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8 years after transplant- Hep C is back- Should I do treatment?
My dear son shared his liver with me 8 years ago... I was dx with Hep C, in 2004 tried the PegIntron and Ribaviron and only lasted 3 doses- my Dr said I had to quit treatment as my counts were too low. I rapidly deteriorated and became a walking encephalopathic corpse and would have most likely died waiting for a cadever liver. Interestingly before transplant in May of that year- the Hep was no longer detected. I just had a biopsy- that came back 2/2- they had been undetectable all these years. My liver labs are pristine. I am afraid to start these meds again because of what happened the first time. My genotype is 2- but it looks like at best- hope for remission is 30%? Any thoughts or suggestions please?
I don't believe the hepc came back after 8 years, I do think it never went away.
Another thing I was told before beginning tx this time by my hepatologist was that even if I didn't clear the virus, tx would help my liver.
With the new orals on the horizon, and doing phenomenally well for genotype 2s, doing tx, could help save your liver even if you aren't successful in beating the virus.
Hector: Is that 33% statistic for all transplant patients or just genotype 1 ?
I know in general, it's easier to clear for geno 2s.
With the new orals on the horizon, and doing phenomenally well for genotype 2s, doing tx, could help save your liver even if you aren't successful in beating the virus.
Hector: Is that 33% statistic for all transplant patients or just genotype 1 ?
I know in general, it's easier to clear for geno 2s.
"Interestingly before transplant in May of that year- the Hep was no longer detected. I just had a biopsy- that came back 2/2- they had been undetectable all these years."
What do you mean?
Have you had a HCV RNA test performed and have a viral load?
If yes, then the test results in May must have need wrong.
If you don't have detectable virus then something else is damaging your liver and you need to find out what it is as get appropriate treatment soon.
"Should I do treatment?"
In eight years you liver disease has progressed from stage 0 to stage 2. IF you don't try treatment you will be a few year progress to stage 3 and then have cirrhosis again. As you know getting a transplant is not easy. Getting a second transplant is even harder.
If you have a hepatitis C viral load. That means you are chronically infected with hepatitis C. The hepatitis C virus that destroyed your liver is now destroying your generous son's donor liver too. You should try to cure your hepatitis C before the damage becomes irreversible and you decompensated again.
In my opinion a 33% chance of cure is better than 0%. You have been through it before so I don't have to tell you what cirrhosis and End-Stage Liver Disease is like. So no sense me preaching to the choir.
Good luck to you!
Hector
What do you mean?
Have you had a HCV RNA test performed and have a viral load?
If yes, then the test results in May must have need wrong.
If you don't have detectable virus then something else is damaging your liver and you need to find out what it is as get appropriate treatment soon.
"Should I do treatment?"
In eight years you liver disease has progressed from stage 0 to stage 2. IF you don't try treatment you will be a few year progress to stage 3 and then have cirrhosis again. As you know getting a transplant is not easy. Getting a second transplant is even harder.
If you have a hepatitis C viral load. That means you are chronically infected with hepatitis C. The hepatitis C virus that destroyed your liver is now destroying your generous son's donor liver too. You should try to cure your hepatitis C before the damage becomes irreversible and you decompensated again.
In my opinion a 33% chance of cure is better than 0%. You have been through it before so I don't have to tell you what cirrhosis and End-Stage Liver Disease is like. So no sense me preaching to the choir.
Good luck to you!
Hector
You need to talk to your transplant center and your hepatologist soon. Usually recurrence of hepatitis C is treated at stage II. So you should look into treating soon. Only the transplant center will know your overall health at this point and they will recommend the best treatment for you considering your physical health.
Yes, SVR (cure) rates post-transplant are dismal. About 33% using peg-IFN and RBV.
There will be a clinical trial at Mayo Clinic Rochester, Minnesota, coming up that will be for post transplant patients.
"Study to Investigate GS-7977 and Ribavirin for 24 Weeks in Subjects With Recurrent Chronic HCV Post Liver Transplant"
http://www.clinicaltrials.gov/ct2/show/NCT01687270?term=gs-7977&rank=8
Unfortunately only 40 people total will be in the study. If you can wait for another year you could try to get in the phase III trial IF the phase II goes well.
Again your hepatologist at your transplant center would know the best options for your situation. Get an appointment and discuss it with you hepatologist.
Good luck!
Hector
Yes, SVR (cure) rates post-transplant are dismal. About 33% using peg-IFN and RBV.
There will be a clinical trial at Mayo Clinic Rochester, Minnesota, coming up that will be for post transplant patients.
"Study to Investigate GS-7977 and Ribavirin for 24 Weeks in Subjects With Recurrent Chronic HCV Post Liver Transplant"
http://www.clinicaltrials.gov/ct2/show/NCT01687270?term=gs-7977&rank=8
Unfortunately only 40 people total will be in the study. If you can wait for another year you could try to get in the phase III trial IF the phase II goes well.
Again your hepatologist at your transplant center would know the best options for your situation. Get an appointment and discuss it with you hepatologist.
Good luck!
Hector
A lot has changed since 2003 with hep C treatment, there's been a lot of research and they now know that it is much harder to succeed with cirrhosis, the further advanced, the more difficult.
I was diagnosed with hep C when I already had decompensated cirrhosis. I did the treatment, which was really hard, relapsed and like you, had a transplant in April 2009. My daughter was my donor.
I was also genotype 2. Unlike you, my liver labs never came back to normal.
In the summer of 2011, a biopsy had me bridging from stage 1 to 2. My hepatologist said it was time to do treatment again.
So, I did 24 weeks beginning last October. At 4 weeks I was undetected.
He said that meant I had 90% chance of clearing.
I completed treatment and last month was my 6 month post treatment viral load, still no virus~ SVR !
Treatment isn't easy but compared to doing it the first time, with a cirrhotic liver, it was so so much easier. Really.
If you weren't post transplant I'd suggest you wait for the new all oral meds currently doing so well in trial. But the truth is hep C can move much more rapidly post transplant. You've already been fortunate.
Many people with hep C advance to cirrhosis within 5 years post tp.
I did it and I am so happy to finally be hep C free !
I was diagnosed with hep C when I already had decompensated cirrhosis. I did the treatment, which was really hard, relapsed and like you, had a transplant in April 2009. My daughter was my donor.
I was also genotype 2. Unlike you, my liver labs never came back to normal.
In the summer of 2011, a biopsy had me bridging from stage 1 to 2. My hepatologist said it was time to do treatment again.
So, I did 24 weeks beginning last October. At 4 weeks I was undetected.
He said that meant I had 90% chance of clearing.
I completed treatment and last month was my 6 month post treatment viral load, still no virus~ SVR !
Treatment isn't easy but compared to doing it the first time, with a cirrhotic liver, it was so so much easier. Really.
If you weren't post transplant I'd suggest you wait for the new all oral meds currently doing so well in trial. But the truth is hep C can move much more rapidly post transplant. You've already been fortunate.
Many people with hep C advance to cirrhosis within 5 years post tp.
I did it and I am so happy to finally be hep C free !
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