Diagnosed with HCV in 2007

[01rm463]

New user here, 37 y/o male, overall pretty healthy. Non smoker, never touched a drug.

As stated, I was diagnosed in 2007 with the virus, I'm guessing I was infected sometime in 2004 (Attended a tattoo party). This is the only way I think I could have contacted it as I was never a drug user.

After being diagnosed I went thru a series of tests to determine I was a 1A. I was sent for a biopsy which turned out to be normal and my gastro DR wasn't concerned and said "long healthy life" and said to wait for new treatments.

I maintained my lifestyle and read up on the risks and overall just took care of myself.

Fast forward to now and now I'm considering treatment as Harvoni seems to be the cure.

Here are my latest blood test results done in November 2016:

Does anything look overly alarming? My Dr has always been impressed with my lab works over the years.

HCV +
VL - 4.2 million

Automated Diff

Baso - 0 (0-1%) Eos - 3 (0-3%) Lymph Auto - 44 (22-40%) H Mono Auto - 10 (0-11%) Neutro Auto - 43 (40-71%)

CBC Diff

Hct - 46.9 (39.0-50.0 %) Hgb - 15.9 (13.0-17.0) MCH - 30 (27-31) MCHC - 33.9 (32.0-35.0) MCV - 88 (80-94) MPV - 9.5 (7.4-11.5) Platelet - 244 (150-400 thou) RBC - 5.34 (4.20-5.40) RDW - 12.2 (11.5-14.5%) WBC - 5.5 (3.6-10.5 thou)

Hepatic Function Panel

Alb - 3.9 (3.5-5.0) Tot Pro - 7.2 (6.0-8.0) Alk Phos - 45 (45-117) ALT - 57 (6-78) AST - 41 (6-40) H Bili Direct - 0.3 (0.0-0.3) Bili Total - 0.9 (0.2-1.0)

Lipid Panel

Cardiac Risk - 0.38 Trig - 63 (0-149) Chol - 122 (50-200) Chol VLDL - 13 (6-67) HDL - 79 (41-59) H LDL - 30 (0-129)

[gnatcatcher]

Welcome, 01rm463.

To answer your specific question, no, nothing looks overly alarming. But the fact that you do have a viral load in the millions and you were diagnosed a lot longer than six months ago means that you were not one of the lucky people who cleared HCV on your own. Barring a miracle, you'll continue to have HCV unless you treat. Chances are good you won't start noticing out-of-range hepatic lab results until you're quite a bit older, but with increasing age, despite all your good habits, your liver will have a tougher job unless you treat.

I, too, on the advice of a gastro, waited for a good treatment to come along. My PCP had me do a liver ultrasound every couple of years. Although they were all normal, a 2015 FibroScan concluded I had early cirrhosis. (I don't drink.)

Fortunately, Harvoni came along in the nick of time, and my liver has improved so much that later FibroScans put my liver at less than cirrhosis.

Now there are several excellent treatments for genotype 1a. You can keep up with the latest official recommendations here: http://www.hcvguidelines.org/full-report/initial-treatment-box-summary-recommendations-patients-who-are-initiating-therapy-hcv  (Harvoni is the ledipasvir+sofosbuvir combination; Zepatier is the elbasvir+grazoprevir combination). Your insurer is likely to work with a prescription benefits company that probably has a deal with one treatment and will balk at approving a different treatment; anything without interferon or ribavirin should be easy to tolerate unless you happen to be that rare person who reacts negatively to that particular treatment.

HTH and best wishes,

Gnatty

[Lynn K]

From my layman perspective your labs look fine for someone with hep c I wish mine looked as good except of course having a viral load.

Viral load really means nothing about severity of illness. We have had some here with much higher loads with no liver damage who were cured with the new medicines.

Best of luck to you 

[01rm463]

Thanks for the replies, I live in the constant fear I have cirrohsis. Lately I've been a bit stressed out and have some anxiety. I have days where I'm in a brain fog from over thinking things. I might be a bit of a hypochondriac at times.

I dont have no signs of jaundice or acsites and I don't think my blood work points to anything major that would cause a red flag, correct?

[gnatcatcher]

Correct. Your ALT and AST are normal. My ALT and AST had been above normal and climbing for almost a decade before the FibroScan yielded a score in the cirrhosis range. Sorry if I scared you by saying "in the nick of time" in my case -- I probably would have developed more serious cirrhosis if I hadn't treated fairly soon after I did, but that's because I am much older than you and had already had HCV for nearly 44 years and too-high liver enzymes for nearly a decade.

