Should I wait for Treatment?

[Biju]

Dear
now Iam 32yrs old. at15yrs during blood transfer(1992)cought HepC.
Recently found HCV positive 5.3, Viral load 21lacIU/ml. LFT Normal.
Ultrasound normal. Genotype1.Liver biopsy normal Necro inflammatory score 1/18.
fibrosis score 0/6.
Should I start treatment or Not.

[mkp13]

Before deciding to treat at all, find out everything you can about progression and childhood exposure.  There are some people who just don't progress toward cirrhosis and some who progress extremely slowly.  People exposed as kids may have a better prognosis (though the science in some of the articles is pretty shaky).  If you're lucky and haven't had any damage after 15 years (as it seems from what you're telling us), think long and hard before starting a treatment regimen which has unpleasant side-effects while on it (as the current interferon/ribavirin therapy does) and on rare occasions produces problems that last the rest of your life.  At a minimum, consider delaying treatment in hope of better approaches.  There's a HUGE amount of research going on right now on how to best treat HCV.  You're well-positioned to benefit from that if you're willing to wait a decade or so.

--mkp (infected at age 5 in 1963; now stage 1; in treatment now, but considered waiting another decade before trying it)

[Isobella]

I remember not too long ago having to make the same decision you are facing.  I am going through the same process with my daughter right now as well.

The decision to treat is so personal.  With your stats it would seem like you have time to do research and learn about all your options.  In my experience, the more information I gathered the easier my decision became.  

Everyone has made excellent points.  Take this information and begin researching...read all through the forum.  And the archives and expert forum.

Tx is a huge time commitment-anywhere from 24 to 48 or 72 weeks.  That factor may play a part in your decision to tx or wait.  

I decided to tx in a trial with one of the new PI's.  My daughter is leaning towards SOC next summer.  I am leaning towards her waiting for the new drugs.  We are both geno 1s.  My VL was 919,000, hers was 400,000. I have minimal damage....her-- we are waiting for the biopsy.

Bottom line....learn as much about HCV as you can.  Ask questions.  We have all been where you are now and are here to help ya through.

Best of luck

Isobella

[Trinity4]

"The current drugs are interferon and ribavirin, neither of which was developed for Hep C and have been likened to using a sledge hammer to drive in a nail, while the newer drugs try to target the virus and leave the rest of the body alone."

The newer drugs are still in the trial phase and the data available is indicating some nasty side effects also.  Severe skin problems associated with Teleprevair and I'm pretty sure I've read blood levels tank rapidly too.  Just pointing out that the newer drugs appear to be much more effective but not without risk either.  Not enough data yet to establish what long term effects may be.  I wouldn't want anyone to think that waiting for the newer drugs would ensure a smooth ride through tx.  Hopefully by the time they hit the market improvements will have been made.
Trinity

[Marcia2202]

Excellent advice and great wording. I would save it for people to refer to in the future!!!

[jmjm530]

To be exact, substitute "newer therapies" with "newer drugs" in the above. For the moment, newer therapies include current drugs but with less exposure. Further down the road, they may replace the current drugs entirely. The current drugs are interferon and ribavirin, neither of which was developed for Hep C and have been likened to using a sledge hammer to drive in a nail, while the newer drugs try to target the virus and leave the rest of the body alone.

-- Jim

[jmjm530]

If I read your fibrosis score correctly then you have zero liver damage. This, combined with your hard-to-treat genotype (1) and  young age, makes the strongest case I can imagine for waiting for newer and better drugs instead of treating with today's drugs. Newer drugs promise a better cure rate in half the time. And further down the road, things might even get better than that. Meanwhile, get under the wing of a good hepatologist and track your liver health with  biopsy every 3-5 years or alternatively use the less invasive "Fibroscan" when it becomes available. The current drugs are not without risks both during and post treatment, spend some time both here and elsewhere independently studing the pro's and con's of treating. Another good site is Janis and Friends.

-- Jim

[moahunter]

It is a trade off between waiting for new drugs, or treating now.

The advantage of treating now is there is uncertainty as to how long the new drugs will take. Another advantage is that the new drugs will likely be an "add on" to existing treatment - so by treating now, you may actually take less poision.  Further, we don't know what the new drugs will cost, and whether or not insurance will cover (they may decide to only cover those who have failed SOC).

On the flip side, the new drugs "may" work over a shorter period of time. Treatment is not pleasent, so if the length of time could be reduced - that would be preferable.

At the end of the day, it depends on how you feel. One option is to try SOC (current treatment), and see how you respond. If you are RVR after 4 weeks (i.e. no virus left), then SOC may work very well for you, in which case you are probably just as well off under existing treatment, as waiting for the new ones.

[Bill1954]

There are no doctors in this forum; only patients dealing with HCV. It’s difficult to offer advice based on the scant info you’ve provided. However, with the minimal damage you report, a case could be made to wait until the release of the protease inhibitor class drugs currently in clinical trial. These show promise of better response with genotype 1 patients, with the possibility of reduced treatment duration as well.

Collectively, the new therapies are known as STAT-C (Specifically Targeted Antiviral Therapy); you should contact your doctor for more information about the timing and availability of these drugs.

Bill