TB treatments and the effects on hep c

[Paddie13]

Okay, I'm being treated for TB and I also have hep c, is anyone else going through the same and if so, how has it effected your liver ~ I live in a little town and the doctor treating me says this area is not funded for lab work ~ I have 4 months left for this treatment before they start my hep treatments ~~
Thanks for any news ~~

[CoWriter]

I'm afraid there's no way of knowing.   Hopefully we can prevent the same thing from happening to others.

Co

[CoWriter]

I'm glad it worked for you.  Make sure they repeat the test every time they refill your meds and when you finish the treatment.  

Best of luck to you,

Co

[sunshine585]

Thankyou for posting the TB tx guidelines. It was especially interesting to me, as you can see by my above posting, I had concerns re liver damage. I wonder if my liver bx would've been much different before the TB meds.

[Paddie13]

so I am scheduled for blood work this Friday morning, thank you co-writer for posting this info for me ~~ it helped in my plea to get them off there bums and do there jobs ~~
have a great day ~~

[Paddie13]

thank you for the info, thats scarey that my Dr. does not test me regularly ~ I'm going to print this out and take it over there today and demand that he either test me or send me somewhere that I can get tested ~~ again thank you ~~~

[CoWriter]

What they're doing is illegal.  You cannot treat somebody for TB with drugs that can potentially damage the liver without doing blood tests to check for damage.  That's just not done (also, one of the medications requires color vision testing).  It's unsafe and they're risking your health.  You need to complain to somebody.  Whoever is above them....or your state official.  By law they can't let you go untreated but there are guidelines they have to follow.  

Here's what the TB treatment guidelines say.....

"Role of the Health Department

The responsibility of the health department in the control of tuberculosis is to ensure that all persons who are suspected of having tuberculosis are identified and evaluated promptly and that an appropriate course of treatment is prescribed and completed successfully.  A critical component of the evaluation scheme is ACCESS to proficient LABORATORY SERVICES FOR WHICH THE HEALTH DEPARTMENT IS RESPONSIBLE.

For all adult patients baseline measurements of serum amino transferases (aspartate aminotransferase [AST], alanine aminotransferase [ALT]), bilirubin, alkaline phosphatase, and serum creatinine and a platelet count should be obtained. Testing of visual acuity and red-green color discrimination should be obtained when EMB is to be used.

Routine measurements of hepatic and renal function and platelet count are not necessary during treatment unless patients have baseline abnormalities or are at increased risk of hepatotoxicity (e.g., hepatitis B or C virus infection, alcohol abuse).

Drug-induced hepatitis, the most serious common adverse effect, is defined as a serum AST level more than three times the upper limit of normal in the presence of symptoms, or more than five times the upper limit of normal in the absence of symptoms. If hepatitis occurs INH, RIF, and PZA, all potential causes of hepatic injury, should be stopped immediately.
Liver disease

INH, RIF, and PZA all can cause hepatitis that MAY RESULT IN ADDITIONAL LIVER DAMAGE in patients with preexisting liver disease. IN ALL PATIENTS WITH PREEXISTING LIVER DISEASE, FREQUENT CLINICAL AND LABORATORY MONITORING SHOULD BE PERFORMED TO DETECT DRUG-INDUCED HEPATIC INJURY.

Hepatitis

(Management of patients with baseline abnormal liver function is described in Section 8.8: Hepatic Disease.) Three of the first-line antituberculosis drugs, INH, RIF, and PZA, can cause drug-induced liver injury (AST level three or more times the upper limit of normal in the presence of symptoms, or five or more times the upper limit of normal in the absence of symptoms). If the AST level is less than 5 times the upper limit of normal, toxicity can be considered mild, an AST level 5--10 times normal defines moderate toxicity, and an AST level greater than 10 times normal (i.e., greater than 500 IU) is severe. In addition to AST elevation, occasionally there are disproportionate increases in bilirubin and alkaline phosphatase. This pattern is more consistent with rifampin hepatotoxicity

It is important to note that an asymptomatic increase in AST concentration occurs in nearly 20% of patients treated with the standard four-drug regimen.  In the absence of symptoms therapy should not be altered because of modest asymptomatic elevations of AST, but the frequency of clinical and laboratory monitoring should be increased. In most patients, asymptomatic aminotransferase elevations resolve spontaneously. However, if AST levels are more than five times the upper limit of normal (with or without symptoms) or more than THREE TIMES NORMAL in the presence of symptoms, hepatotoxic drugs SHOULD BE STOPPED IMMEDIATELY and the patient evaluated carefully. Similarly, a significant increase in bilirubin and/or alkaline phosphatase is cause for a prompt evaluation. "

[Paddie13]

I really don't like this little town doctor, when I tell him I'm tired all the time and that I have a lot of joint pain and muscel fateig he just tells me that I'm getting older and that is normal ~~ grrrrrr ~~ it's nice that I can come here and talk to others that might be able to steer me in the right direction ~~ I live about 75 miles or so from ST.Louis Mo. and I understand that SLU is a good hospital to go to for treatment ~~ however my Dr. says not to worry about anything until I get off the TB meds ~~ that nothing can be done til then anyway ~~ so I just go on day to day and at times the joint pain is a real pain ~~

[sunshine585]

I was treated for TB 6 yrs ago, before I was aware that I had HCV. The tx made my liver enzymes skyrocket, and I had to stop some of my TB meds a couple of times, til my enzymes came back down. They asked me if I was drinking, which I wasn't. Nobody thought to check me for anything else, my HCV wasn't discovered til 2 yrs ago. My enzymes dropped back down to normal after TB tx was over. I often wonder if the TB meds, (since they were so hard on my liver), made my Liver damage progress faster.
My liver biopsy was 2/2
  

[Paddie13]

no, I'm not, the health department is where I go for my meds each month, but they said the cost of labs aren't included and when ever they send to the doctor for related problems the cost is on me, so I'm trying to get medicare or medicaid, so thats why I was so concerned, I'm planning on moving to a bigger city so I can get the right treatment ~~ Thank you though, but I really need to get to work ~~

[CoWriter]

What do you mean by "this area is not funded for lab work".  You're having a blood test to check your liver enzymes once a month, right?  Because that's what the Health Department does.  

Co

[CoWriter]

The medications used to treat TB can increase your liver enzymes so make sure that they are checked frequently.

Also, do not start the Hep C treatment until you are completely finished with the TB treatment.

Co