On dialysis and Hep c

I have been on dialysis for a year now. They think the Hep C ruined my kidneys. They also found out about a year ago I have Hep C Geno 2. I have had this for many years apparently because I was given blood when I had surgeries as a child (now in my 50's). I started treatment of Interferon and Rib. last January and they ended it the beginning of Sept. I had to take reduced dosage due to side effects. My blood test all came back good..until this week- its back. The doctor said the numbers are much lower than when they initially started treatment and wants me to do another 12-16 weeks of treatment at a higher dose. I don't know if I can take it I could hardly breathe and blood count was so low I was getting weekly injections for it also. If I don't I can't get a kidney transplant though so I'm between a rock and a hard place. Has anyone been in this position before? Any help appreciated.

[Trinity4]

I don't think 12-16 weeks of treatment even with the full dose of interferon and ribavirin would be effective.  I don't understand your doctor's logic.  Generally, if a geno 2 relapses and treats again the duration is usually 48 wks.  It looks like you did 8 months at reduced dosage.  Given the kidney disease it may be dangerous to full dose.  

Have you spoken with a hepatologist?  If it were me, I would definitely have a liver and kidney specialist on board before I attempted an further treatment.

Trinity

[philbert58]

And I thought I had it bad. I'm with Trinity4 that I'd certainly bring a hepatologist or specialist on board. On the flip side geno 2 is the easiest of the genos types for a complete cure. I'm not so sure your doc isn't making a good call at just 12 to 16 weeks with geno 2. I have 2 friends that were cured with soc. Both were hep-c geno 2. One went 24 wks and the other dropped out at wk 20. Both have been SVR "cured" for over 10 yrs. If there's such a thing as having a good Hep c it would be Geno2. Good Luck Joyceanne, I'll keep you in my prayers...

[Diane12855]

What kind of doctor are you going to? You really need to be seeing somebody who deals with lots of HCV cases and knows about all of the newest advances. Your health is so important that you should find another doctor if this one isn't good enough.

Diane

[mikesimon]

Impaired renal function often necessitates a lower dose of ribavirin and in some patients ribavirin is not appropriate.

"Patients With Renal Failure or Receiving Dialysis

Unfortunately, patients with renal failure or patients who are receiving dialysis are difficult to treat because we cannot use ribavirin in these patients. Ribavirin is renally excreted, and if there is impaired renal function, ribavirin blood levels are higher and hemolysis is greater. This is a population in which viramidine might be of some use. If creatinine levels are greater than 2 times the upper limit of normal, ribavirin is generally not used. A reduced dose of ribavirin has been used in some patients with creatinine levels less than 2 times the upper limit of normal. Since many of these patients are infected with HCV genotype 1, the efficacy of peginterferon monotherapy is reduced, and oftentimes these patients are not treated.

In patients with membranoproliferative glomerulonephritis due to hepatitis C, there can be a benefit from peginterferon and ribavirin, particularly if there is an SVR. Oftentimes, these patients have cryoglobulinemia and antigen-antibody complexes that are involved in the development of the renal disease. Treatment in the absence of viral eradication is helpful for some patients. One of the bigger limitations in the use of ribavirin in renal failure patients is the lack of an accurate, reliable, and rapid test to determine ribavirin blood levels."

http://www.clinicaloptions.com/Hepatitis/Annual%20Updates/2005%20Annual%20Update/Modules/Bacon/Pages/Page%206.aspx

[nygirl7]

You da killa Michael ;) I had to stop you  :D

[merryBe]

go figure, within 2 days we find we can get a transplant for 60K.

oh joy.

Look Joyce ann, first I'm sorry you are going through this. Secondly, if you were transfused that may be why you are now having kidney problems, not the hcv but likely the complex create by transfusions which puts the immune system into a tail spin. Transfusions creat antigen antibodies that cause issues throughout the body, and also make one a poor candidate for any transplant so I wouldn't rush out looking for organs here.

If it were me, I'd think long and hard before starting tx again. I don't know what stage/grade you are in now, but new drugs coming may lessen the impact on the kidney and require less ribavirin, they are working on this as they know this treatment is majorly difficult. Sorry for your trouble.

mb.
Meanwhile you need to search for a hepatologist, not a Gastro doctor, a LIVER doctor.