And now, we wait

[hepcandme]

I had a much anticipated consult with my Doc yesterday about what is next for me with Hep C and cirrhosis. A "little" Ascites 3 months ago (though you probably wouldn't notice and not enough to warrant Paracentesis) and Edema that has gone away entirely. 2 months of detox diet, more exercise, no alcohol or Advil. (Most) Blood tests are all close to normal and continue to improve steadily and MELD dropped from 12 to 10. So, the problem is, what to do next? I geared myself up for a Hep C regimen that would include Interferon - hopefully for 12, not 48 weeks but now there are the new drugs that will be out in 9 months or so and new, less intense treatments just on the horizon. My doc says we should wait a few months and do blood work again. Meantime, I am plagued by constant fatigue. Am I just being impatient to have a more concrete plan and timeline? Because of the cirrhosis, I could go from not so sick to Very sick if something were to go wrong at any turn. I know there are people out there who are much sicker than me. I have a consult with another hepatologist next week but no one seems to want to give me what I really want : A LIST -  here are 5 courses of action we could take and here are the pros and cons of each one

[HectorSF]

What to do next?

Generally speaking based on the facts you have presented you should be treating your hepatitis C soon. Someone with cirrhosis should not be waiting a year for interferon free treatment to be available. You are still compensated and should treat with one the new treatments soon to prevent further liver damage from the virus. Should your liver decompensate while waiting for new treatments, it may be too late to treat your hepatitis and then the only option will be a liver transplant. You have the most options you will ever have now. As your liver disease advances less options will be available. In my opinion you should be pro-active now, 'waiting' can be a poor choice for someone with cirrhosis. You still have time cure your HCV and prevent it from causing irreversible damage to your liver.

I would imagine that any hepatologist will tell you the same.

Have you seen a hepatologist at CPMC or UCSF yet?
They will treat you with the best HCV treatment for your situation and monitor you liver status during the treatment.There are many people here in the Bay Area who are going to be treating soon in 2014 with the new treatments. We are gearing up for it at UCSF so I would recommend getting set up to treat with a hepatologist with a plan for treating in place as soon as you can.

Here is UCSF's clinic for treating hepatitis C
Liver Disease and Liver Transplant
350 Parnassus Ave., Suite 300
San Francisco, CA 94143
To schedule your first appointment at the Gastroenterology and Liver Clinic, please fax the following information to [phone]:
* A referral letter, including your current diagnosis, from your primary care doctor or GI specialist.
* All related doctor's notes, and lab and test results. Ask your GI.
* Copy of your insurance card (front and back).
* Your contact information, including mailing address and phone numbers.
If you have any questions, please call the clinic at [phone]."

Best of luck to you!
Hector

[hepcat1954]

Have you considered doing off-label Olysio & Sovaldi?  Several people are doing that as both are approved now!

Ask your doc if you're a good candidate for it.  Be aware, that you should take the new enhanced Genosure test (by Labcorp) to determine if you have the polymorphism Q80K.  It greatly reduces the effectiveness of Olysio as Olysio is a 2nd gen protease inhibitor and susceptible to resistant variants.  Because Sovaldi is a RNA polymerase inhibitor, it has a high barrier to resistance.  

If you can afford to wait, you might want to wait for the crucial NS5A inhibitors, Daclatasvir or Ledipasvir to take with the Sovaldi. They should be out in 2014.  Also, the FDC (Fixed Dose Combination) of Sovaldi & Ledipasvir (i.e., one pill) has been designated as a FDA "Break Through Therapy" recently.  It should also be out in 2014.

http://orphandruganaut.wordpress.com/2013/08/23/gilead-sciences-receives-19th-fda-breakthrough-therapy-designation/

Good luck,
HepCat
...

[can-do-man]

Treating for 12 weeks with interferon would not be that bad. From everything that I have read it will be at least 12 months before the all oral DAA's could be here as they should be submitted sometime in the first quarter of next year then you have about and 8 month wait for approval.

Best to you.

[hepcandme]

I am C 1a so, hafta do the Interferon, sadly. At least for now

[IAmTheWalrus]

With a MELD score, I imagine you may be on the list for transplant. Treating with DAAs to bring a patient to UND prior to transplant has been successful in preventing reinfection of the new graft. No interferon required. This a possibility?

[IAmTheWalrus]

With a MELD score, I imagine you may be on the list for transplant. Treating with DAAs to bring a patient to UND prior to transplant has been successful in preventing reinfection of the new graft. No interferon required. This a possibility?