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Morbid obesity and treatment
Jun 3, 2009
Dear Dr. McGovern,
My sister went through interferon and ribviran treatment three years ago. She became undetectable within 12 weeks. Unfortunately, the Hep C virus rebounded after treatment. Her physician refuses to treat her any further with interferon treatment unless she loses weight. She currently is 5' 5'' and is 320 pounds. He will only offer interferon treatment to her if she gets below 250 lbs. She appears either unwilling or unable to lose those necessary pounds. In addition, her viral load is very low, in 5k - 10k area. Finally, she is in the very beginning stages of stage four liver cirrhosis. Is it time to consider another physician who will offer treatment for her?
Seriously concerned
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Response from Dr. McGovern
I have a similar approach to my patients as well. Treatment for hepatitis C is more effective in patients with lower body weight. This is particularly true if she has insulin resistance as well.
I would recommend a fasting glucose and insulin level. If she has insulin resistance (pre-diabetes state) then her re-treatment would have a low chance of success.
There are also new therapies on the way in about two years that may help her. However, such severe obesity is also associated with fatty liver which can also lead to cirrhosis. So even with a CURE of her HCV she may still have severe liver disease on the account of fatty liver.
These are all the reasons why - I agree - that she needs to lose weight since she is at risk for end-stage liver disease, not to mention heart problems, diabetes, and other issues.
A visit to a obesity specialist is probably needed to help her along.
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