Interferon Therapy on Liver Chirrhosis

[dhksaife]

Friends,

I was suffering HCV Gentype 3. My Age 42 yrs.

On July 2007 My Hepatologist given my Pegasys 180mcq + ribavirin 1200mg/per day 135mcq when platelet count decreases.

After six months of my therapy I found the report:

ULTRA SOUND: Portal fibrosis, Scarred Tissues & Mild splenomegaly
Had my pathology reports followed:


21.07.2009 ALT(SGPT):73 U/L
           S.Bilirubin:1.0 mg/dl
           Prothombine: 1.13 INR
           HBsAg:Negative
           Anti HCV:Reactive
           HCV Quantitive: Less than detectable limits/Super Raligare SRL Mumbai
           Andoscopy: Grade ii-iii Oesophaegal Varix
           Moderate Degree of portal hypertensive gastropathy
           Duodenal Ulcer
           CBC & Blood Film: are normal except lower platelet count 108x10

After that they Made EVL
From the day the made EVL I was unable to eat very well,It was paining.
Doctor gave me some 3rd generation antibiotic
After that he made pathology test on  

22/08/2009

ANA=Negative
SGOT=100 U/L
SGPT=125 U/L
Serum Total protein: 85gm/l (63-84gm/l)
Serum Albumin:38.00gm/l( - )
Anti –HBs:<3.0mIU/ml
Anti-HAV IgM:Non Reactive
Total Cholesterol:167.0mg/dl
H.D.L:51.0 mg/dl
LDL:102.0 mg/dl
Triglycerides:70.0 mg/dl
Chest P/A View:Normal

Now I am Taking medicine:
1.Leganon 75mg (Sylimarin)2x3 times daily
2.Losartan Potassium 25mg 2 times daily
3.Amino Acid 2 times (Hepa-Merz) daily.
4. Vitamin E 400 mg
5. Vitamin C 500 mg

After 1 month he advised me to made another HCV RNA test report follows:

HCV RBA: POSITIVE
HCV RNA IN IU/ml:4.7x10(7)
HCV RNA COPIES :1.9X1(9)

He adviced me to take pegasys therapy & wants to see the response after 1 months

My questions to you is it fatal for me to go on pegasys therapy while i am suffering Liver cirrhosis?

Thank you.

[HCA]

It is not definitive that you have cirrhosis,although you have advanced fibrosis at least.
Another course of anti-viral therapy is your best and possibly only option.

[HCA]

Re-reading your notes I see that you do have portal hypertension with varices,so cirrhosis is pretty much confirmed.
Same answer though-get back on therapy.
The drugs are only dangerous in so-called  'decompensated' cirrhosis which you do not yet have.

[dhksaife]

Dear Friend,

Thank you.
Unfortunately i failed to get a liver biopsy,so i don't know what portion of my liver are damaged.

Also i am confused on PCR report HCV RNA which done on 27/09/2009 it shows the Virus are not detectable,i am wondering is it possible to increase the viral load with in a month as mentioned above!

do you have any idea?

[dhksaife]

Sir,would you please let me know the symptoms of decompensated cirrhosis?

[HCA]

For the symptoms of decompensated cirrhosis use google,but the key one is called ascites.
Look it up.
Your doctor obviously thinks you have active virus again or he would not want to do more treatment.
If you became virus positive again a few weeks after stopping treatment it is called relapse and quite common.

[newleaf09]

Therapy is not fatal but you must be watched very carefully.  They will be watching you for dangerous drops in platelets and further decompensation.  Successful therapy is about the only thing that can help you now.  If it were me, I would take the doctor's advice.

[dhksaife]

Dear HCA,

Thank you for your advice.
I had my therapy finished on january 2009
HCV RNA & QUANTITIVES Tstes on 21/07/2009
After only one month made same test & it sjows the virul load near 2 crore!!!
Is it possible to relapse the virus within this quantity?
Also I never had ASCITES
I am healthy person,weight 75kgs,height 168cm
No more complication except portal hypertension.

Just clarifying do you suggest to made anotther PCR?

[dhksaife]

Thank you for your nice comments.
Now my platelet counts are 105000
It always decreasing when i am going on pegasys therapy.
My doctor planned to continue with Pegasys 135mcq what you think?

[GoofyDad]

A viral relapse as you experienced frequently results in a spike in viral load. Often this will drop after some time.

Therapy will lower platelet counts. That's normal. Most patients starting at 105,000 will be able to complete the treatment course even though platelets may drop below 50,000. For most liver specialists in the US 35,000 or so is the point for concern - they would likely reduce interferon dosage.

You can also expect anemia and low white blood cell counts while on therapy. There are drugs to help boost those.

If you redo therapy (and you should) you must do something more than last time. More drugs or a longer course of treatment.

[can-do-man]

Like goof said after my first relapse my viral count went very hign, when i started this tx it was lower then its ever been, just over 600,000 go figure. Sense i' have cirrhosis my platelets run around 80, to 90 off tx.

My first tx my platelet count went to the low 30's, this time they got to 29. Neither time did my liver specialist who also specializes in TP's lower my dosage. Odd thing is both times they went back up on their own. From 29 to over 60 in a months time and have been holding study.

Did 86 weeks 2 years ago, just about to finish my second tx and not having any problems being cirrhotic........... Wishing you the best.

cando

[dhksaife]

Thank you.during my therapy my platelet counts never decreased below 60,000
Now my doctor decided to take another HCV RNA test from different path lab than he will go on IFN/RIBAVIRIN (if relapsed viras are confirmed)please pray for me.

