when do you know your hep c is bad????

[Brilorra]

Hi to All:

trying to understand this disease.  i am wondering if you could tell me what the main tests are for knowing and learing about your hep c.  my husband is geno 3, cirrohsis is currently compensated, VL 700,000 alt and ast seem to be normal.  platelet count low 75,000 and has been low for years - even lower than this.  i guess my question is, with regards to meld etc.  what are all the danger numbers for transplant preparation.  

also, what if you cant get tx, and you have the above? is it possible for the hep c to clear itself at this point or are you definately on a downward motion to severe illness.

thank you all, and i love this site and appreicate everyones input and knowledge.

Leslie

[mikesimon]

You seem to know a lot about HCV/liver related issues and I know you value valid information. I think I have seen you suggest on at least one other occasion that an enlarged spleen is the reason for a decreased platelet count. I believed that to be the primary, if not the only, cause of the low platelet count often associated with cirrhosis until lately when I have begun to see it a little differently. I think it may be more complicated than merely splenic platelet sequestration.

Review article: blood platelet number and function in chronic liver disease and cirrhosis.
Witters P, Freson K, Verslype C, Peerlinck K, Hoylaerts M, Nevens F, Van Geet C, Cassiman D.

RESULTS: Thrombocytopenia is a marked feature of chronic liver disease and cirrhosis. Traditionally, this thrombocytopenia was attributed to passive platelet sequestration in the spleen. More recent insights suggest an increased platelet breakdown and to a lesser extent decreased platelet production plays a more important role. Besides the reduction in number, other studies suggest functional platelet defects. This platelet dysfunction is probably both intrinsic to the platelets and secondary to soluble plasma factors. It reflects not only a decrease in aggregability, but also an activation of the intrinsic inhibitory pathways. The net effect, finally, is a decreased platelet function in the various types of chronic liver diseases and cirrhosis. Finally, recent data suggest that platelets are not only affected by but can also contribute to the liver disease process, as for instance, in viral hepatitis and cholestatic liver disease. CONCLUSION: Platelet research in liver disease is a growing area of investigation and could provide new pathophysiological insights.
PMID: 18331464 [PubMed - in process]

Review article: the pathophysiology of thrombocytopenia in hepatitis C virus infection and chronic liver disease.
Weksler BB.

Division of Hematology and Medical Oncology, Weill Medical College of Cornell University, New York, NY 10021, USA. ***@****

BACKGROUND: The pathophystology of thrombocytopenia in patients with chronic liver disease resulting from hepatitis C virus (HCV) infection is complex and involves several complementary mechanisms that likely act in concert. AIM: To summarize the available data on the etiology of thrombocytopenia in patients with chronic liver disease. RESULTS: In patients with untreated hepatitis C, both prevalence and severity of thrombocytopenia increase in parallel with the extent of disease, usually becoming clinically relevant when patients develop extensive fibrosis and/or cirrhosis. Pathogenetic mechanisms include hypersptenism secondary to portal hypertension, bone marrow suppression resulting from either HCV itself or interferon treatment, aberrations of the immune system resulting in the formation of anti-platelet antibodies and/or immune-complexes that bind to platelets and facilitate their premature clearance, development of immunologically-mediated extrahepatic manifestations including mixed cryoglobulinemia with or without associated joint, renal, or cutaneous involvement, and thrombopoietin (TPO) deficiency secondary to liver dysfunction. In chronic liver disease, the natural inverse relationship between TPO and platelet levels is not maintained; therefore, blood TPO levels fail to have clinical relevance or predictive value in assessing the thrombocytopenic status of a given patient. CONCLUSIONS: The development of thrombocytopenisa in patients with chronic liver disease is complex and multifactorial.

PMID: 17958515 [PubMed - indexed for MEDLINE]

Mike

[Grace724]

If you are having to convince your doctor to provide care or treatment for you husband with HepC...get a new doctor. Preferably a hepatologist or a gastroenterologist. Regular family practitioners aren't usually up to speed enough to deal with this disease. So that would be your first and most important step.

ALT and AST #'s can be normal, yet the person is still very ill. So you can't rely on numbers. I do believe that a biopsy is the most effective way of determining where you stand as far as how sick you are. So I'd also have him get scheduled for a biopsy soon. My husband is having his July 18th and from everything I've read here and elsewhere it's quite an easy procedure. Outpatient so it can't be too difficult.

Good luck and seriously...get a doctor who knows how to treat a person with HepC.

~Grace

[Rockerforlife]

you asked:so what is it too look for and convience a doctor you need help


Most Docs i know recommend you start TX BEFORE YOU HIT STAGE 3...in at stage 2 right now and on my way into stage 3....i have to treat very soon...hope this helps

[HectorSF]

I am sorry to hear about your husband's condition. I'm glad you are trying to learn all you can about his disease.

The Model for End-Stage Liver Disease (MELD) is a numerical scale, ranging from 6 (less ill) to 40 (gravely ill), that will be used for adult liver transplant candidates. It gives each individual a ‘score’ (number) based on how urgently he or she needs a liver
transplant within the next three months. The number is calculated by a formula using three routine lab test results:
• bilirubin, which measures how effectively the
liver excretes bile;
• INR (prothrombin time), which measures the
liver’s ability to make blood clotting factors; and
• creatinine, which measures kidney function.
(Impaired kidney function is often associated
with severe liver disease.)

The four MELD levels are:
greater than or equal to 25
24-19
18-11
less than or equal to 10

Platelet count goes down as platelets get trapped in the enlarged spleen with is a common symptom of cirrhosis.

Yes, it may still be possible for your husband to undergo treatment for his Hep C depending on how damaged his liver is. He has a genotype that has a high rate of success with current treatment protocols. Please talk to his doctor about this.

Best of luck to your husband.
Hector

[Bill1954]

Here is a relevant link to address your question; it is from the UNOS site, and will calculate meld score, assuming you have patient date of birth, bilirubin, serum creatinine, and INR.

UNOS is an acronym for united network for organ sharing, the organization for organ allocation and distribution here in the U.S. Make sure that the Canadian units are equivalent to the U.S. units- they vary sometimes, and could obviously cause discrepancies.

HCV will be self-limiting in approximately 20-30 % of HCV patients during the *acute* phase; i.e. after the first six months of exposure. Once diagnosed with cirrhosis (assuming this diagnosis is secondary to HCV), it is assumed that the patient is in the *chronic* phase of the disease, and almost universally requires treatment to successfully eradicate.

For a good general education regarding HCV, try Janis and Friends;

http://janis7hepc.com/

Just click on any item of interest in the blue box.

Good luck,

Bill

[Andromedae]

I'm really a newbie at this but as I understand it ALT and AST levels are two very important indicators of liver function along with platelet count and bilirubin levels.  I'm very sure that there are more and others will chime in about them.  An ultrasound of your liver followed by a possible liver biopsy would pinpoint the degree of liver damage.

If you have this, and it is active, meaning that you are not one of the 15-20% or so who's body fights off the virus completely (and if you have viral load levels in your blood then you aren't), my understanding is that the virus will pretty much always degrade your liver and overall health over time.  

[Brilorra]

im sorry i know i worded it all wrong, what i mean is all the numbers,  i know having hep c isnt good, but some can live for ever with it, and others go down hill to ESLD.  when it comes to results, what is actually need to check for severe liver damage. is it just a biopsy that is definate.  alts and ast normal range i understand dont me a thing, so what is it too look for and convience a doctor you need help

[Rockerforlife]

when do you know your hep c is bad????


never heard of it being good...i guess youll know if it get real bad...ESLD...end stage liver disease...your liver turns into a rock.