Either a FibroScan (a special type of ultrasound that gently thumps your liver to estimate fibrosis level) or a Fibrosure (a blood test that also estimates fibrosis level) can put your mind at rest about cirrhosis. Since you sound like you're ready to seek treatment now that good treatments exist, the hepatologist will probably do one or the other of those tests (mine did both) instead of a biopsy as documentation for your insurance company. Based on the results, you'll be told a fibrosis rating of between F0 (no fibrosis) to F4 (cirrhosis -- extremely unlikely, given your normal labs).

Just knowing the HCV is inside of you quite naturally causes stress and anxiety. Even though your lab results indicate you're not in any sort of imminent danger, what will put your mind fully at rest is to have been treated and cured. The sooner you start treatment, the sooner you're cured.

Every good wish,

Gnatty

[Lynn K]

One common first indication of cirrhosis is a low platelet count. As you see in my dignities my platelet count is 110 well below minimum normal of 150 while yours is 224.

Jaundice and major gross ascities are symptoms of late stage cirrhosis or decompensated cirrhosis. ALT and AST levels are not perfectly correlated with severity of liver disease. They only indicate something is injuring the liver and not the extent of damage. There are people with very high ALT and AST but no liver damage and others with only slightly elevated results who have much more liver damage.

I had just barely elevated liver enzymes for years but i progressed to cirrhosis. Currently as I am now cured of hep c my ALT and AST are in normal range but I still have cirrhosis.

Also it takes decades of infection with hep c to develop cirrhosis. This is assuming you have not been drinking alcohol to excess. But anyway only about 20% of people with hep c will progress to cirrhosis after 20 years of infection.

I was monitored every 5 years with liver biopsy on my 4th biopsy after being infected for 30 years I finally had progressed to cirrhosis. That was in Jan 2008 so I have had it for over 9 years now. I have never had jaundice and only have mild ascities only detectably by ultrasound. I also have some edema so I take a diuretic to help with that.

I am sure with your platelet count you will be fine.

[lporterrn]

Hi,
Although your ALT/AST appear normal, they really aren't. The normal ranges have just been reestablished, and most labs haven't caught up to the new norms. From my perspective, your enzymes are slightly elevated, which one would expect for someone with hep C. Not alarming, but something to know.

I'd like to address your lack of risk factors. Your guess makes good sense. However, you are young enough to make me wonder if there is any chance you could have a mother with hep C or if you received blood products as a baby/kid. Is there any chance of this? I know that sounds scary, but most young people do well with hep C, even if they've had it for decades. However, things change with age because our immune systems decline. There are so many reasons in favor of treatment, regardless of how long one has had hep C.

[01rm463]

I don't think my mother has it, she is 65, seems healthy and has never mentioned it.

Is brain fog, fatigue and sometimes abdominal discomfort a common symptoms of the virus? I try not to read a lot on it because every website seems to say something different especially webmd, so I just freak myself out and think the absolute worst.

On days I go to the gym I have no worries and my workout goes on like it should. No lifting problems, no weakness. But when I come home and sit down the immediate symptoms seem to start.

[Lynn K]

While in general hep c is considered a silent disease with most people not having symptoms the most common complaint is tiredness but that is such a vague complaint it is a little hard to quantify. I mean I was tired but was it too much work, getting older, or hep c? Also many do report what they refer to as brain fog although I personally can't report that symptom maybe a part of being tired and thus making it difficult to focus?

Abdominal discomfort is again so vague it could be many things or not really anything.

Some people do experience extra hepatic symptoms a group of illness that may have an association with long term hep c infection. But again for the majority of people hep c is without symptoms except for the commonly reported tiredness.

Curious what you are seeing on web md that you didn't think to be helpful. To me they seem to be a good resource for a lay person

[Mugwump]

I don't think my mother has it, she is 65, seems healthy and has never mentioned it.

Is brain fog, fatigue and sometimes abdominal discomfort a common symptoms of the virus? I try not to read a lot on it because every website seems to say something different especially webmd, so I just freak myself out and think the absolute worst.

On days I go to the gym I have no worries and my workout goes on like it should. No lifting problems, no weakness. But when I come home and sit down the immediate symptoms seem to start.

The only significant effect of HCV long term is liver damage and this is why for all of us who have had it monitoring of liver functions is so important. Brain fog again as Lynn said is something very hard to quantify, however if your liver functions are close to normal then this aspect does not usually happen until the liver starts to go way out of whack and the byproducts of liver damage and the reduced ability of the liver to remove toxic by products in the blood is compromised.

