Triple Treatment

[ranice]

My husband just completed 14 weeks of double treatment and the transpant doctor informed us his viral load went way down the first month but this month the viral load is coming back up.  He said the double treatment was not working.  I asked about triple treatment and he agreed to one of the new drugs but was very hestiate because his hemoglobin is 10.  What does 10 mean?  Is that really bad.  

Anyone have any pointers for starting triple treatment.  Double treatment was really rough how will triple be?  I have read a lot about needing to eat lots of fat.  He starts in two weeks.  Any pointers would be greatly appreciated.  Thank you all.  

[eureka254]

I don't have any advice in regards to triple treatment, but there are many folks here on triple who hopefully will give you feedback.  However, as you probably already know, treatment can be especially hard on those with cirrhosis; if your husband has decompensated liver disease, it is absolutely essential that he be monitored very very closely during triple treatment.

In regards to hemoglobin, most men feel pretty lousy when hgb gets to 10 (normal range for men is about 13-17); dropping below 10 raises risks for other medical concerns, so perhaps your doctor wants your husband's hgb to recover a little before smashing them down again.  

You did not mention your husband's MELD, but in his situation, imho I do feel it is a wise decision to give triple a try.  Because the triple therapy currently is not being used for post-transplant patients as yet, there indeed would be high concern for return of cirrhosis after transplant.  Treating post-transplant as far as I know is only using Inf/Riba and with your husband's history, it is unlikely that would be anymore successful after transplant.  Hope that helps some. ~eureka

[ranice]

We are nervous because he does have decompensated liver functions.  Do you know how long post transplant before someone can start treatment?  His meld score is still not high enough to be listed.  

I was told that the hep C would attack the new liver if he gets one really quickly.  I guess I worry is if he gets a new liver it will end up badly damaged before he is strong enough to start the new drugs.  Thank you for responding.

[ranice]

His beginning viral load was 21,600 at week four it was 8600 then at week 12 it is almost 8800.  The doctor was hoping the number would continue to go down.  But of course it did not.  He is hoping by adding the third drug he will be undectable.  But with the hemogloblin I am not sure how much he can take.

He is already extremely tired and has not worked in months.  The double treatment has been really hard on him.  Thanks again for the great information.

[HectorSF]

From the information you provided it appears your husband is non-responder to treatment. What was his viral load before starting treatment, after week 4, after week 12?
Hemoglobin is a substance found in your red blood cells and carries oxygen to different part of the body. When a patient’s hemoglobin becomes < 10 g/dl they are said to be anemic. They become very tired. This is a common complication of treatment. It occurs even more in patients treating with triple treatment. And can usually be managed by reducing the dosage of one of the drugs or by taking extra injection of another drug. Again if you are concerned ask your doctor about what could happen during treatment. It is their job to explain it to you.

Adding another drug adds more side effects when a person is treating this is especially true for people with cirrhosis as they are the most difficult patients to treat because of the damage the liver has already received. But treating any cirrhotic is complex and your doctor knows this. Now that your husband has failed treatment and has cirrhosis the odds of cure are very low. It all depends on how he responded which is why I asked for the exact changes to his viral load.

I am assuming his doctor is a hepatologist at a transplant center. He must believe your husband has some chance of curing the virus since he has decided to start treatment with the new antiviral drugs."He starts in two weeks"

Talk to the doctor. He will explain how and when your husband will need to take his drugs and change his diet.

Good luck to your husband.

Hector

[orphanedhawk]

I don't have personal experience with triple treatment. I do know it tends to drop people's hemoglobin causing them to need a rescue drug known as procrit, and sometimes  a blood transfusion.

From reading posts of this forum the triple treatment appears to me to be more difficult. Its adding a third potent drug to the same double therapy.

Assuming your husband already has decompensated cirrhosis, I'd be reluctant to encourage him to try this.
Its hard enough on healthier people beginning without cirrhosis and normal hemoglobin levels to begin with.

There's no guarantees in life but it is possible he could do one of the new oral meds after his transplant.

Good luck
OH