When should treatment begin?

[Sonflower]

My 32 year old daugher was diagnosed with Hep C in  Feb. 07.  

Her ALT Plasma was elevated at 227 normal (0-60) IU/L.  
AST Plasma 84 normal (8-40) IU/L.  
Ketones 15
Epithelial cells 21 normal (0-10) #/HPF
Urobilinogen 1
Alpha Fetoprotien <3.3  normal (<8.1NG/ML)  including a note that low level are seen in 1.5% healthy patients and 10% of Hepatitis patients assoc w/ malignances.
Total Bilirubin  0.2  normal (0.1-1.0 MG/DL)

Everything else on the lab order was within the normal range.

Does anyone know what any of this means?

[Sonflower]

Thank you all for your responces...  You have all been so helpful !  

I just spoke to my daughter this evening, I shared with her about this forum, and I have encourage her to join.  After sharing with her breifly how informative and supportive everyone has been, she sounded interested in at least checking it out.

Thanks again;  Sonflower

[Mr Liver]

The high ALT reading may hold quite a bit of meaning for your daughter. It could be a reflection of the direct correlation found between high ALT and viral activity and ongoing inflammation/damage. The longer ALT remains nearly 4X normal (like hers) the faster liver damage will progress regardless of the source(s). How much faster will depend on many co-factors. If the inflammation is caused  primarily by HCV it is important to have follow-up labs to determine if this high ALT reading persists upon repeated exams. And as everyone before me has mentioned, a bx may be useful in her case. It is even more important to have a bx if you DON'T intend to treat, rather than when a decision to treat has already been reached. Good luck to both of you.
Mr Liver

[portann]

You want the best for your daughter but both of you need more information about the condition of her liver before you can debate whether to leave the matter on the back burner or plan for treatment.

Your daughter's reaction is not surprising. I was forty-five when I was accidently diagnosed in 1995, I probably already had it for more than twenty-five years and did absolutely zilch about it for another six years. I was 'too busy' and didn't want 'trouble'.

Then finally in 2001, I had a liver biopsy, found out my liver was in good shape and again did nothing about it until this May, thirteen years after diagnosis and possibly forty years after infection. And I never had side effects that I could attribute to the HCV with any certainty.

I'm not recommending that your daughter do what I did. In fact, the most important lesson I learned is that I should have had the biopsy right away and then followed up every three years with further biopsies. It's a minor procedure but will tell your daughter the critical things she needs to know about whether to wait-and-see or not.  Most likely, the biopsy will tell her she can afford to wait for better and shorter treatments, if she'd rather choose that path.

I was lucky, though, that I maintained a healthy lifestyle throughout those years and that may have contributed to my liver toughing it out as well as it did. Drinking alcohol makes the situation worse.

You said that: "My daughter shuts me down everytime I try to talk to her about getting further testing done to see what treatment is available for her. She immediately says; "Mom, I can't deal with it right now, it is making me sick thinking about it"!   She is in big time deniel.  She is very scared, and I am scared too.  I fear that she is waiting to long to get help."

My thirty-two year old daughter-in-law shuts me down everytime I try to talk to her about postponing childbirth! She says she can't deal with it right now. I think that's the mantra that a lot of young women say to their mothers, so perhaps it would be better for her to also join the forum. I know there are several young men and women her age here on the forum, some who are treating and some who have decided to wait for better options.

And getting an experienced hepatologist to monitor her is probably the most important thing you can do for her. How to get her to her appointment is another matter.

[pjhep80]

does she drink/do drugs?

if so, she should stop... prob no rush to tx but she should be aware of things that can make things worse really quick

[CMcH]

It will have to be her decision. I waited many years before deciding to TX.
It is usually a slow moving disease depending on your circumstances.
All you can do is inform her and try to get her to do some follow up with a biopsy.
Just to see where she stands it does not mean that she needs to treat right away.
On another thread you can read about people having this for decades.
It is a huge decision to TX as it turns your life upside down.
Good luck

[Sonflower]

Thank you for your responce, any and all information is most helpful....

I have been doing some research online regarding the Hep C.  My daughter shuts me down everytime I try to talk to her about getting further testing done to see what treatment is available for her. She immediately says; "Mom, I can't deal with it right now, it is making me sick thinking about it"!   She is in big time deniel.  She is very scared, and I am scared too.  I fear that she is waiting to long to get help.  After she was diagnosed, a doctor ordered further testing and she never went back to the doctors.....  

  

[Bill1954]

Sorry to hear about your daughter’s diagnosis. Hep C (HCV) is a fickle disease, and treatment is not always the most appropriate option for all of us. It’s hard to get a very good picture of where she’s at in terms of disease advancement based on the labs you posted, unfortunately. While she certainly has elevated liver enzymes, that in itself isn’t enough to paint an accurate picture.

HCV progression is measured by liver damage; this is usually determined by liver biopsy; there are other less invasive measures to consider, but the biopsy is still considered the gold standard.

The treatment itself can be rather trying for some of us; it currently consists of a weekly injection of interferon, combined with the oral drug ribavirin. Treatment last for .5 to 1.5 years, and is quite a commitment. Some get through treatment with minimal side effects, others really go through the wringer; and only a portion of patients respond to this treatment.

For more specific info regarding HCV, try the following site:

http://janis7hepc.com/

In the meantime, try to get a better picture of what this all entails; it’s generally a slow moving disease.

Best of luck—

Bill

[mkp13]

ALT and AST don't tell you much.  I'm not as sure about the others.  The test that matters is the liver biopsy, from which you learn the stage (how advanced the disease is) and grade (how active it, and thus a  proxy for how it might progress).  You'll also want a blood test to find the strain (there are a whole bunch of 'em and the difficulty of treatment varies) and her viral load.  Once you have those test results it's possible for a doctor to intelligently discuss treatment options with her (and you).
--peg