Aa
what is yir opinion of Hep C treatment with cirrhosis
It's stupid to ask.but is there more,less or no difference in complications doing it at this stage.
Thank You
Thank You
People with Cirrhosis have a tougher time with the side effects and the success rate is not as high with Cirrhotics. Yet they are the ones for whom successful treatment is most urgent.
Advocate1955
Advocate1955
You can go to the Cirrhosis of the Liver Community for help with issues particularly around cirrhosis.
"Is there more,less or no difference in complications doing it at this stage."
Side effects and adverse events such as servere anemia, dangerously low platelet counts and low white blood cells are more common and servere in patients with cirrhosis. The gather the degree of cirrhosis the more impact cirrhosis has on these events and the less likely a patient will achieve SVR.
Many have cured their hepatitis C with cirrhosis. A lot depends on you own liver's health and how you respond to treatment. The only way to know is to treat and see how your viral load responds.
"According to a technical review by the American Gastroenterological Association,patients with compensated liver disease due to HCV infection should be treated according to standard protocols, provided S-albumin is > 3.4 g/dl, S-bilirubin < 1.5 mg/dl, INR 75,000/mm3, haemoglobin (Hb) > 12/13 g/dl (males 12 g/dl; females 13 g/dl) and S-creatinine < 1.5 mg/dl. However, the SVR is generally lower and adverse events necessitating dose reductions are higher (and more so for PEGIFN than standard IFN) in patients with cirrhosis compared to those without cirrhosis.
Cytopenias and growth factors Patients with cirrhosis are more prone to adverse effects due to therapy. IFN, by virtue of its bone marrow suppression effects, is known to cause thrombocytopenia, neutropenia and anemia. RBV can cause anaemia due to haemolysis as well as bone marrow suppression. Treatment-related cytopenias are more common
with PEGIFN than standard IFN. Also, pre-existing cytopenias may preclude treatment with IFN. Neutropenia, while on treatment, may put the patient at risk for infections, which can be life-threatening at times. Thrombocytopenia and anemia may cause bleeding episodes and exertional fatiguability. Cytopenias due to AVT can be managed by the use of either GFs or by dose reductions. GFs (G-CSF and/or erythropoietin [EPO]) were used in a majority of studies on patients with decompensated cirrhosis to enable the continuation of treatment without dose reduction."
"Hepatic Fibrosis:
The presence of cirrhosis attenuates response to HCV therapy and has long been linked with lack of response. Genotype 1 patients with cirrhosis in particular are at greater risk of non-response, or lack of viral suppression, on interferon-based therapy. In one study of genotype 1 or 4 patients taking peginterferon and ribavirin, SVR rates decreased progressively from 60% in patients without advanced fibrosis to 51% in those with bridging fibrosis and 33% in those with cirrhosis[20]. This fibrosis-related decrement in response is still observed when treatment includes one of the HCV protease inhibitors among treatment-naïve genotype 1 patients, those with advanced fibrosis (stage 3 or cirrhosis) had SVR rates of 42 to 62% with triple therapy with peginterferon, ribavirin and either telaprevir or boceprevir compared with 70 to 81% in patients with minimal or early stage fibrosis. Treatment of cirrhotic patients remains a high priority but precise estimates of treatment response to these new agents are not available since this group comprised only a small proportion of participants in the large phase 3 trials of telaprevir and boceprevir."
If you have cirrhosis you should be treated by a hepatologist at a liver transplant center as they are the only doctors that have the resources to get you through 48 weeks of treatment if you are having major issues caused by the treatment.
Also you should be aware that treatment in a small group o cirrhotic patients can make their liver disease worse. This is a risk you should be aware of. I know of two people on the forum here who had serious complications from treatment. One vomited blood the other had ascites over a period of months and has now lost 40 lbs.
Best of luck with your treatment!
Get the best medical help you can before starting treatment so you can give it your best shot.
Hector
"Is there more,less or no difference in complications doing it at this stage."
