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Avatar universal

Update

Hi Everybody,

I am posting my latest info as much to organize my own thoughts in a narrative as anything else but I do have a couple of questions which will be at the end of this post. He are my stats as of today:

HCV+ probably infected sometime in the 80's when I was working in EMS
Biopsy scheduled for June 5, 2013
Genotype 2b
AST 59
ALT 141
Viral Load 44,000
Platelets 198
INR 1.1
Prothrombrin time 14.2 sec
Albumin 4.4
Globulin 2.9
Alkaline Phosphatase 36
Bilarubin 0.4 (0.1 direct 0.3 indirect)
WBC 6.1
RBC 4.89
Glucose 104 (non-fasting)
Total Cholesterol 192
HDL 70
LDL 106
Triglycerides 78
HIV-
IL28b result is not in yet.

I have had my first consult with the hepatologist at Dartmouth Hitchcock medical center in Hanover, NH (a Dartmouth College/Mayo Clinic facility) May 2, 2013 My take away from this meeting:

*They see about 2 new HCV patients a day.
*I was told that they are not treating any genotype 2s until non-interferon treatment is available. They say this will happen within the next 12 months.
*No treatment until 6 months after stopping drinking (in my case this would be the end of September '13)
*Cirrhosis cannot be ruled out in my case but there is no indication of it from the above numbers. Duration of infection and drinking history (moderate or more the last 10 years) are the factors that suggest a risk of cirrhosis.
*I need to lose weight, 20 lbs or so but am relatively fit. My BMI is 34 but I have always had a high BMI I was a professional mountain biker in the late 80's to mid 90's and BMI then was 30. I still ride my road bike 125-180 miles a week in season and cross country ski in the winter.

So my questions are following. These are the things I am wondering about. if anyone has any thoughts that would  be wonderful but I am putting them down here as much to organize my own thoughts as anything else.

How much stock should I put in the scores of Fib-4 (1.46), APRI (0.85), HALT-C Formula for Predicting Cirrhosis? (27%) None of these calculations would indicate a definite diagnosis for cirrhosis.

Does anything else above stand out one way or another? My platelets are a bit low normal and my INR is at he top end of normal. Do these values tend to be dynamic or change slowly?

Does what the Hep doc is saying about not treating gen 2s make sense?

Does what the Hep doc is saying about not treating until 6 post post drinking make sense? Is this about treatment efficacy or concerns about treatment adherence?

I take fish oil supplements, could this affect my INR?

I am thinking if my biopsy indicates F2 fibrosis or less I will take their advice and wait. F3 or more I will get a second opinion.

That's all I can think of right now. Thanks, best to all!










12 Responses
766573 tn?1365170066
Wow you sure have been busy. I have heard that *No treatment until 6 months after stopping drinking" before but never really seen it written anywhere. It makes sense though. I don't know how much you drank before all this but when I totally stopped drinking I saw a drastic improvement in virtually all the values on my CBC & CMB. A lot has the potential to change so it will be interesting to see.

It can take a while to get things lined up for treatment so your doctor's time line may not be that far off. There are threads on here with what will be available toward the end of the year as well as a few people who might post all that data right here in this thread. I think the main thing now is you are gathering *all* of your treatment options and you will have a choice. Plus you will have more insight when you finally know what stage you are.

I am not sure what the reference interval is for INR on your labs but 0.8 - 1.2 is what is listed on my LabCorp labs. 9.0 - 12.0 is listed for PTT.

Since you have experience with physical fitness and endurance training it seems like you will be able to lose weight if you want to and when you are ready.  I used to be overweight for my height and I know I felt better when I lost weight.  I mean from getting in and out of my car to hurling heavy bags of mulch and having the energy to walk my dogs.
Best of luck and I hope you keep us posted :)
Avatar universal
Thanks for the reply! The values from the lab that did the INR and PT are .9 - 1.1 for INR and 12.0 - 15.0 for PT so I am in the normal range for both
230202 tn?1370797179
Does what the Hep doc is saying about not treating gen 2s make sense?

