Hep C Relapse Treatment

[graphicalman]

Hi Everyone:

I am writing this on behalf of my mother. She is 62years old, is 5ft 2 inches tall and weighs 58kg.

In 2005, we discovered she had Hep C. She was treated with interferon+ribavirin. Although, I don't remember exactly but she had type 1 genotype most likely. The virus was undetectable within 3 months. However, she completed 48 weeks of therapy.

My mother had issues with depression and anxiety in the past. In 2011, we tested her for Hep C randomly and turned out it was positive again. She had some scarring on liver but doctors suggested that it wasn't that bad. They decided to put her under 48 weeks of ribavirin and interferon therapy with higher dose. The virus was cleared by 5th month. She attained SVR at 6 months after treatment. Her Haemoglobin dropped much rapidly this time around and doctor prescribed blood transfusions for last 6 shots. One of the blood transfusion went bad and she had a "blood reaction/ septic shock" due to negligence of nurse. Consequently, we couldn't complete last 4 shots as septic shock was pretty bad and she ended up in ICU. Since then, she has recovered very well. Her haemoglobin and liver functions are well. Since then, she gets tested for hep C and liver ultra-sound every 6 months.

Last month, after almost 2.5 years of undetected viral load. We found out her Hep C was positive again. Doctor also noticed two small bubbles on her liver but thinks they are benign. She is now in USA for next 5 months to spend vacations with her sister. However, doctor requested her to perform an ultra sound test around mid-trip and send them his way so he could keep an eye. Doctor believes her medical tests suggest that her liver is in good shape and there is no need for knee jerk reaction. We could opt for Solvadi in future (easily available in Pakistan) and even gain access Harvoni If she relocates to Canada to live with me in coming 2-3years. Harvoni is not yet available in Pakistan. Although, I do think that it would be available over next 2 years.

My mother's latest results:
AFP: <4.86 (less than 5 normal)
Haemoglobin: 15.5
Anti HCV: 6.81 (cutt-off rate 1.0)

LFT tests:
Total Bilirubin: 0.43 mg/dl (normal upto 1.0)
ALT: 27 U/L (normal range 10 - 35 )
AST:18 U/L (normal 10 - 35 )
Alkaline Phosphate: 82 U/L (35 - 104 normal)
GGT: 57 (5 - 35 normal)
Total Protein: 7.32 g/dl (5.5 - 8 normal)
Albumin: 4.59 (3.5 - 5.5 normal)
Globulin: 2.73 (2 - 3.5 normal)
A/G ration: 1.68

*normal refers to normal range
My mother is very discipled about diet and medicine. She is in good health and follows her daily routines. Would you guys suggest me to persuade the doctor into going with Solvadi and turning the virus negative once again or should we wait for some years and then opt for Harvoni as my mother simply hates those interferon injections.

I would really appreciate you advice.

Regards,

[GLCII]

Hello Graphicalman.

That must a real mind blower to her. I'm sorry to hear that!

Her treating is a personal choice. One that only she can make for herself. I've never done Solvadi. That being said though, If it was me and it's not, I would go with the Solvadi. There's a good chance it might work and she might not need the Harvoni. If the Interferon & Ribavirin worked, the Solvadi might just do the trick.

Good Luck

[Lynn K]

I am only seeing an anti HCV test which is the test for the antibodies to hep c. Once infected with hep c a person will test positive for the antibodies for life.

Has she been tested for the hep c virus itself? That would be the HCV RNA by PCR or similar which tests for the presence for the hep c virus.

Good luck

[graphicalman]

Hi Lynn:

My mum goes through bi-annual check ups. Like I said she had attained SVR 12. Now, this Anti HCV test was not ordered by doctor. I just wanted it done and thought it would be a test to check presence of Hep C.  On discussing this her doctor, he suggested that this test will be positive and there is not much to worry about. So, no PCR was done before she left for vacation in USA. At this point in time, She is Dallas. I hope to meet her in a month or two and will try obtain an appointment with some hepatologist in Dallas to get her checked to satisfy myself. Before meeting the heptologist, I will get her AFP, LFT, PCR, and ultra-sound done.

I am just a son, who is just a bit cautious about the health of his mother.

I would appreciate your opinion.

Regards,

[Lynn K]

You said originally her hep c was positive again and that she has relapsed.

A hep c antibody test for her will always test positive. If you mean she had a PCR test that was positive and has a viral load that would mean a relapse. If this test has not been done you do not know if she has relapsed or not. Only by testing for the virus can a relapse be determined. So I am a little unclear at this point if she is still SVR or I she has relapsed from what I am reading.

All her labs look great I wish mine looked so good. Has she ever had a liver biopsy or fibroscan to stage her level of fibrosis? The biopsy if you are not familiar they put the patient under anestetic and using a long needle take a small sample of liver tissue to examine. A fibroscan is similar to an ultrasound except the devise produces a thump and reads the result to determine liver stiffness.

I was diagnosed in January 2008 with liver cirrhosis I am 57 y/o female for your reference.

I hope your mom still remains clear of the hep c virus and is still SVR.

You are doing fine your moms results look good not sure about what liver bubbles might be but never heard of that. Just get her in to see s hepatologist in the U.S. with her records so the doctor will know where she is at.

Good luck

[graphicalman]

Lynn:

I agree and I was misinformed. No Anti HCV and PCR was suggested by doctor during her recent bi-annual tests as he felt that rest of the tests were good so there was no need for that. I was just anxious so got anti-HCV test done. Due to my misinformation, I thought that a +ve anti-HCV meant Hep C has relapsed and got into panic.

My mother has never had any biopsy done. Just bi-annual ultra-sounds apart from other tests.

I wish you luck in your efforts.

Regards

[Lynn K]

So glad it wasn't a relapse that is a very scary word to us here.

Wishing you and your mom the best hope she gets to be feeling better every day!