When is treatment for Hep C not indicated

[gigimonde]

Hi.  I know someone who has Hep C and recently went to a Doctor to be evaluated for treatment.  They were told they were not a viable candidate because of spleen involvement and liver damage.  

This is a vague response and nothing else was offered (person is incarcerated currently).  Is there no other option?  I am sure they need to have a biopsy ASAP.  

Please advise

[nan535]

     Sorry to hear about your friend's situation. When my husband found out he had Hep C, he already had advanced decompensated cirrhosis with symptoms of hepatic encephalopathy, extensive edema in his legs and ankles, esophageal varices (which were confirmed after the doctor did an endoscopy), and portal hypertension. His doctors did not do a liver biopsy because it was deemed  unnecessary to confirm the actual condition of his liver when he already  had the symptoms of end stage liver disease. It would have put him even more at risk for infection and further damage.
    So my question is, does your friend have any symptoms of decompensation as I described, particularly hepatic encephalopathy, edema or ascites (fluid in the belly). If so, he is much greater danger.  If not, then
the doctor who told him he was not a candidate for Hep C treatment is likely wrong.  
     Your friend should consult an attorney to see what his rights are to proper medical treatment which incarcerated.  I don't know the circumstances of his being incarcerated but that should not prevent him from getting proper treatment for a potentially life threatening virus and disease.

I wish this person the best. You are a good friend in trying to help.

Nan

[gigimonde]

Thank you for taking time to respond to me.  I so appreciate this information as I know next to nothing about Hep C.  Every bit of information that I receive will help this person with whom I am close.  Unfortunately, they will not be released from prison for 9 months.  I do realize after reading this forum and the responses I have received that time is of the essence.  I will relay this message, continue to educate myself, and pray for God's grace.
Thanks again.

gm

[gigimonde]

Thank you for this intelligent and informed response.  I am so grateful to have your input.  The person in question is not getting any treatment currently as they are incarcerated due to drug addiction.  They were evaluated by a prison doc, therefore, a second opinion is critical.  They will not be released for 9 months.  There are so many layers to this problem, but for me to have found this forum is a blessing.

[Dee1956]

Hi it sounds like your friend is in a bad place. Flyinlyn is right, many people treat with symptoms similar to your friend.  Before I treated I had a slightly enlarged spleen and the beginning of cirrhosis.  I treated twice and am now cured.  Is there any kind of appeals board?  From what I understand your friend needs to see a hepatologist.
Can he request a biopsy?  He needs to have that to see if he is viable.  It almost sounds as if the doctor he saw is not a hepatologist and is giving him a line because he is in prison.
I hope you can find some help for  him
Take Care, Dee

[flyinlynn]

Hi Gigi

This link is the latest Recommendations for Testing, Managing, and Treating Hepatitis C from the AASLD American Association for the study of liver disease.

http://www.hcvguidelines.org/sites/default/files/full_report.pdf

The only people I have heard who are too ill to treat have very advanced liver disease and are in need of immediate transplant and even then some of those patients are treated under close medical supervision.

The old treatments using interferon can be too dangerous for patients with cirrhosis but late last year several new medicines were approved by the FDA that are working quite well with limited side effects, however they are very expensive. The medicines are discussed in the link I sent.

Basically the patients with the greatest need for treatment are those with liver damage and many are treating now with the new medicines.

I have an enlarged spleen and I was diagnosed with cirrhosis on 08 and I am currently taking Sovaldi and Olysio.

I don't know how your friend can get a second opinion or a better diagnosis but is doesn't sound like he is receiving the best medical advice right now. Is there anyway he can get his case reviewed by a hepatologist?

Good luck
Lynn