Unsure of RX Decision

I was diagnosed with Hepatitis C with Cirhosis and history of esophogeal varicise (tied off x 5 since March 2010) my spleen is also enlarged. I have had ascites but it is now under control. My hepatologist has ordered Pegasus and Ribo for me. He says that I only have a small window for treatment success (which he says is probably very low 20-40% if that) and I am wondering whether it worth going through the side effect and complications. I also have a long standing history of dysthymic disorder/personality disorder.
My Rx is ready for me to pick but I am reluctant.
Any comments.
T

[HectorSF]

I think it is great that your hepatologist is willing to treat you. But you should be aware the risks vs awards.

You will need to be closely monitored. It is very unusual to be treated when you have decompensated cirrhosis. There is warnings on the meds against treating patients who are decompensated with these meds. There is a chance that the meds can cause liver failure. In that cause, you will need a liver transplant very quickly to stay alive. Are you listed at a transplant center? Is this where your doc works? I could be wrong but those odds of success sound very optimistic to me. Maybe you are not genotype 1? That could explain it and also why you are not treating with the new DAAs meds with give genotype 1s better odds.

Because you have advanced cirrhosis you are likely to have many complications from treatment? Your platelet count will be reduced (what is your current platelet count?) and you may need helper drugs to get through treatment because of other blood level issues.

You need to have your mental issues under control before starting treatment. Peg-interferon is known to cause depression in patients as a side effect. So having dysthymia, you need to be monitored throughout treatment by a psychiatrist. Your hepatologist needs to coordinate your care with a psychiatrist. This is very commonly done as a preventative measure.

I understand you are reluctant but are you aware that your only other option is a liver transplant and then you will still need to treat your hepatitis C either before or after treatment? Hepatitis treatment is a minor issue compared to a liver transplant which is a life and death option. Remember that nationwide, approximately 18 people die each day awaiting life-saving organ transplants.

My opinion? Do anything you can to rid yourself of hepatitis C even if you end up needing a transplant anyways. You need to rid yourself of hepatitis C at some point. The sooner the better. If you don't rid yourself of hep C you will need to try again after transplant. The issue is not going to go away. Hepatitis C will destroy your new liver too in time.

Good luck.
Hector

[22hamilton]

Great answer Hector. I can completely understand your dilemma tabitha, you need to do something though. Actually asking for advice on here is a great first step.

Good luck

Paul