For Dr.Thomas D Schiano, MD

[jwalia]

Respected Sir,

I am father of a 14 year old thalassemic girl, named Yuviana.J.Singh, who underwent BMT at CMC Ludhiana, India in November 2009.  The situation is that Yuviana only find out her  HCV status to be HCV positive in her pre BMT regimen only.  When they conducted the HCV RNA qualitative it was negative. The doctor clarified that her tests indicated that her antiHCV antibody was positive and HCV RNA qualitative was negative.  The liver biopsy was done and it showed  grade IV iron load, mild portal and focal periportal fibrosis and focal mild to moderate portal inflammation. which he clarified means that she had some infection previously in her life from which she recovered so that is why antiHCV antibodies were present.  At that time she had normal LFTs,   They decided to go for the BMT.  During BMT she had veno occlusive disease (moderate). Post BMT  on her discharge on December 22, 2009 she had SGOT/SGPT levels of 47/49.  She was doing well.  Vitals were all good.  She was taking cyclosporin dosage of 100mg BD, which was increased after 10 days(January 4, 2010) to 150/100mg bid . her SGOT/SGPT level started rising from December 28, 2009  they started fluctuating till Feb 8,2010.  After Feb the SGPT levels shoot up and it was highest of 218/398 on March 22, 2010.  When there was no sign of decrease in SGOT/SGPT levels the doctor ordered the HCV quantitative test which was 12100000 IU/ML. When i asked the doctor concerned he told us that virus got reactivated during the Immunosuppresant therapy. further details in my second message

[Thomas D Schiano, MD]

if at all possible i would hold off on interferon therapy.  frankly i have never seen HCV reactivate in such a manner and wonder if it could be a new, acute infection.  Who was the bone marrow donor?  i like your idea of the chelation.  Things are getting better--i am concerned about using interferon in the post-BMT setting.

[jwalia]

Sir,

I have sent you the email. As the address given by you here is not working.  I had sent it on your hospital address.  I don't have words which can show how grateful i am for your kind interest.  You are just like a ray of hope when everything was so dark and dismal.

Thank you again.

walia

[Thomas D Schiano, MD]

you can email me at thomas.***@****.  His her brother HCV (-).  She could have also acquired an acute from some of the blood products that presumably she received.

[jwalia]

Respected Sir,

First of all thanks for your response.  The donor for her bone marrow was her brother.  further i will like to have your permission to remain in touch with you so that i can discuss this case with you as required in future.  if you want to see her previous data regarding her brief history, LFT counts and medication i will feel very much obliged to provide you with that.  
I will also like to know where i can send you that data, appreciate if i can have some email address.

Sincerely yours

walia

[jwalia]

He told us to wait till the cyclosporin is stopped.  When the cyclosporin was stopped, we waited for 45 days and had a HCV quantitative done.  It was 1420000IU/ML ie 88% less than the last test conducted and SGOT/SGPT levels were 60/109.  I had also gone through some articles on HCV which stated that out of 100 people who gets infected, 15 will get rid of the virus without any treatment.  Now my question is if there is a decrease in SGOT/SGPT levels and Her HCV quantitative is also coming down, doesn't it is required that we should wait and watch?  If she had recovered previously in her pre BMT period, is it not possible that she can do it again? My view is that we should wait, go for the iron chelation, give her some time to relax, and if there is increase in HCV levels then we go for the new drugs which will be available in 2011.  She got mild yellowness in eyes except that she is totally normal.  NO signs of jaundice, fever, vomit, appetite normal,  color of urine normal.  her current ferritin level is 8340.  I consulted two gastroenterologists but they have divergent  views regarding her interferon treatment and none of them had experience of treating a post BMT patient. I am totally confused .  Hence this email to you.