Side effects and adverse events such as servere anemia, dangerously low platelet counts and low white blood cells are more common and servere in patients with cirrhosis. The gather the degree of cirrhosis the more impact cirrhosis has on these events and the less likely a patient will achieve SVR.
Many have cured their hepatitis C with cirrhosis. A lot depends on you own liver's health and how you respond to treatment. The only way to know is to treat and see how your viral load responds.
"According to a technical review by the American Gastroenterological Association,patients with compensated liver disease due to HCV infection should be treated according to standard protocols, provided S-albumin is > 3.4 g/dl, S-bilirubin < 1.5 mg/dl, INR 75,000/mm3, haemoglobin (Hb) > 12/13 g/dl (males 12 g/dl; females 13 g/dl) and S-creatinine < 1.5 mg/dl. However, the SVR is generally lower and adverse events necessitating dose reductions are higher (and more so for PEGIFN than standard IFN) in patients with cirrhosis compared to those without cirrhosis.
Cytopenias and growth factors Patients with cirrhosis are more prone to adverse effects due to therapy. IFN, by virtue of its bone marrow suppression effects, is known to cause thrombocytopenia, neutropenia and anemia. RBV can cause anaemia due to haemolysis as well as bone marrow suppression. Treatment-related cytopenias are more common
with PEGIFN than standard IFN. Also, pre-existing cytopenias may preclude treatment with IFN. Neutropenia, while on treatment, may put the patient at risk for infections, which can be life-threatening at times. Thrombocytopenia and anemia may cause bleeding episodes and exertional fatiguability. Cytopenias due to AVT can be managed by the use of either GFs or by dose reductions. GFs (G-CSF and/or erythropoietin [EPO]) were used in a majority of studies on patients with decompensated cirrhosis to enable the continuation of treatment without dose reduction."
"Hepatic Fibrosis:
The presence of cirrhosis attenuates response to HCV therapy and has long been linked with lack of response. Genotype 1 patients with cirrhosis in particular are at greater risk of non-response, or lack of viral suppression, on interferon-based therapy. In one study of genotype 1 or 4 patients taking peginterferon and ribavirin, SVR rates decreased progressively from 60% in patients without advanced fibrosis to 51% in those with bridging fibrosis and 33% in those with cirrhosis[20]. This fibrosis-related decrement in response is still observed when treatment includes one of the HCV protease inhibitors among treatment-naïve genotype 1 patients, those with advanced fibrosis (stage 3 or cirrhosis) had SVR rates of 42 to 62% with triple therapy with peginterferon, ribavirin and either telaprevir or boceprevir compared with 70 to 81% in patients with minimal or early stage fibrosis. Treatment of cirrhotic patients remains a high priority but precise estimates of treatment response to these new agents are not available since this group comprised only a small proportion of participants in the large phase 3 trials of telaprevir and boceprevir."
If you have cirrhosis you should be treated by a hepatologist at a liver transplant center as they are the only doctors that have the resources to get you through 48 weeks of treatment if you are having major issues caused by the treatment.
Also you should be aware that treatment in a small group o cirrhotic patients can make their liver disease worse. This is a risk you should be aware of. I know of two people on the forum here who had serious complications from treatment. One vomited blood the other had ascites over a period of months and has now lost 40 lbs.
Best of luck with your treatment!
Get the best medical help you can before starting treatment so you can give it your best shot.
Hector
More complications, Marco. But everybody is very
different, and there are different stages of cirrhosis, as well.
I know quite a few people with cirrhosis, who have Treated, and done very well. They cleared the virus, but they still have their cirrhosis. But if they hadn't cleared the virus, they would have needed a Liver Transplant.
different, and there are different stages of cirrhosis, as well.
I know quite a few people with cirrhosis, who have Treated, and done very well. They cleared the virus, but they still have their cirrhosis. But if they hadn't cleared the virus, they would have needed a Liver Transplant.
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