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3133172 tn?1342659330

tx can make hcv worse?

(first, about that VL mystery - omg - I was given copies of my and two other people's labs - can you believe it?  Yes, you can.  So anyway, my VL is 1,300,000 doubled since May - not sure if there's any significance to that other than a baseline # for tx)

I was told by one of my doctors that tx could make the HCV situation worse.  I have read that somewhere as well.  If that is the case, (1) how would one know before it's too late? and (2) would this not be taking a huge risk for someone who is cirrhotic?

This is troublesome to me.  Do I take a risk and treat and maybe go into failure?  Or do I not treat and just....... wait for........ end stage anyway but maybe later?
24 Responses
3242225 tn?1348340121
There is actually a post up there somewhere that addresses this but in a nutshell, if you go through a treatment like, for example, Peg Interferon and Ribavirin and you leave the treatment before the virus is killed OR if you go through treatment and relapse, the virus "rebounds" and strengthens and can be harder to treat the next time.  From what I have read just within the last week, the rebound effect isn't happening with 7977.
2114467 tn?1358213856
Hey there, glad the labs got cleared up. I'm sure you'll be hearing from someone that is cirrhotic and treated. I do understand though, that the more liver damage one has the closer you will need to be monitored by your doctor. I would want to have standing orders for very regular labs, in hand. Many people here, have made lists of important info to get hold of; you may want to view some old posts of questions to ask doctor.
These are some dang serious drugs, and definitely everyone here has had concerns prior to starting tx. There are lots of warriors out here. Good luck with your plan of action.
3133172 tn?1342659330
I'm just so frustrated.  The only good doctor I've been able to find, and he was the best, is no longer available to me.  If the new doctor on Monday doesn't seem competent ~~ and he's not local, the local ONE scares me with his sloppiness, I'm not sure what to do.  Yes, I'd need to be monitored carefully.  If I don't have access to a doctor who really knows what they're doing, then....   well, ya know, I'm really tired of this.  This is what happens when I didn't take a shot at the double when my grade and stage were low - and now unexpectedly find that my stage and grade have zoomed 10 years later ~ when I'm 65 and nowhere near a large city/hepatologists.

Frustrated, scared, tired.
2114467 tn?1358213856
In order to start tx you'll need to know that this new doc has got your back. Make your list now. Find out if he/she has treated w/ the new drugs. Can you reach him in an emergency. Will he use rescue drugs. How informed is this doc with tx protocol.
Try not to fret about the what ifs and focus on this appt. Be prepared. If this is not the right doctor... On to plan b. Stress is only going to make you ill; I know by experience. It's hard sometimes, but you have to get out of your head, and try to get a good nights sleep.
446474 tn?1446351282
Swimmer made some good points. 'the more liver damage one has the closer you will need to be monitored by an experienced and knowledgeable expert in liver disease and cirrhosis (a hepatologist).

First and foremost if you have cirrhosis, you should only be treated by a hepatologist who is experienced in treating scores of patient's with hepatitis C when they have cirrhosis of liver. A gastro does not have the experience, expertise or resources to manage what can happen to a cirrhotic during hepatitis C treatment over a 48 week period.

Assuming that your liver disease if not too advanced to treat, you will be monitored closely for signs of your liver disease getting worse as indicated by blood levels becoming dangerously abnormal. I have cirrhosis and I have blood tests every week to look for any signs of danger that my treatment could be causing. Blood level will probably indicate problems before you feel the effect yourself.

'I was told by one of my doctors that tx could make the HCV situation worse.'  
That is correct. Treatment can cause decompensation of cirrhosis (ascites, bleeding varies, encephalopathy is a small portion of patients. Treatment can cause liver failure in an even smaller percentage of patients. If this should happen you will need a transplant very soon. This is why patients with advanced cirrhosis may be listed for transplant before starting treatment. It is a backup plan. Which can only be done at a liver transplant center with the assistance of a hepatologist.

