Hepatitis C type 2, treatment for 66 years old female, need advice.

[toni888]

Hi There,

Sex : Female,
Age 66 years old.

Diagnosed with Hepatitis C, type 2, Sub Type 2a/2c

i'm planning to take Ribavirin+Interferon therapy.

does anyone know if this therapy will be good for my age.

i already take ribavirin for 6 months.
and i think this ribavirin has drop my hemoglobin down.

appreciate any help.

regards

[toni888]

Thanks you so much for taking your time responding.

i'm gonna see another doctor for second opinion.

[Pdilly]

I too am 2a/2c and just finished tx.   For most the tx is doable.  Some will have more sides than others and it does change from week to week.  I worked the whole way through.  There was one day I left at noon (I had already put in 6 hours and had 4 more to go.  I was just exhausted and went home and slept.   I am in my Mid 50's and  am stage 2/3.   I recommend that you at least try it.    

[pigeonca]

In addition to all the good advice above, let me add that 66 is simply not that old nowadays.  I'm 63 and just finished treatment with Interferon and ribavirin for genotype 2.  I suffered some bad side effects, but none of them were caused by my age.  I'm quite sure that I would have had the same difficulties at age 40.

Don't let anybody tell you you're old.  80 is old, not 66.  And probably when we're 80, we'll say that WE'RE not old, people over 90 are old.  

Toni, I'm so glad you found this forum.  It has enabled me to deal with this disease and has really saved my life; hopefully it will provide you with similar help.   I look forward to hearing more from you as you proceed in this strange adventure of battling hcv.

[jmjm530]

I missed that one. A little bit bizarre reasoning from a doctor in my opinion. That combined with the all-riba approach leads me to a conclusion that this may be a general practitioner not up to speed on hepatitis c and its treatment.

Toni, you shouldn't have to worry about transmitting hepatitis c within a household as long as you take normal blood-to-blood precautions like not sharing personal items such as toothbrush, nail clippers, etc.  There are others important reasons to treat -- or not to treat -- but this doesn't rank up there near the top.

-- Jim

[Forseegood]

I thought it was curious that they gave you a reason - that you live with your family, and they don't want you to infect them? - as a reason to start combo therapy now...unless youre all sharing razor blades, and/or other blood products, that's a stretch that you'll infect anybody in your family, living with them or not...as long as youre all careful...

I'm with Jim on this, I get leary when I hear weird reasons like this, or weird therapies...if youre around here long enough, you'll see that more then one opinion from the professionals is often a good idea...we don't always get good therapists, good construction guys or good doctors our first time out...Not that your doctor isn't perfectly great, he's the professional, not us...but this would get my eyebrow up....

[dlr2007]

Hi- I just saw that you wrote about your family- sounds like they are concerned about getting infected from living with you- or perhaps you are concerned? And I just wanted to tell you that there is really no chance of getting infected just by everyday contact, sharing cups, toilets, etc. Do not share razors, toothbrushes, nail clippers, or anything that could possibly transmit blood from one person to another. That's about it! It's hard enough to haveHep C, even though it is not the end of the world. So anyway, your family shouldn't be worried about getting Hep C themselves- just helping you stay healthy! As for treatment, it sounds like you really need to see a liver specialist because they could figure out exactly what would be the best and safest tx for you. Take care. -dee

[jmjm530]

Out of curiorisity I did a quick "google" on "ribavirin monotherapy". Some early studies suggest it may temporarily reduce viral load and/or normalize liver enzymes. A more recent study suggests it won't. Do you know what your liver enzymes (ALT and AST) were before the ribavirin and what they were after taking the ribavirin?

-- Jim

[Forseegood]

forgot to say, I'm not implying that you shouldn't go into combo therapy, I'm not your doc to make those kind of decisions for you, I'm just saying that it was odd that he gave you that as one of his reasons....be well...

[chcnme]

Hi Toni.   I didn't know Ribavirin was used like that (alone, without interferon) and I was kind of shocked to read you were on this type of therapy (but then Jim apparently found something on its use like this),  but still - there are unanswered questions on your end and about this method of treatment, I think, and I guess it's best I reserve judgement on how your doc is treating you (and especially since you are 66 and a doctor has recommended standard treatment now.)  

Are you seeing a hepatologist?  

You say "they" are concerned about your family and burden of cost if they contract this virus from you.   Is your doctor the "they"?  If so, find another doctor as soon as possible because that would be absolutely no reason whatsoever to treat you now - none at all.  That is no reason whatsoever to treat a patient for Hep C for this reason.   Your family  (if they have not contracted this virus from you yet)  should be educated on the very low probability that they will EVER be infected from you if you all institute some very simple precautions, as someone - I think - has already put up  (don't share razors, toothbrushes, don't share needles, clippers, etc.)  

I did a quick search on treating the eldery and found this (below):  There are many other articles, too.  Hope it helps some.  

I wish you the best of luck.  Glad you stumbled upon this forum.   Get back with us and let us know how you are.  This is a great forum for support and info.

=====================================
Chronic Hepatitis C in the Elderly

During the past decade, knowledge of the pathogenesis, clinical course and treatment of chronic hepatitis C virus (HCV) infection has expanded enormously, but there are few data on the course of the disease and its treatment in the elderly population (age >/= 60 years).

The burden of chronic hepatitis C virus infection in elderly persons is expected to increase significantly in the United States during the next 2 decades. Chronic infection is prevalent in elderly patients and may be more severe than in younger adults. As middle aged patients with HIV infection become elderly, the number of individuals with liver disease related to chronic hepatitis C will grow.

