The good, the bad, and the ugly.

[Bill1028]

I'll get the bad and the ugly out of the way.  It's baaaack after 76 weeks of tx.  On my 1 month post tx heptamax, my VL is a low 987 and my ALT and AST are normal.  I'm not sure of what to make of this.  When I relapsed after the first round of tx, my VL, AST, and ALT doubled.  I have another VL scheduled in 3 weeks.  I'm hoping to pull off a NYGirl.  :)

Please don't let this discourage anyone, because I have about all of the negative predictors for SVR.  I have no regrets and I'm glad that I had the opportunity to treat.  I had a very easy treatment except for anemia and no post sx.  I feel absolutely great, except for when I received my heptimax fax.  That sucked!


The good:

My labs are bouncing back nicely.  My platelets due to cirrhosis are up to 110,000, they were 99,000 pre-tx.  I was borderline diabetic before treatment.  During treatment, I had to take oral meds to control my glucose.   Within 1 month, I'm no longer on meds and my glucose is normal.  On my labs, during treatment, I had 15 things out of range and 1 month post, I have 8, and every one has moved in the right direction.  Even my bilirubin moved into the normal range.

               ON TREATMENT           1 MONTH POST
Platelets          63,000                        110,000
Nuetrophils         864                             2,250
Hemoglobin       10.8                              12.6
WBC                 1.8                                4.1

NYGirl, what were your numbers when you thought that you relapsed?

Would I treat again?  Hell yeah, they say 3 times the charm.  I wanted to restart now and my wife said she would divorce me.  Now that's food for thought!

[mikesimon]

Thanks for the medhelp site. I have read about this but I didn't recall a member saying this happened to her - which is what I thought you were saying. I dimly recall Bill's post though.
The link to the article on graft dysfunction is unavailable for some reason. Are you sure the link is right?
Mike

[BThompson4]

Didn't find the study mentioned by Mrs. Ockert but this one is disturbing for post-tx treaters:

http://www.tiny.cc/VBGua

Gut. 2007 Feb;56(2):237-42. Epub 2006 Jun 23.
High incidence of allograft dysfunction in liver transplanted patients treated with pegylated-interferon alpha-2b and ribavirin for hepatitis C recurrence: possible de novo autoimmune hepatitis?

[BThompson4]

This thread has something on it.  A post by Bill 1954.  Looks like she was only UND at six months and relapsed at one year mark after the prednisone bolus.

http://www.medhelp.org/posts/show/270244

[mikesimon]

I do not recall the lady who relapsed following bolus steroid. Do you recall anything about that - name of lady, approximate date of thread or thread title? Mike

[BThompson4]

I think it was return to sender that had the post-tx positive then got to svr.

http://www.medhelp.org/posts/show/95830

[BThompson4]

I think a relatively low immediate post-tx viral load may not signal treatment failure.  There was discussion here fairly recently I think about how little troughs in the immune and tx processes may allow the virus to show up in low numbers and then be repressed back down to nothing.  NYGirl might be a prime example with her very low post-tx pcr at one month and then UND later.

I had no less than 16 bi-weekly UND pcr's since clearing at week 22 until a few weeks ago when I showed up with a 43 IU/ml on my most recent test.  I suspect it was brought on by an "immune crisis" when I spend two hours a day for three days almost literally swimming in poison ivy from an apple tree that had the vines and leaves wrapped around it.  Naturally it was my first exposure and knowledge of the plant and at age 52, so I had no idea what was happening until it was too late, and it really wrecked my immune system.

I am immune suppressed from liver transplant so symptoms (body did not attack the poison ivy aggressively) did not show up for almost a week after the exposure; in a normal person, I would have got the message withing 24 hours and probably limited exposure by quite a bit.  I slept only an hour or so for about a week and was a total wreck.  Developed a facial fungus, got attack of viral or fungal dermatitis on my scalp (a more-or-less constant condition while I had cirrhosis), and got my first urinary tract infection since pre-transplant days, and there is no sign of the uti going away after three weeks and three courses of antibiotics.

I am in week 60 of treatment and will keep at it if my most recent pcr is UND.  My situation reminds me of the mention of a lady on this board who was svr and relapsed after getting a prednisone bolus.  I took some extra cyclosporine (doubled my mg to 400 a day) for five days in order to sleep after a week of suffering, and I am sure that did not help my immune status, but it did repress skin outbreaks (just as often-prescribed for poison ivy prednisone would have, but without having to drive my blood sugars above 500, which happens in me with only about 40 mg of prednisone) and not become a raving lunatic from lack of sleep.  Hopefully the viral load did not/will not get out of the two or three digit range and was/could be suppressed.  I am running out of time to get to 72 weeks (I'm definitely stopping tx then.  If I get a very high viral load in my next pcr,  I will probably stop tx right away.