Interferon for 81 yr old

[HepDad]

My dad is 81 yrs old - was in the hospital 2 months ago (Oct 2011).  He had a stroke a long time back (1981) and recently had some non-convulsive seizures. The docs put him on Sodium Valporate. While he was in the hospital, his LFT's were perfectly normal.
A few weeks ago (Jan 2012) he got all icteric, eyes were jaundiced and his urine was dark. Did an LFT and his enzymes were extremely high, ALT was 1160, AST was 1450. His neurologist immediately stopped the Sodium Valporate, and told us to see a hepatologist.
After a bunch of tests, my dads HCV RNA came back positive. The hepatologist suggested we wait for a few weeks and repeat an LFT, something about anti-bodies and the infection leaving the system.
Most recent LFT done today (FEb 20, 2012) showed a drop in Bilirubin to 1.4, ALT is 140, AST is 90, GGPT is 259.

Questions:
1. Does it make sense to consider the Interferon/Ribavarin treatment.
2. If he got the Hep C during his stay in the hospital, how long will it take before things get really bad for him.
3. How risky is it to wait and hot do anything.

Thanks for all comments and suggestions.
  

[Willy50]

"Are there any other signs that I should look out for, that may suggest that things are deteriorating. "
=============================

That is what the fibrosure test would provide, but I think that he would need to normalize for it to be of use.

If he is a stage 1, his health could be fine for the rest of his life.  If he is a stage 4, cirrhotic, it might mean you need to get a much better handle on many issues; dirt, drugs, possible upcoming procedures and health issues.  you can call and get a price estimate, but when i had one it was about $325.00 and w/ insurance my co-pay was like 25 dollars.  I'm sure it is more now, but it wasn't expensive.

willy

[pooh55811]

"Are there any other signs that I should look out for, that may suggest that things are deteriorating?"
-------------------------------------------

To be honest, I don't really know. Obviously, if he gets jaundiced again or has dark urine they would be signs of problems. I think that question would be a very good question to ask his doctor.

I hope he does well and I wish you both the best.

[HepDad]

Thanks Willy50

[HepDad]

Thanks willbb -

[HepDad]

Thanks crigger!

[HepDad]

thanks, appreciate your suggestions.
I do tend to agree - time for him to enjoy his remaining years, rather than go through  gruelling treatment.  

[HepDad]

thanks for your detailed  reply.
As I mentioned before, I think we will wait and see how he progresses over the next few weeks.
Also, no way of knowing where and when he got the infection. In the hospital, his ALT was normal - They did an LFT a couple of times to see how he would react to the Sodium Valporate, but 6-7 weeks after that, things flared up.
Now he is on a liver friendly diet, moderate exercise (20 min walk daily), and no alcohol.
Are there any other signs that I should look out for, that may suggest that things are deteriorating.
Thanks again!

[HepDad]

thanks for your reply.
I think we will wait and see how he progresses over the next few weeks.
He is on a liver friendly diet, moderate exercise (20 min walk daily), and no alcohol.
Are there any other signs that I should look out for, that may suggest that things are deteriorating.
Thanks again!

[Willy50]

I think you  ask a good question, but the answer interferon is a tough treatment and really...... you don't yet know if it is really indicated.

Your father may have a challenged liver, that in the face of taking

http://en.wikipedia.org/wiki/Valproic_acid
".........Preexisting severe hepatic (liver) and/or renal (kidney) damage and certain cases of metastatic cancer, severe hepatitis or pancreatitis, end-stage AIDS HIV infection, marked bone marrow depression, urea cycle disorders, and coagulation hematological disorders that have caused impairment are absolute contraindications."

....."Temporary liver enzyme increase has been reported in 20% of cases during the first few months of taking the drug. Inflammation of the liver (hepatitis), the first symptom of which is jaundice, is found in rare cases"
===============================

I think your dad may need to recover from the drug, and allow his normal blood chemistry to return.

I think you might also be well served by getting a simple blood test, a "fibrosure
type test, available from LabCorp
http://www.mayomedicallaboratories.com/test-catalog/print.php?unit_code=91402

You will get the results probably within a week and an assessment of your dad's liver damage staging.  This in turn will help you understand your next course of investigations and actions.  You may not need to take any medical interventions.  

Sometimes it is wise in investigate before acting.  An *informed* course of action is what your dad needs.

Willy

[willbb]

Most doctors are very reluctant to treat the elderly. I realize "elderly" is a "relative" term  ,however once one hits the age of even 65 and most assuredly 70 ,doctors are concerned with the possible underlying health issues one has to be able to navigate without adding HCV treatment to the mix and possibly adding all sorts of other problems..

