Treating vs. watching-and-waiting

Just curious to hear some opinions on my situation.  I'm a 36 y.o. male, diagnosed right after Christmas (bummer!), think I might be infected 4 months (caught it from a bad cut on a gas station pump handle--ouch!).  I don't know genotype (yet) but I'm guessing I'm a 1.  My ALT, tested 4 times in the last year has ranged from a high of 17 to what it is now, 14.  My AST has ranged from a high of 16 to 11 now.  My viral load was 4,057.  The only thing troubling me has been my AFP, which peaked at 20.9 n/g, was 18.4 n/g a month ago, and I'm currently awaiting the results of what it is now.

I'm wondering...if indeed I am acute (I had no risk factors other than filling my car with gas, which is a new one, I'm sure!), would it be smarter to treat?  My doctor has given me 50-50 odds, and says if I don't clear it in the next several months, I'll see a liver specialist, though I'm asking to see one ASAP.  Would treating be a viable option?  I'm not even sure if the patient can demand to go on treatment, if the doctor says no.

Thanks in advance for any responses!

[jboyhk]

There are very few studies on treating acute HepC since it is generally symptonless and people never really know if they are acute or chronic.

Saying that, if you are acute, you do have up to a 25% chance of just clearing it on your own.

[Forseegood]

I can only tell you what I'd do in your situation, no way would i treat if I was only acute...figure it this way, I was acute over 30 years ago and I've had a long and happy life till just recently, as the virus is now rearing it's ugly little head at me...this virus is slow going for the vast majority of people who have it, and there will be new things on the horizon, especially in the next 10 years, and you have at least that long before you have to worry about anything, course I'm only guessing based on experience and reading and hearing....I know I'm going against the thinking of a many on this board, some good friends, ha ha! but no way would I treat with this particular protocol if I were you, and of course I'm not...

I've gotten a lot of guff for waiting as long as I have, but I'm glad I've waited this long on one hand, in that they know a lot more then they did just 5 years ago...but then maybe *I* should of treated before now (I'm 53), at least you could make a case for it, but that's my case... but in your shoes? naaah....these aren't optimum drugs and they don't have sterling success rates as they are now...we have a disease that doesn't devastate right away, which is about the only good thing about it....just MY  opinions....

[dointime]

You are in the fortunate position of knowing how and when you got the virus.  This makes you comparable to a health care worker who contracts acute hepC via needlestick.  A minority of people do clear hepC spontaneously in the acute stage, however if you do treat in the acute stage then you have a much higher chance of success than if you leave it.  I recommend that you enquire at your healthcare facility how they treat needlestick accidents and get fully informed on your situation.  Bear in mind that advice on how to handle chronic hepC may not apply (yet) to you.

dointime.    

[debnevada]

Here is what I have learned. I am identified by Gish and company as an acute. I got this somewhere around November 23-26 of last year.  The SOC for acutes in Gish's group is treat at 3 months and no later than six. I started two weeks ago.  My geno is 4 and my pcrs were
42,000
192
last one 4000

the numbers that i have seen for acutes are higher than chronic and potentially a shorter treatment length. initially i was told 72 weeks!...then 48.  I am hoping for 24 weeks. Gish's groupo doesn't do a pcr until week 12 but my internist will order one for me tomorrow (2 week) and again at four.

The treatment is progressively getting rougher now with regards to fatigue for me and increasing sides but no anemia as yet.

my personal opinion is ...if you have a favorable window, use it.

deb

[mikesimon]

From: A Short Course of Pegylated Interferon-alfa in Acute HCV Hepatitis
See: http://www.medscape.com/viewarticle/554480?src=mp

"In conclusion, this study describes the second largest series of patients with AHC treated with IFN so far and confirms that higher cure rates are achievable during the acute rather than the chronic phase of HCV infection. The 12-week regimen leads to an SVR rate equal to that achieved with a 24-week regimen, provided that a full dosage of peg IFN is administered. Moreover, the adherence to this regimen is complete, making it suitable for difficult-to-treat populations such as IVDUs. Should higher doses prove to be consistently more successful, the possible increased burden of side effects will be likely counterbalanced by the shorter treatment duration. As best results are achieved in patients with early (4 weeks) viral response, we suggest that this short regimen could be recommended to this subgroup, and a longer treatment schedule or possibly the addition of ribavirin could be limited to late responders in order to reduce the relapse rate."

Mike

[timedog]

how is it possible to get hep c from cutting oneself on a gas pump?

[nygirl7]

I agree with the other guys - plus the 'way' you believe you contracted it really sounds a bit odd.

Since hep is a blood borne virus - you have to have blood to blood infection and well unless the person before you cut themself with a hacksaw right before you did - I just don't see that making any sort of sense.

Perhaps you have had it longer than you believe.

What made you go and get tested in the first place? Usually there has to be a pretty valid reason before a doctor will order an expensive test.

[jmjm530]

time: how is it possible to get hep c from cutting oneself on a gas pump?
-------------
I suppose one might be engaged in some high-octane activities :)

[jmjm530]

Your diagnosis of "acute" is questionable. Many of us don't have classical risk factors and the gas station incident, while possible, seems unlikely.

Also, one would expect spiked liver enzymes in the acute phase, and yours appear to have been normal.

Personally, I'd get that referral to a liver specialist (hepatologist) and let them poke around. They may want to do further testing, including a liver biopsy to determine how much liver damage you have. If you don't have much damage, you have the option of not treating and waiting for better drugs.

You also want to know your genotype. If your current doctor did a viral load test, I'm assuming he did a genotype test as well. Hopefully, your doctor is correct and you are acute and you will clear on your own, but best to cover bases and get a more expert opinion from someone who specializes in liver diseases.

-- Jim

[shastri20032003]

I was diagnosed as an acute case last september facing the same million dollar question that you are facing....to treat or not to treat

I had jaundice with high ALT/AST in the  900's

I was advised by one hepatologist to treat immediately as my chances of beating the virus would be higher the faster I started treatment

Another hepatologist advised me to wait for 3 months or max 6 months before starting treatment since acute cases have a 20% chance of clearing spontaneously
I did a lot of googling on acute hep c and treatment and both the hepatologists seemed to be right in their own way!

I decided to wait for 6 months and  hoped I would clear spontaneously which didnt happen and started my treatment beginning of march

Guess the ball is in your court......to treat or not to treat
Hope this helps
Regards