In an article appearing in the December 1, 2005 issue of Clinical Infectious Diseases [1], two Israeli researchers review the data on the epidemiology, immunology, and clinical manifestations of chronic HCV infection in older adults and suggest an approach to management of the infection in this population.

Most of the older adults with chronic hepatitis C virus infection have acquired the disease earlier in life. These patients often present with complications of liver disease, mainly cirrhosis and hepatocellular carcinoma (HCC)..

It is estimated that, each year, HCC will develop in 1%-2% of patients with chronic HCV infection and cirrhosis [2]. The risk of HCC increases significantly with age, probably owing to age-related changes in the ability to repair DNA [3] and to the prolonged interval from the time of infection. The interval between infection and diagnosis of HCC may be shorter when the infection is acquired at an older age.

Up to 30% of patients had psychological disorders, including depression, and up to 67% complained of fatigue [2,4,5]. These symptoms may appear even in the absence of clinically significant liver disease. Age of >50 years was found to be associated with fatigue [5]. Chronic HCV infection was associated with cognitive impairment, which was reported in patients aged 2869 years with mild liver disease [6]. The prevalence of cognitive impairment among older patients, who may have a higher susceptibility to this complication, has not been studied.

Despite the decrease in the incidence of acute hepatitis C, the prevalence of long-standing chronic hepatitis C infection is increasing among older adults. The management of chronic HCV infection in older adults is complex in terms of comorbidities and quality of life.

There are few data on the efficacy of antiviral therapy for elderly persons. Therefore, the study authors recommend that patients up to the age of 75 years be included in trials of chronic hepatitis C treatment.

For elderly patients with chronic hepatitis C, risk-benefit of antiviral therapy should be assessed on an individual basis. There is a need for research on treatments with efficacy that is at least the same as that of pegylated IFN and ribavirin but with fewer adverse effects. In large, multicenter, randomized trials of therapy with pegylated IFN and ribavirin involving cohorts with a mean age of 4243 years, older age was associated with poorer response to treatment [7,8]. Age of >40 years was an independent predictor of poor response to treatment.

Assessment should be performed in all cases before considering treatment, and it should include evaluation of the degree of liver fibrosis by means of liver biopsy or, possibly, by means of noninvasive methods, such as FibroTest-ActiTest, which combines the quantitative results of 6 serum markers together with age and sex. Other methods for assessing fibrosis is transient elastography (FibroScan; Echosens), which measures liver stiffness through pulse-echo Ultrasonography.

In the not-too distant future, novel antiviral drugs that may have fewer adverse effects are expected to be developed, such as HCV protease inhibitors, may serve as potential alternatives to peginterferon/ribavirin. Early access to these drugs prior to their approval should be available to elderly patients (as well as to younger patients) who are non responders to currently approved therapies.

It is also recommended by the authors that elderly patients (up to the age of 75 years) be included in randomized trials of chronic hepatitis C virus infection treatment.

Acute Geriatric Department, Herzog Hospital, The Hebrew University-Hadassah Medical School, Jerusalem, and Department of Medicine D and 3Liver Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

E-L Marcus and R Tur-Kaspa. Chronic Hepatitis C Virus Infection in Older Adults. Clinical Infectious Diseases 41(11): 1606-1612. December 1, 2005.


Marcus E-L and Tur-Kaspa R. Chronic Hepatitis C Virus Infection in Older Adults. Clinical Infectious Diseases 2005; 41(11): 1606-1612.

McHutchison JG. Understanding hepatitis C. Am J Manag Care 2004; 10(2 Suppl):S21-29.

Ben Yehuda A, Globerson A, Krichevsky S, et al. Ageing and the mismatch repair system. Mech Ageing Dev 2000; 121:173-179.

Poynard T, Cacoub P, Ratziu V, et al. Fatigue in patients with chronic hepatitis C. J Viral Hepat 2002; 9:295-303.

Hassoun Z, Willems B, Deslauriers J, Nguyen BN, Huet PM. Assessment of fatigue in patients with chronic hepatitis C using the Fatigue Impact Scale. Dig Dis Sci 2002; 47:2674-2681.

Forton DM, Thomas HC, Murphy CA, et al. Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease. Hepatology 2002; 35:433-439.

Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon -2b plus ribavirin compared with interferon -2b plus ribavirin for initial treatment of chronic hepatitis C: a randomized trial. Lancet 2001; 358:958-65.

Fried MW, Shiffman ML, Reddy KR, et al. Peginterferon 2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002; 347:975-982.


SOURCE:
http://hepcassoc.org/news/article121.html

[jmjm530]

I've never heard of treating with ribavirin only. Studies suggest that used alone it's ineffective against the virus. Are you seeing a hepatologist (liver specialist) here in the United States? If not, give your age and situation, I'd strongly suggest you see a hepatologist, as they are better equipped to evaluate you properly and are more up to date on treatment protocols. Hepatologists are not necessarily the same as Gastronenterologists. I assume you've had a liver biopsy to find out how much liver damage you have?

Curious, how much ribavirin were you prescribed and what was your hemoglobin before you took the ribavirin and what is it now. Also, what was your viral load before you took the ribavirin and what is it now? Again, this is very unusual that you were prescribed ribavirin only.

All the best,

-- Jim

[toni888]

Thx Jim

the ribavirin was prescribed by my doctor.

i guessed he might think that i'm already 66.
and my body might not stand the side effect of interferon. instead i was given ribavirin to maintain the level of the virus to constant.

but since i live with my family, they thought it will better if  treat my Hep-C.
considering the costs if they  get infected .

[jmjm530]

Welcome to the discussion group. Why have you been taking ribavirin for 6 months? Did you it alone or with another medicine or injection?

-- Jim