Gee that i don't know why.....I would love to know the reasons for it.  Others here might know.

All the best......

3159077 tn?1356034731
I think the 6 month sobriety wait relates more to adherence and being able to stay committed to treatment. Of course it doesn't help to drink while on treatment and further damage one's liver.

Your plan on waiting if stage 2 or less and treating if stage 3 or more makes sense. I was stage 3 and felt compelled to treat. I didn't want to get to stage 4. There are much more knowledgable people on here who may be able to help you with your other questions.
Avatar universal
The reasoning (as explained to me) is that because the interferon treatment has so many risks and side effects and that genotype 2s have such a high cure rate with the new drugs with much fewer sides and complications that it makes sense to wait. The Sofosbuvir/Ribavirin all oral submitted to the FDA early last month and fast tracked is only for genotype 2 and 3 If I understand it correctly. The hep doc told me if I was a genotype 1 it would be a different story and they would either treat now with triple therapy or try and get me in a trial. There are no trials that I can find for genotype 2,  except for relapsers and non-responders.I suppose because the definitive treatment has been submitted to the FDA for treatment naives
2059648 tn?1439770265
No drinking and no drugs is a requirement of Treatment.  I think your doctor response may have been to what you put down on your medical history.
There is many reason why your doctor would want you to show sobriety.  
I think some reasons like: Its bad for your liver and more so in Hepatitis C
type 2,  It will throw off blood tests, advance you stage in liver damage and
as one senior poster says....It's like pouring gasoline on your liver if you
have Hepatitis C.  The bright side is...your liver might get healthier from not
drinking for six months.  It's something to think about if you decide to wait.
Best to You

Avatar universal
I stopped drinking as soon as I heard my enzymes were up, before I got the hep c diagnosis. I have no temptation to drink whatsoever. I wouldn't do anything to jepordize the outcome of treatment. I mentioned it because I was wondering if the biopsy came back in a certain way is it standard procedure to have to wait the six months, or is it up to the particular facility. I haven't heard that genotype 2s have more damage from drinking, I did read that 3s have more rapid progression
2059648 tn?1439770265
That's great. Sorry about 2s... you right it's 3s.  I'm not sure what your biopsy came back as.  I have heard no drugs or drinking during treatment.  Hep C
treatment in challenging to just about everyone who takes it on.  Many of us have gone into treatment with little direction.   My doctor never brought up
drinking or 6 months waiting time.  All I'm saying, is that you most like put down on the family history questionnaire - you drank. I put down I don't drink.  
I think your doctor may just be telling you this because you have hepatitis C
and shouldn't be drinking at all.  If it was a year away before you we're to start treatment - you shouldn't drink at all.  Hang in there... It could just be that. :)

230202 tn?1370797179
Ok thanks for that info Klonny55.  I am just glad I had the chance to treat when I did...........
take care
Avatar universal
Hi Linda,

I looked at you profile and saw that you have been SVR for three years now, congratulations! How was the treatment for you and how are you doing now?
230202 tn?1370797179
Klonny when I look back at treatment I think it was okay but when you are going through it.......it's a different story.  Basically I got through it all except for when my HB levels dropped between 8 & 9 I was so lethargic and that was really hard to deal with.  All okay now thankfully..
take care
x  
2059648 tn?1439770265
I did some searching and found that its your alt ( yours is 141) that reveals
alcohol.  If the high alt is the result of alcohol, then it will go down when you stop drinking.  It's my understanding that this will only happen if you completely stop drinking.  So you can't have a casual drink here and there.
Your did go down to 141 so clearly, it shows you stopped.  It will
be really interesting to see the results of your biopsy because your stage may not be as bad as thought.  I sure hope that's the case.  You're biopsy will
determine if you can wait or not for treatment.  If your biopsy confirms you
are in need of treatment now - I doubt that this 6 month warning will stop you from treating due to the fact that you had no problem stopping drinking.
Looking forward to hearing the results of you biopsy.
Best to You
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