If that is the case, (1) how would one know before it's too late?
Because you are being monitored closely. If a hepatologist saw signs of decompensation or liver failure they would stop treatment immediately and try to stabilize your condition.

(2) would this not be taking a huge risk for someone who is cirrhotic?
All cirrhotics are taking a risk. It is a risk if you do treat and a risk if you don't. We know what will happen if you don't treat. Your liver disease will progress to the point you will no longer be able to treat your hepatitis and the only option at that point will be a liver transplant. Whenever a patient has progressed to cirrhosis they are in a risky situation. In time they will develop life-threatening complications and need to be hospitalized on an ongoing basis until they get to the top of the transplant list which could take a long time. Also having cirrhosis we all have an increased risk of liver cancer who's only cure is a transplant.

Most cirrhotic patients decide to treat because they understand that without treatment the will get progressively more ill and become disabled. At least we can say we gave it our best shot if then we fail treatment and have to have a life-changing liver transplant. While the chances of SRV are lower than in patients with less liver disease, many of us think that any chance no matter how risky is worth it to avoid the inevitable and slow nightmare of End-Stage Liver Disease.

So find the best hepatologist you can so you will have the best chance of success treatment while being closely monitored for any signs of decompensation.

Hepatitis C viral infection in patients with cirrhosis
Clinical Liver Disease
Volume 1, Issue 3, pages 65–68, July 2012
Copyright © 2012 the American Association for the Study of Liver Diseases

'The eradication of HCV is the only therapeutic intervention that can halt disease progression and improve the quality of life in infected patients. A recent Markov model constructed for a cohort of 4000 patients with genotype 1 disease found that in comparison with no treatment, HCV therapy for patients with compensated cirrhosis (Child-Pugh class A) saved $55,314 and led to a 0.950 increase in quality-adjusted life years; this resulted in 119 fewer deaths, 54 fewer cases of HCC, and 66 fewer liver transplants.5 Successful antiviral therapy has been observed to reduce the incidence of complications from progressive disease both before and after liver transplantation.

The care of patients with HCV cirrhosis involves the prevention and management of recognized complications. Furthermore, those with advanced fibrosis and cirrhosis are most in need of HCV therapy; however, interferon-based antiviral treatment in these patients is challenging because of the frequent comorbidities affecting patient adherence and tolerance, the risk of serious adverse events, and the hyporesponsiveness to therapy. Bridging fibrosis and cirrhosis are negative predictors of HCV treatment outcomes. Additionally, patients with cirrhosis are often male and older and have comorbidities (including diabetes mellitus, obesity, and alcohol consumption) that adversely affect the efficacy of antiviral therapy. In patients with compensated cirrhosis, the sustained virological response (SVR) rates with pegylated interferon in combination with ribavirin range from 10% to 44% for genotypes 1 and 4 and from 33% to 72% for genotypes 2 and 3, whereas in patients with decompensated cirrhosis, the SVR rates drop to less than 16% for genotypes 1 and 4 and to 44% to 57% for genotypes 2 and 3.

In patients with cirrhosis, treatment with either boceprevir or telaprevir in combination with pegylated interferon and ribavirin is recommended for 48 weeks; the SVR rates in treatment-naive patients range from 50% to 60%. However, SVR rates are lower with triple therapy in treatment-experienced patients who have cirrhosis (primarily prior null and partial responders), whereas relapsers have SVR rates comparable to the rates of patients without cirrhosis. Patients with cirrhosis are not eligible for response-guided therapy with nonstructural protein 3/4A serine protease inhibitors, and treatment is recommended in this cohort for a fixed duration of 48 weeks with both boceprevir and telaprevir regimens.'


Good luck to you!
163305 tn?1333672171
If it's financially possibly, you might consider renting an apartment for a while closer to a good hepatologist for the duration of your treatment. That's what I did but I'm used to being a nomad :)
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