to treat or not to treat

[Alecat25]

My husband has had hep c since 2004, he had been drinking heavily but has stopped. He's 26 years old, in good health. We've been to a GI doctor who has done a battery of tests. The results were...Genotype 1a, viral load 850,000, low enzyme levels (not sure of the exact numbers), the biopsy showed stage 1 grade 1 with a slight increase in periportal fibrosis. Slight periportal chronic inflammatory infilatrate consisting almost entirely of small, mature lymphocytes. Rare macro and microvesicular steatosis is seen. No increase in iron storage. The GI doctor has recommended that we check his lab work every 6 months to monitor his progress and not do treatment at this time. He says that there are alot of new drugs coming out in 2012 that will be better than what there is today. My questions are: is it better to treat now while the effects of the virus are minimal? What kind of drugs are they working on and are they going to be better than the interferon/ribovirin combo? At what point would he need to start treatment? When the viral load elevates or when if the enzymes elevate? Or is it just really up to him? I just don't want things to get worse and have him wishing he had done something about it now instead of when it gets worse. I know that it is a virus and we cannot predict how it will effect him. Its just very hard for me to let this ride and hope it doesn't get worse. I know it won't get better without the treatment.

[Douglas Dieterich, MD]

Hi,
There is no clear answer to you question. It depends how you see things. We know that you have better chance of response to treatment when you are young and at an earlier stage of disease. There are many drugs in the pipeline. The ones that will be approved first are protease inhibitors (telaprevir and boceprevir) and they are pills that are taken, for now, with the present standard of care, peginterferon and ribavirin. The combination of the 3 is superior to the present treatment. We think that approval is for 2010 or 2011. The viral load fluctuates and the lower, the higher chance of response to treatment. Below 800 000 increases your chance of response.
So treatment is not an emergency, but why not give it a try and if the present standard of care does not cure your husband, you know that you have future options. Good luck! DTD

[WifeOfSoulKiss]

I would get treatment and  go to another Dr.get a second opinion.

[IAmTheWalrus]

That is an excellent question, and often discussed on the Hep C Medical and Community Forums.

[ram921]

Treat now while the virus is weak and you are young and strong. There will always be excuses to wait- not sick right now, need to work, busy with life, etc...go after it now.

[bandman54]

Why does no one ever mention that treatment and failure can result in a stronger mutated virus the next go round.
Is this not true?

bandman

[zazza]

Only true with the PIs, not with SOC.

[bandman54]

Thanks Zazza!

Being an nr that makes me feel a little better!

I know SOC... interferon and riba.. correct?

But what is PI?

jp

[zazza]

SOC = standard of care = pegylated interferon and ribavirin

PI = polymerase inhibitor (for example Boceprevir) or protease inhibitor (for example Telaprevir)

Best wishes,
Za

[plunkshack]

A related discussion, pronosis was started.

[gangchoi]

A related discussion, HCV and hip pain was started.