[dhksaife]

I got 3 different HCV RNA Result from 3 Different path lab
One pathology reported:HCV RNA Negative(Non Detectable)
(Knowing my Elevated Enzyme level(ALT,AST) My physician advised me to test again)

2nd pathology lab reported:

HCV RNA: POSITIVE
HCV RNA IN IU/ml:4.7x10(7)
HCV RNA COPIES :1.9X1(9)

3rd Report:(National university hospital singapore)
HCV RNA Detected
5.47X10X3 IU/ml (3.74 LOG)
Assay Dynamic Range: 43 IU/ml to 6.90x10x7IU/ml (Estimated 116 copies/ml 1.90x10x8 copies/ml

Serum Bilirubin(Total) 0.94mg/dl ref value <1.00
S.AST(SGOT) 87 U/L ref value <37
S.ALT(SGPT) 125 U/L ref value <40
S.Alkaline phosphate 52 U/L ref value <22-92)
S.Total Protein 8.18 g/dl Ref  value 6.40-8.20

Friends please advice me about my health condition,what should i do now

thanks

[JennyPenny]

You should get evaluated for liver damage by biopsy or one of tghe other non-invasive tests if available, and treat if warranted.

[redrodeo]

Your profile looks just like mine. I had genotype 3, stage four, similiar enzymes. Thinking about doing tx for a 3rd time just didn't seem to make much sense. But for some reason I did. My md wanted me to tx for 48  wks but I was just to sick. So I did it for 24 wks and I am here to tell you I am still SVR 2 years after tx. So it can be done. I remember I went undet after 3 weeks which was very encouraging. But that stuff really frys me. Almost inhumane, but it worked
Red

[dhksaife]

Dear Sir,

I am suffering Hepatitis C,Identified on 2001 was unable to effort the expenses that time.

Started my treatment on 2008 under prof.Mian Mashhud Ahmed,MBBS,MD,PHD,FRCP
Before starting my treatment the blood test results followed:

Ultrasound:Splemagely(enlarged Spleen),liver slightly enlarged & course
HCV RNA:8.33,000 IU/ML
Genotype:3b
ALT(SGPT):175 U/L
Billirubin(Total) 0.7 mg/dl
Alkaline Phosphate:70 U/L

Knowing all my specialist suggested me Inj.Pegasys 180mcq(weekly) & Tab.Ribavirin 1000mg(daily).
Therapy started on may,2008.
after 2 weeks my platelet becomes decreasing quickly 60,000 also my ALT(SGPT)increased to:210.0 U/L
Blood sugar increased to:10.72(R.B.S)

Some how i have reduced the Pegasys dose on 135mcq+Ribavirin 1000mg

My specialist advised me to continue 24 weeks among those 24 weeks i was unable to tolerate
for that reason the dose decreased from 180mcq to 135mcq(Taken total 6X135mcq 1 week breaking injection)
& Unfortunately failed to shot the 24th injection.

After finish my duration of treatment i was unable to check the Viral load,(SVR),RNA test
only tested ALT(SGPT):115.0U/L
Platelet:88,000


On 5/10/2009 I went hospital with some complication
their investigation identified
Ultrasound:Scared Tissues on liver
PT:13.2
INR:1.15
Portal Hypertension.



On 07/21/2009 visited to my specialist Prof.M.M.Ahmed the investigation followed:

Endoscopy report:

Easophagel Verix II-III
(Done EVL first session)
Doudenal Ulcer
R.B.S=5.9
S.ALT(SGPT)73.0 U/L
S.Bil 1.0mg/dl
S.Total Protein:85.0gm/L
S.Albumin:38.0 gm/L
Total Cholestrol 167.0mg/dl
HDL-Cholestrol 51.0mg/dl
LDL-Cholestrol 51.0mg/dl
Triglycerides 70.0 mg/dl
Prothombine time:
Paitent:14.2
INR:1.15
HBsAg:(-Ve)
ANA:(-Ve)
Anti HBs:<3.0 mIU/ml
Anti-HAV IgM:Non Reactive
Anti-HBc:(-ve)

After EVL AST & ALT tested again
Both increased as
ALT(SGPT):125 U/L
AST(SGOT):100 U/L

Then he adviced HCV RNA test

On 09/10/2009 Report follow:
HCV RNA Detected
5.47X10X3 IU/ml (3.74 LOG)
Assay Dynamic Range: 43 IU/ml to 6.90x10x7IU/ml (Estimated 116 copies/ml 1.90x10x8 copies/ml
(National university hospital singapore)

Genotype:Report not found(waiting)

Serum Bilirubin(Total) 0.94mg/dl ref value <1.00
S.AST(SGOT) 87 U/L ref value <37
S.ALT(SGPT) 125 U/L ref value <40
S.Alkaline phosphate 52 U/L ref value <22-92)
S.Total Protein 8.18 g/dl Ref  value 6.40-8.20
Paltelet count 193X10^9/L


Any one please advice me what should be my next steps while my physician are trying to continue Pegasys therapy.

[dhksaife]

Friends,

I have new HCV QUANTETIVE & RNA,GENOTYPE test result.(Non responder or relapse

HCV RNA Detected
5.47X10X3 IU/ml (3.74 LOG)

Genotype:3b

Please advise me is it pssible to continue Pegasys+ribavirin therapy with my present health condition(Portal hypertension,Esophaegal Verix ii-iii)?