treatment

hello doctor,
my husband is been begging the doctor to treat him for his recurrent hcv. he had ldlt a year ago and his liver enzymes is 10 times higher than normal so as his viral load counts (>100millions).
my questions are why do they hesitate to treat him? and whats the worse that could happen to his liver and conditions? he knows that if not treated  hes liver will eventually become fibrosis and then the rest of it.  in your center, do you treat post transplant patient right away? or wait till it become fibrotic?
he never have treatment for hcv before the transplant. so he is hoping it could work for him.
he is genotype 1A the worst one.
tell us what your input and suggestions
thanks a lot.

[Thomas D Schiano, MD]

every patient after a liver transplant for HCV has the virus come back.  the findings on the liver biopsy are the key points in deciding on the need for treatment.  at our center we start considering treatment if histological recurrence is very early or if there is stage 2 or more fibrosis.  therapy may be very difficult to tolerate and can cause rejection and other problems such as severe anemia, so its not an easy decision.  Very few programs if any use preemptive therapy and they generally wait for the histological recurrence.