Question for my dad

[Curious2010]

Can someone please help me answer my question about my father since I'm unclear on what we should do.

My dad have contracted Hep C for almost 15 years now. He is currently 85 years old.

Blood tests showed that his viral load is in the millions: AST: 265; ALT: 227: AFP marker: 69

However, ultrasound and MRI findings are considered normal and does not reveal any mass or signs of lesions that would be indicative of liver cancer. He is also a Hep B carrier but his viral load is UND.

His doctor recommended treatment with Pegasys because of the high viral load. However, considering the age of my dad at 85 years old, we are worry that he may not be able to withstand the side effects of the treatment. The doctor recommended Pegasys treatment at a half dose of  90 ug per week injection and see how he progress. The normal dosage is 180 ug per week.  

We asked around for second and third opinions from specialists and they are reluctant to start him on the treatment because primarily of his age and other medical conditions such as carotid stenosis, some heart problems.

We are concerned that if left untreated, it may accelerate to liver cancer. At the same time, if the drug  Pegasys  offered great promises with slight risk, it may be worth it.

Should we leave it untreated and hope that his immune system can fight off the high viral load? Currently, he is healthy for his age.

Thank you, any advise, opinions, point of views, would be greatly appreciated with much respect.

My dad said he want to try it but currently he feels very healthy.

[Mr Liver]

There is no need for concern about his viral load. It is irrelevant unless treatment is decided on and even then it is just one of many predictors of success and not too much weight is given to it. The elevated enzymes are more indicative of viral activity and much more significance is placed upon those findings when considering tx options. Your dad's are considered to be very high. Make sure the doctors explore every possible reason for elevated enzymes such as medicines, both OTC as well as Rx, close proximity at home to any possible toxins, etc.

AFP is not an extremely reliable tumor marker and even less so in those with more advanced disease. I would not place much weight on this lab value, especially in lieu of the fact he has had 2 other much more reliable diagnostic tests to look for lesions, nodules, etc.

Age of course is the main factor behind this decision that your dad is facing. Just how sick is your dad ? Treating to allay cancer fears would not be a decision I would personally make. Primary cancer risk is very low (1%-5%) and getting tumors is not a death sentence , especially with close monitoring. Many tumors can be eradicated using several different methods that have a proven track record of success.

Without knowing the stage of disease of your dad's liver it is impossible to state with any degree of certainty which course of action I would take in his shoes. However if I were 85 and cirrhotic I most likely would not treat. Super low odds of clearance, a good possibility that tx could inflict more harm than to help, and results that could include a worsening of general health resulting in a reduced quality of life for my remaining days would be enough to probably dissuade me from attempting tx.  

OK--the decision is always with the patient. If for some reason your dad wants to undergo tx after consideration of all the known risk factors ( incl the ones you listed) I would get in contact or have a treating doctor of your father's do so with Dr Greg Everson at the Univ of Colo and discuss LADR (low  accelerating dose regimen) and how, if at all, it could possibly play a useful part in a tx plan for your father. Best of luck to you and your father.
ML

[rockin516]

that would be  hrd decision just do to the age, but wht does he want,and you said he has cardiac problems did you talk to his cardiologist about treatment well good luck to your dad and family!!!

[Isobella]

Excellent advice from Mr. Liver.

Without a good idea of liver damage, it's impossible to decide.  Even with one it's tough.  If he is cirrhotic and has a low chance of clearing, might not be worth txing.  But if he has little liver damage at this point, why risk any potential risks of  sx from txing.

The hcv could really never be a factor in the scheme of things.  It is human nature, though, for us to just want to be rid of the virus at all costs.  I know it was with me.  But I'm 47 and otherwise healthy.

One possibility is to tx for the first 4 weeks and determine how he is responding virus-wise and sx-wise and go from there.

Of course, the final call has to be made by your father.  Make sure he has access to good information and let him go from there. This site is  a great source.  Google Janis and friends.....iti's very helpful too.

Tough call.  My heart goes out to you and your family.  Please keep us posted.  

Isobella

[WriteItDown]

If I were 85 there's no way I'd want to do this treatment. At that age I would want to preserve quality of life for what remained, and treating with pegasys could seriously compromise 6 or more months of his life.  

Of course I am not a doctor, but I'm frankly surprised anyone would recommend pegasys for an 85-year-old person.

Best of luck to you and your dad.

[nygirl7]

Very good advice from the folks above.  If you  knew he  was at a low stage of liver damage I would say to try and live the most liver healthy lifestyle possible and forget treatment.  Most people who find out when they are in their 40s are told that they will most likely die of something else well before their livers will be the cause.

It really is a tricky situation - if he could get a biopsy it would help a lot...especially if he has cardiac issues it just might not be worth it.

Any chance that they could do one?

[Curious2010]

Thank you everyone for your inputs. It's heartfelt to know how many people care.

My dad is healthy right now. The doctors said there is no tell tell signs of liver damage of any kind. Hopefully, it will stay that way.

The docs do not want to do a biopsy because of age. But ultrasound and MRI revealed nothing significant.

His internal medicine doctor insist that we treat him NOW , the same doctor that insisted we operate on him to remove the plaques build-up in his carotids.

It's a tough decision. I can't bear the pain of watching him go through this at his age.

15 years ago, he was on interferon for Hep C for a year and it was successful . That is the reason why he feel like he can do it again now. What a strong man.

So from what I read, it's best to leave it alone.

My dad is taking alot of other medications such as high blood pressure pills, etc, nothing for serious conditions.

[WriteItDown]

How much does your internal medicine doc know about Hep C?  Blockage in the carotids is one thing -- but likely to be a much more immediate issue than Hep C.

Were the "specialists" you consulted for second and third opinions hepatologists who treat a lot of Hep C patients?  If so, I would certainly take their opinion seriously.  A hepatologist will know much more about the benefits and/or drawbacks of treating -- or not treating -- someone your dad's age with Hep C. If you did not have a consult with a hepatologist I would recommend that.  It could put your mind at ease regarding what to do.

By the way I agree with not doing a liver biopsy.  For a young person it's relatively safe, but there is certainly the risk of bleeding, which I imagine would be much higher for an older person.

It sounds like the docs who already gave you second opinions are reluctant to treat him.

[Isobella]

The docs don't want to do a biopsy because of his age, but the IM doc wants him to tx now?   As Write says above, if you're not hearing it from a hepatologist, rethink.

You state that he was on tx  15 years ago for one year and it was successful.  So he tx'd when he was 70 and cleared?   Did he have a biopsy back then?  Doesn't make much of a difference in the advice given so far...just trying to clarify.  

[Joey_M]

Many doctors do not balance quality of life against medical treatments. At 85, treatment would be very difficult on him and would have not have a very high chance of clearing the virus anyways. Going through and recovering from treatment is difficult enough for someone in their 40's or 50's (I have done treatment twice) but I can't imagine how it would be for someone who is 85. Given his age and the fact that most people with Hep C do not progress to cancer anyways, why would your father want to go through with this? Tell you Dad to enjoy his remaining time on this earth and not put himself through the treatment.