recourence of HCV post transplant

I had a biopsy 18 month post living donor liver trnsplt., caused by HCV /HCC
, results show return of hcv and scarring level3 stage 2. ,. doctor wants me to return to treatment peg intron / ribavarin,.  which I tried twice pre transplant but could not complete due to low platlet count,  I saw a trial for addition of a third drug Difluxen ??? would this be a better alternative for me?
stu426.  

[mikesimon]

I've never heard of "Difluxen". There is an anti-fungal drug "Diflucan" but I have not seen it used as treatment for HCV. I was under the impression that it's not a liver friendly drug but I could be wrong about that.

Is your platelet count better now than it was pre-transplant? Treatment drugs do impact platelet count significantly but I get the feeling that doctors allow patients to treat with a lower platelet count than they did previously. I treated post-transplant with a pretty low platelet count and I did clear the virus.

The new protease inhibitors (Telaprevir & Boceprevir) look extremely promising and hopefully they will be available in 2011. I have not seen any trials involving transplant patients but I don't see any reason not to believe they will boost the likelihood of successful treatment significantly in the transplant population.

One very positive result of HCV eradication is that the liver histology improves in many patients - your liver fibrosis reverses to some extent. I guess the question is - can you afford to wait for the PIs or should you try treatment now. That is a complex issue and the best advice I can give you is to follow your doctor's advice - if you trust your doctor.
If you can get a viral load at 4 weeks into treatment you should have more information to decide whether to continue. I had to treat 3 times - the first two times I was under-dosed with ribavirin. A lot of transplant centers do use low doses of ribavirin and I believe this in one of the reasons we see a low success rate among transplant patients. It's a complex issue but I tend to think that the primary goal is clearing HCV and maybe we should be more aggressive about it.

Good luck,
Mike

[mikesimon]

I've never heard of "Difluxen". There is an anti-fungal drug "Diflucan" but I have not seen it used as treatment for HCV. I was under the impression that it's not a liver friendly drug but I could be wrong about that.

Is your platelet count better now than it was pre-transplant? Treatment drugs do impact platelet count significantly but I get the feeling that doctors allow patients to treat with a lower platelet count than they did previously. I treated post-transplant with a pretty low platelet count and I did clear the virus.

The new protease inhibitors (Telaprevir & Boceprevir) look extremely promising and hopefully they will be available in 2011. I have not seen any trials involving transplant patients but I don't see any reason not to believe they will boost the likelihood of successful treatment significantly in the transplant population.

One very positive result of HCV eradication is that the liver histology improves in many patients - your liver fibrosis reverses to some extent. I guess the question is - can you afford to wait for the PIs or should you try treatment now. That is a complex issue and the best advice I can give you is to follow your doctor's advice - if you trust your doctor.
If you can get a viral load at 4 weeks into treatment you should have more information to decide whether to continue. I had to treat 3 times - the first two times I was under-dosed with ribavirin. A lot of transplant centers do use low doses of ribavirin and I believe this in one of the reasons we see a low success rate among transplant patients. It's a complex issue but I tend to think that the primary goal is clearing HCV and maybe we should be more aggressive about it.

Good luck,
Mike