Abnormal LFTs after Interferon Therapy

[QamarZ]

Dear Sir/Madam,

I had interferon therapy 1 years ago and achieved RvR.

Few days back, I got my Real Time PCR HCV(QN) with 354130 - IU/ml.

MY HCV Gentotype is '3a'

Can anyone guide me what should I do? If I go for interferon therapy again, Dr says I've to go for therapy for 12 months and only 50% chances are I'll get recovered. And if not, my liver will get worst.

I got married about a year ago and trying to have baby. Please someone help me..

My LFTs are:

----------------------------------------------------------------------------------------
TEST(s)                               UNIT(s)    NORMAL    RESULT
----------------------------------------------------------------------------------------
TOTAL BILIRUBIN                 mg/dL      Up to 1.0    1.05
DIRECT BILIRUBIN                mg/dL     0 - 0.4         0.2
INDIRECT BILIRUBIN             mg/dL     < 0.7           0.85
ALT                                       U/L        10 - 50        76
AST                                      U/L         10 - 50        77
ALKALINE PHOSPHATASE   U/L         40 - 129      92
GGT                                     U/L         8 - 61          136
TOTAL PROTEIN                   g/dL       5.5 - 8.0       7.93
ALBUMIN                              g/dL       3.5 - 5.5       4.48
GLOBULIN                            g/dL       2.0 - 3.5       3.45
A/G RATIO                                                            1.3
----------------------------------------------------------------------------------------

Best Regards,
QZ

[ceanothus]

I have to admit, I'm a little confused by your reports but it does sound like your doctor has not been doing a really top-notch job on your treatment or testing. Do you have the option of looking for a doctor with either better training or better follow-through? Have you asked for copies of all your test results and medical reports? I see your previous treatment ended in January 2012. What did the PCR test show at that time? It is important to know if the virus was detectable or not at that time. Normally a new genotype test would not be run unless you were UND for at least 6 months after tx ended and then the virus reappeared after that. I'm afraid your results of mild esophageal varices, mild portal hypertension, enlarged spleen and cirrhotic texture to your liver are all very worrisome results. I think you will find that most hepatologists would recommend that you treat now rather than waiting for the new drugs. It sounds line you already have cirrhosis (compensated), and although you may feel fine, your liver, and thus your life, are in danger. The steps from early cirrhosis to advanced cirrhosis are very unpredictable when the liver is still being damaged every day by the virus. I stayed fairly healthy with cirrhosis for 9 years, from the time it was first diagnosed until I was finally able to beat it (SVR as of last month), and now that the virus is gone I have a much lower risk of my liver decompensating. This is not necessarily typical however. We have other forum members whose livers decompensated very quickly after being diagnosed with cirrhosis. Once your liver goes over that line, very few people can safely be treated for the virus and your only hope becomes a liver transplant. Many people don't even notice anything wrong until their liver begins to fail, so you can't rely on the idea that since you feel okay you still have plenty of time.

I'm sorry to be giving you this kind of news, and since I'm not a doctor and haven't ever even met you in person, I could very well be wrong, but I do believe this is serious enough to warrant finding the very best doctor you can and going through the options carefully with him/her. The best doctor for someone with any degree of cirrhosis is a hepatologist who works with a liver transplant center. Most of us will hopefully never need a transplant, but these doctors are best for us because they have the training and skills to handle the kinds of complications we are vulnerable to, and they best know how to help us avoid needing a transplant – including when to do treatment. I hope you will be able to at least get another opinion from such a specialist, and will come back to let us know how you are.

[Idyllic]

I see you had your viral load (PCR) during treatment but normally patients have one at the end of treatment (EOT) to make sure they are still UND
Then there is a PCR at 12 weeks
But the one at 24 weeks after treatment is what determines if you are SVR (sustained virological response) free of the virus.

Because you did not have the EOT PCR it is difficult to determine if you relapsed, had a viral break through (became detectable again somewhere during the six months you treated) or contracted the virus anew

I do not know much about cirrhosis but the results you report may indicate further consultation with your doctor. I have seen elsewhere on here (and uin WIKI) that Cirrhosis of the liver is one of the most common causes of  Portal hypertensive gastropathy
_____________________________
I am sorry treatment was not easy for you. These are very harsh drugs. I am not sure what your options are since you just finished treating.

There are many others who will offer insight.

[QamarZ]

Abdominal Ultrasound Results:

Spleen 15 CM & CLD (Cirrhotic texture)

[QamarZ]

I had my EGD few days back with following results:

* Grade I esophageal varices.
* Small size hiatus hernia.
* Mild to moderate portal hypertensive gastropathy.

[QamarZ]

@Idyllic: I only achieved RvR and that within 1 month i.e., '7-Jul-11 PCR (QL)' was 'detected' and then by '12-Aug-11 PCR (QL)' was 'non-detected'. My Dr never asked for SvR :-(

@ceanothus: I had 'PEGASYS 120ug' 8 injections and then Dr suggested to go for '16 PEGINTRON 50ug' injections along with Ribazole 400mg twice a day. So total 24 injections for 6 months.