Hope your dad is ok and best wishes to you both...

Will

[crigger]

All I can say is if it were me and I was 81 I would pass on treatmemt. This treatment is really rough on a 58 y/o. I  did treatment at 48 the frist time and there is a big difference on how I feel. Hopefully his liver does not have too much damage. I know the valporate can cause problems to a heathy liver. So once that clears hopefully he will see that his liver is not that bad.   Good luck . I know its difficult to see your Dad sick.

[orphanedhawk]

He's 81. He's already beat the odds for a male.
Interferon tx isn't easy. It's hard emotionally and physically.

My advice would be to keep him on a liver friendly diet, no alcohol, and let him enjoy his final years.

[pooh55811]

I am sure the experts will respond to you because they know more than I do about Hep C. However, I will offer my general opinion about this situation based on what I do know.

First, do the doctors think he contracted Hep C during his recent hospital stay? If so, did they say how they think he contracted it? Hep C is transmitted from blood to blood so he would have had to have had infected blood somehow get into his blood stream. (This, of course, is possible, but far less likely than it used to be. A tiny percentage of the blood supply can still be contaminated. Also, the possibility of improperly cleaned and contaminated equipment does exist and thus presents a vehicle for transmission.)

Second, I would follow the hepatologist's advice and wait to see how things go. If his infection is recent, he could clear the virus on his own (about 20% of cases do clear on their own). He would still have the antibodies but not an active infection. The doctor would need to repeat the HCV RNA test to determine if the virus had cleared or is still active. LFTs will not tell him if the virus has cleared on its own. Most people who have chronic active HCV have normal LFTs until they have major damage to the liver, usually many years down the road.

Third, your father is 81 years old. Interferon and Ribaviron are powerful drugs which bring with them many side effects, some minor and some much more problematic. The older a person is, usually the more difficult treatment can be. I don't even know if a heptologist would consider treating a person who is 81. In addition, you do not mention which Genotype your father has. The treatment varies depending on the Genotype. Treatment for Genotype 1, which most people in the US have, usually involves a third (also very powerful) drug with many side effects in addition to the Interferon and Riba. Your father, at 81 years of age, may not be able to tolerate the treatment.

Fourth, most of us have had the virus as a chronic active disease for 20, 30, and 40 years. Hep C can sit around for years without producing significant damage and without progressing significantly. Of course, progression is not linear and people are different so no one knows exactly how long progression will take in specific cases.

Fifth, at the age of 81, I think I would follow the doctor's plan and opt for a wait and see approach. Even if the virus does not totally clear, I would be extremely reluctant to treat at 81 years of age due to the reasons I mentioned above.

I am 66 years old and treating (in week 22 of 48 weeks treatment). This is a difficult and grueling treatment with many side effects, some severe and some not so severe. It is hard on me. It is hard on people younger than me. Some develop severe side effects and have to stop treatment, but even if they do not develop severe side effects, the other side effects can be a problem and need to be controlled, often with other medications. In addition, treatment can worsen some pre-existing medical problems. Normally I think it is best to treat when one discovers the active and chronic Hep C virus, but there are several reasons I think that. First, most people have had it for a long time. Second, usually by the time people find out they have it (often 20, 30, 40 years down the road), the disease has progressed to some point and caused some liver damage. Third, the disease tends to progress faster as one ages. People tend to develop diseases as they age. Therefore, I think it is best to eradicate the virus before it causes more damage and/or before one develops a disease or condition that would prohibit them from treating. However, I am generaly thinking of people in their 40s, 50, 60s (who potentially, if they did not have progressive liver disease, would still have 30-50 years of life left). I am not thinking of people in their 80s.

So, again, in your case, I would do as the hepatologist recommends. If things do not resolve, then other options could be considered, although I highly doubt a doctor would think it wise to subject an 81 year old to the grueling Hep C treatment regimens.

I wish you both the very best and I hope his Hep C resolves on its own.

[SusieS2010]

Interferon and ribavirin are not approved for someone your dad's age. It is likely that he has had hep C for many years and didn't know it. It is a slowly progressive disease. It is also possible that his medication caused a flare of the disease and that is why he became icteric, etc. I think it is more risky to try and treat HCV in a person of such advanced age. It takes decades for hep C to become a problem in most people. It is extremely unlikely he got hep C during this hospital stay. How would he have gotten it? The blood supply is safe and all hospital caregivers use universal precautions.

As long as your dad is under a physician's care I think it would be safe to take a wait and see approach.

I am not a doctor, but those are my feelings. I wish your dad the very best and hope he gets back to good health very soon. He is lucky to have you as his advocate.