverse (not always be frequently enough) with SVR and therefore the eventual outcome is not always HCC.
Here is what I have:
Recently, in many different entities that can all result in cirrhosis, we have learned that cirrhosis may be reversible. Some of the most convincing data has been published in individuals who had biliary cirrhosis in which a blockage of the bile duct leads to cirrhosis. In a large number of individuals in whom the blockage is relieved, the cirrhosis can reverse. These investigators have now demonstrated the same phenomenon in HCV. This is a very important study because it challenges our thinking regarding the reversibility of cirrhosis in HCV-infected individuals and shows that it can regress in 75/153 patients.
http://www.natap.org/2001/aasld2/day38.htm
"Reversal of cirrhosis has been described in 49% of patients"
http://www.medscape.com/viewarticle/475417_2 (free Medscape Registratrion Required)
"The latest studies show that cirrhosis IS reversible. "
-- Jules Levin, Founder of NATAP
http://www.centerforaids.org/rita/1204/personal.htm
-------------------------
You've posted this numerous times, and I've tried to correct the statment every time I catch it. Either you've been missing my posts, or disagree and aren't responding. If you disagree and have some recent studies to support your position, please post. Bottom line is that cirrhosis can reverse (not always be frequently enough) with SVR and therefore the eventual outcome is not always HCC.
Here is what I have:
Recently, in many different entities that can all result in cirrhosis, we have learned that cirrhosis may be reversible. Some of the most convincing data has been published in individuals who had biliary cirrhosis in which a blockage of the bile duct leads to cirrhosis. In a large number of individuals in whom the blockage is relieved, the cirrhosis can reverse. These investigators have now demonstrated the same phenomenon in HCV. This is a very important study because it challenges our thinking regarding the reversibility of cirrhosis in HCV-infected individuals and shows that it can regress in 75/153 patients.
http://www.natap.org/2001/aasld2/day38.htm
"Reversal of cirrhosis has been described in 49% of patients"
http://www.medscape.com/viewarticle/475417_2 (free Medscape Registratrion Required)
"The latest studies show that cirrhosis IS reversible. "
-- Jules Levin, Founder of NATAP
http://www.centerforaids.org/rita/1204/personal.htm
Not to mention the other physical and social problems that can arise from heavy consumption, when combined with HCV it can have a devastating effect upon ones liver.
If allowed to progress to stage 4 (cirrhosis), the damage generally is considered to be irreversible with hepatocellular carcinoma (HCC) being the eventual expectation.
Perhaps she is drinking to medicate the effects HCV is having upon her, but the net result is a wicked death dance occurring within her using her liver as the floor. Of course being that the primary function of the liver is to filter toxins from our blood, this can result in them not being properly filtered out which worsens the situation with secondary effects being felt throughout her system.
From personal experience I would say that if the virus is present and active to any degree, then consumption of any amount seems to increase the effects felt so that only dangerously large amounts seem to medicate them away.
If allowed to progress to stage 4 (cirrhosis), the damage generally is considered to be irreversible with hepatocellular carcinoma (HCC) being the eventual expectation.
Perhaps she is drinking to medicate the effects HCV is having upon her, but the net result is a wicked death dance occurring within her using her liver as the floor. Of course being that the primary function of the liver is to filter toxins from our blood, this can result in them not being properly filtered out which worsens the situation with secondary effects being felt throughout her system.
From personal experience I would say that if the virus is present and active to any degree, then consumption of any amount seems to increase the effects felt so that only dangerously large amounts seem to medicate them away.
Tell your sister that HepC can not only be cured but the liver can reverse the damage (heel itself) with time. But for this to happen she needs to get educated about HepC (you can obviously help here with this), proactive and change her lifestyle.
As jmjm530 and Jakied said; she needs to stop drinking ASAP and get evaluated by a specialist, who will order her a liver biopsy to know how much damage the liver already has. Then consider treatment to get rid of the virus, but for this to happen, she has to quit alcohol. The longer she waits to take any of these steps, the harder it will be. Treatment is much more effective when people have little liver damage. Good luck!
As jmjm530 and Jakied said; she needs to stop drinking ASAP and get evaluated by a specialist, who will order her a liver biopsy to know how much damage the liver already has. Then consider treatment to get rid of the virus, but for this to happen, she has to quit alcohol. The longer she waits to take any of these steps, the harder it will be. Treatment is much more effective when people have little liver damage. Good luck!
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