Odds of clearing

[Upbeat]

You always hear about 50/50.  I will be talking to a new liver doc soon and making up my mind as the best course of action.   I am a male  62  with diabetes,  have had the virus for over 30 years,  geno 1b,  last week my viral load 2.5 million (down from 7 million 4 years ago)   The blood work from the fib-4 and halt c show Cirrosis.  Over the last 2 years platelets have gone from 169 to 121.  Last test even showed protein levels were up.  ast 125 alt 204.   The diabetes is liver caused as I am 6.0 and only weigh 165 lbs and no history in my family.  I am sure the doctor will want to do a biopsy to confirm the Cirrosis but there is not much doubt in my mind.  The question is what truly are the odds with someone with Cirrosis and the other neg factors odds of clearing.  We come down to the quality of life or quanity.  What are the odds of making a bad situtation even worse with the dangers of Tx.  Sorry about the long post just trying to come to grips.
                                                                                                                                                             Ron

[fretboard]

If you look on pubmed I'm sure you can find something on hcv and cirrhosis.  I will leave what I found, but there is alot more information on that website.  Also, there have been a couple of ppl tx on this forum who were cirrhotic and are now SVR.  Maybe they will chime in here later in the day.  good luck

Antiviral therapy in hepatitis C virus cirrhotic patients in compensated and decompensated condition.

Iacobellis A, Ippolito A, Andriulli A.
"Casa Sollievo della Sofferenza" Hospital, IRCCS, viale Cappuccini 1, San Giovanni Rotondo 71013, Italy.

The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance (SVR), halt disease progression, and prevent re-infection of the liver graft. However, while the medical need is great, the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological cytopenias. We have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis, due to hepatitis C virus (HCV) infection. In cases presenting with bridging fibrosis or cirrhosis, current regimens of antiviral therapy have attained a 44%-48% rate of SVR. In cirrhotic patients with portal hypertension, the SVR rate was 22% overall, 12.5% in patients with genotype 1, and 66.7% in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of ribavirin. In patients with decompensated cirrhosis, full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35% overall, 16% in patients with genotype 1 and 4, and 59% in those with genotype 2 and 3. Use of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side effects. Major benefits after HCV eradication were partial recovery of liver metabolic activity, prevention of hepatitis C recurrence after transplantation, and removal of some patients from the waiting list for liver transplant. Several observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve (Child-Pugh-Turcotte score >= 10). Although SVR rates are low in decompensated cirrhotics due to hepatitis C, these patients have the most to gain as successful antiviral therapy is potentially lifesaving.

PMID: 19030197 [PubMed - indexed for MEDLINE

[moahunter]

I think it is difficult to predict odds as there are so many different factors that can influence. It seems to me, the best way to find out your odds, is to do between 4 and 12 weeks of treatment and see how you respond (both to the virus, and the side effects). If you don't respond well, you will know your odds are low, so maybe stop. But with RVR or similar, your odds will be very high, so carry on.

I don't see the downside to "giving it a go". At least, that was my logic. True, you may be one of the unlucky ones who has an adverse reaction to interferon, but any treatment for any illness, can be like that.

Whatever you do, good luck.

[nygirl7]

I would be definitely proactive about trying to stop this disease from spreading further.  Some of us have treated and found that we were not in the 50/50 range and had to treat longer. I do believe that your diabetes and cirrhosis can make it harder for you to clear however - you might be on of the people that respond rather easily for some reason.........you can't know unless you try.

That is definitely a better option than doing nothing - that practice hasn't gotten you anywhere good at all.  I wish they had advised you to try earlier.

Good luck.

[justme53]

"The question is what truly are the odds with someone with Cirrosis and the other neg factors odds of clearing.  We come down to the quality of life or quanity.  What are the odds of making a bad situtation even worse with the dangers of Tx. "

That's a question we'd all like answered when contemplating tx. I also have cirrhosis (1a) and am 14 weeks into tx that was tailored for my personal issues. So far it's working..I had a complete EVR at 12 weeks with the higher dosing.

One of the most encouraging things for me, is that if I SVR, even with a cirrhotic liver, indications are that the damage CAN regress...and that's something I'm willing to fight for.

http://natap.org/2008/EASL/EASL_75.htm

For me, a Stage 4 with Grade 3 inflammation, my non-treating options ran out and I began to look harder at the percentages that DO clear, as opposed to those that don't.
And I'm not getting any younger plus being infected for 35 plus years.

It does all come down to some serious soul searching, doesn't it?

Good luck finding a decision that's right for you......Pam

[newleaf09]

I am a 1b with cirrhosis and over 30 years of virus, too.  I had the good luck to have a low VL and am doing well on treatment, in spite of the fact that cirrhotics don't normally respond as well as non-cirrhotics.  

Number one is to remove as many stressors on the liver as possible.  NO alcohol, no NSAIDs, nothing unnatural that the liver has to filter out.  Cells have been highjacked by the virus, so they scar over instead of doing their job correctly.  

There are 2 new proterase inhibitors (boceprevir and teleprevir) that will hit the public market in the next 2 years.  They are as rough on the blood as the standard drugs but can be monitored well by a decent doctor.  They greatly increase the chances of success.

It comes down to the virus being the last stressor, so if it can be cleared with the triple drug therapy, and you don't go back to adding the other stressors like alcohol, the damage can actually reverse.  Of our internal organs only the liver can repair itself. Regressing 2 stages (from 4 to 2, say) after successful treatment is not uncommon and people have even done much better than that.

It takes a year after eradication of the virus for the scarring to break down.  I will get another biopsy (by choice) a year after I finish treatment and then should feel confident enough to move on with my life.

Even if you don't succeed in clearing the virus, treatment can repair enough cells to give you more time and put more distance between you and decompensated cirrhosis.  Quality of life is only an issue if you believe that you will die. Keep trying.  Don't give up.

[Upbeat]

Thanks for all the imput. Its much appreciated. I decided to at least kick this around with a liver doctor and maybe do the biopsy,  if that is really needed  seeing how all the blood number come up cirrosis.  I tried to make an appointment at the UMC here in Tucson and the best I could do was a Nurse Practisoner on June 2.  Can you believe that?  I amagin I know more about hep-c that she does.  I remember when I saw a Gastro guy a few years ago and asked him what he knew of the halt-c trial and he didn't have a clue as to what I was talking about. I am thinking about checking with Mayo in Phoenix but the last time I tried to deal with them they would not acccept Blue Cross Blue Shield. They were not willing to accept what Blue Cross was willing to pay.

[FlGuy]

A few months wait to get into a liverhead is not that surprising.  The U of Miami has such a wait time and many people on this forum have put in the wait. So, keep the appoint as you look for other alternatives.  The high-volume and experienced groups can be worth the wait, even if it a consult.  I'm not sure about the nurse though, one of the MDs at UMC is the way to go.  You had it for 30 years and although the right time might be now waiting to get the right attention might be worth a little more time.  Good luck.