Some of us do seem to develop flu like symptoms to a greater extent than others, rather like always feeling like hell for no reason. It could very well be the effects of high levels of antibodies piled on with an increased production of natural interferons created by the slow progress of HCV as it kills greater numbers of liver cells over time. Immune reactions to virus caused disease are usually closely symptomatic in nature, so feeling like you have a mild flu all the time can be symptomatic of chronic HCV infection. I know it was for me. But for some these aspects of having HCV never seem to manifest themselves in any way that can be nailed down clinically.

It was constant flu like symptoms and out of whack blood work that finally lead my doctor to test me for HCV in 1993. So a very great many who have the disease do not get tested for HCV because they have no real indication of a test being necessary. For some of us the disease waxes and wanes to a greater extent for most however the disease just sits there at low levels so it is very hard to ascribe symptoms to HCV other than the liver damage that it does.

All the best getting treated and cured before the disease has a chance to progress any further.
Eric

[lporterrn]

Your mother is a baby boomer, and the CDC recommends a one time hep C test for her based on her age. She could be without symptoms. She should be tested.

[01rm463]

Thank you all for the replies.

Is brain fog associated with High Ammonia levels? This is why I freak out when I read Webmd and think I have Cirrohsis.

[Mugwump]

Thank you all for the replies.

Is brain fog associated with High Ammonia levels? This is why I freak out when I read Webmd and think I have Cirrohsis.

By the time ammonia levels increase the liver damage is at a very advanced stage. It is a good idea to have CBC done and at the same time fibroscan or fibrosure. Either of the scans and blood work are not good at diagnostics for pre cirrhosis but are fairly accurate in diagnosing cirrhosis. Most likely a specialist will call for these procedures before making a treatment recommendation. Or they might call for a biopsy to determine the exact level of current liver damage. I had a biopsy done in 2003 and it was F2-F3 but I did not progress to full blown F4 cirrhosis until 2012-13. So the regular monitoring of complete blood count and liver scans is standard diagnostic procedure with chronic HCV infection.

It is also a good idea to have a TSH or thyroid stimulating hormone reading done at some time. In close to 50% of individuals there are increases in the production of thyroid antibodies because HCV is known to throw the immune system out of whack in other ways.

Thyroid disorders are more frequent in women who have HCV but in my case my immune system attacked my thyroid gland and caused me to have very elevated levels of thyroid hormone in my blood. This can also cause brain fog, euphoria, headaches and high blood pressure, because excess thyroid hormone in the blood is not used and breaks down into substances that are nasty and cause all these symptoms. This is not common but can occur because of long term HCV infection.

Most commonly, those who have thyroid issues because of HCV are not diagnosed until the thyroid gland is damaged to the extent that it cannot produce adequate thyroid hormone, so it is more common that thyroid hormone replacement therapy becomes necessary.

But if you do have elevated levels of TSH this could also explain things. Unfortunately most MD's who are not experienced with dealing with large numbers of HCV patients do not know all the secondary crap that can happen. But as long as you are being monitored for cirrhosis, the complications that can occur with cirrhosis and liver cancer, the most important things are being monitored.

On the issue of whether or not you may have had this disease from birth. It is possible, but it is also possible that your mother may have had HCV and gone on to clear it naturally, or she could be infected and not show any signs whatsoever of the disease. One cannot be certain of much with this disease except that it should be discovered and treated if possible.

Eric 

[Lynn K]

In cases of very advanced decompensated cirrhosis something called Hepatic encephalopathy can develop. However, HE is a far cry from brain fog. People with HE cannot drive a car because they can become lost in their own neighborhood, they can just drift off on the middle on a conversation and just stare into space, they have difficulty with the simplest of tasks like operation a remote control to change the volume on a TV. HE would occur along with other symptoms of decompensated cirrhosis like having ascities to the point the patient has so much fluid in their abdomen they appear pregnant.

Decompensated cirrhosis can occur after having been a compensated cirrhotic for a long time especially if the underlying cause is not treated.

Really with your normal platelet count there is no way you have cirrhosis compensated or decompensated. I have had cirrhosis for 9 years and am still considered compensated.

As I mentioned "brain fog" is a not uncommonly reported symptom of hep c infection also with some vague fatigue.

Try not to worry I know easier to say but harder to do. But really you will be fine