My treatment was ended by Jan-2012. At that time, my Dr only asked for PCR(QL) and no Genotype etc.

I'm also not sure whether its relapsed or new infection? the biggest blonder that my Dr made was not to ask for Genotype and SvR. If he could have asked, I could use that to compare with current Genotype to know whether its relapsed or new infections.

I really had bad experience so that's why I'm asking you guys to help me so if I go for treatment again, I have enough info to choose best treatment/dr.

Thanks for all the help..
-QZ

[Idyllic]

The thing is no offense but it sounds as if your friend does not understand
Hepatitis C and the terminology.

The viral load does not reflect the amount of damage to
your liver.  This is why a biopsy is a good idea. It shows

how far your fibrosis has progressed. An acquaintance of mine has
a low viral load and she is stage 3 fibrosis. Her liver enzymes are only

slightly elevated.

The VA web site says in some cases a low viral load might mean it is easier to clear the virus but mostly a viral load only matters when you
are treating. It shows how you are responding to the meds.

AlSo did you reach SVR or were you only RVR?

Hepat

[ceanothus]

It is generally accepted that the degree of liver damage you are accumulating is not well correlated with either viral load or lft numbers, so its hard to say if treatments that lowered those numbers would be helpful as a temporary measure (if there even are homeopathic remedies that can lower those numbers, which I don't know). At any rate, you cannot be cured by those means, and getting completely rid of the virus is the only sure way to stop it from continuing to damage your liver. Again, a lot depends on your current liver condition (fibrosis stage as indicated by a biopsy or a fibroscan), which would tell us how urgent it is to treat the virus now versus waiting for the next generation of meds, and on the odds of successfully treating the virus with existing meds. If we knew more about your previous treatment (how long did you treat, what your viral load was pre-tx and what it was at all the tested points during and immediately after tx), then someone could probably pull up some studies that would give your odds of successfully treating it now.

If you have minimal liver damage (either 0 or 1 on the fibrosis staging), then you can probably afford to wait for the next meds, IF you take very good care of your liver in the meantime. That means no alcohol consumption at all, using great caution with all meds and dietary supplements, including avoiding all NSAIDs, eating a healthy diet and getting enough exercise. Don't take any medicines or supplements without checking with your liver doctor on whether they are safe for your liver condition. Some "natural" cures may help reduce inflammation in the liver, but some can be deadly. Natural does not necessarily mean safe.

[QamarZ]

Thank you all for your support and help.. I appreciate your time and the care..

A friend of mine suggested me to go for Homepathic treatment. He says your virus may not be cleaned out completely but viral load will become low i.e., at a minimum possible level and your LFTs will become normal.

Is this possible?

Thanks again for your time and all the care..
-QZ

[ceanothus]

I'm so sorry to hear the HCV is back again. It's not clear to me whether this is a relapse or a new infection, as you only mentioned achieving RVR (rapid viral response, which means the virus dropped quickly when you started the drugs), but you did not mention SVR. (Sustained viral response, meaning the virus remained undetectable for a full 24 weeks after your treatment ended). Did you actually achieve SVR, or did you at least remain UND throughout your previous tx? A more detailed history of your previous tx would be helpful. Have you had a liver biopsy in the last few years? It is true that new drugs are currently being developed which will make treatment both easier and more effective, but this must be carefully balanced against the current degree of liver damage and the likelihood of further damage occurring while waiting. You must also keep in mind the fact that you absolutely should not try to father a child while taking ribavirin OR for six months after taking it. When to treat is a complicated decision and everything needs to be taken into account and the answer is not the same for every person. I'm also not that familiar with your genotype, so I'm hoping someone else  with more knowledge of genotype 3 will chime in soon. Good luck!

[Willy50]

To the best of my knowledge since you last treated there has been no major advance in treating geno 3.  I would not expect a dramatically different outcome if I did the same treatment.

There are several new treatments coming for geno 3's.   Might you be able to wait a year or two?
Have you had a biopsy/what is your staging/can you wait would weigh into factors on deciding what to do.

In 5 years perhaps there could be MANY better treatments and it is also possible that prices could come down due to competition.  New treatments should have increases in safety, a shortening of the TX duration and reduced side effects during and post TX.

If money is less of an object the newest/ best I am aware of will be a Gilead treatment which will be interferon free for g-3's, should be a shorter treatment.  This may be approved in the United States in 3-4 months.... we will see...... If you are from another country I cannot speculate on that time table.

willy

[desrt]

If I were in your place I would hold off on treatment and try to get a liver biopsy to assess the degree of fibrosis and steatosis in your liver. You should not have any treatment drugs in your system  --  especially ribavirin  --  for at least six months before you try to concieve.
I carried a geno 3 virus for almost 30 years with viral load and ALT/AST very similar to yours and had only minor fibrosis  --  but that's just one person. Others progress faster. Get the biopsy and find out whether you have time to wait on treatment.