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Hep C treatment
Feb 25, 2006

My brother-in-law in Thailand is naive about his recently diagnosed Hep C and doesn't want to do a biopsy or start treatment. Here's what he says about his labs:

I'm 57 years old, have Hep C genotype 1a (Lipa assay), the viral load was 3,530,000 IU/ml (test methodology by Amplicor assay,detectable range 600-700,000 IU/ml, value over 700k by approximation). Log equivalence is 6.55, whatever that means. All the other tests, ultrasound, MRI, blood tests, show no damage, very slightly elevated levels in ALT/AST blood tests.

I want to wait on the treatment since it is very nasty and in some cases can make things worse. Also, from what I have read, it is the most difficult to cure, only works 40-50% of the time for this genotype and tends to reoccur. I get a blood test for the Diabetes (another complication) every 3 months so I figured I would throw in a Liver panel screening to keep track of it, and if the problem got worse, then I could reevaluate. I'm just not 100% sure what to look for in these tests so far. For instance, Alt/Ast/Bilirubin levels can rise with exercise, which I do for the diabetes control, all these tests are subjective to some degree. ----- Shouldn't a biopsy be mandatory? What other factors should be considered before deciding on starting meds?

Response from Dr. McGovern

If your brother is reluctant to get therapy, I would still pursue a liver biopsy. Blood tests do not reflect the level of disease. If there is mild disease then the decision to not pursue treatment may be justified. If however the biopsy shows moderate to advanced disease, it is important to pursue treatment.

Furthermore, not everyone gets a lot of side effects. I have many patients whose major complaint is only fatigue. Secondly, at 12 weeks, if there is no virologic response, it is reasonable to stop treatment. If there is a great response and the side effects are manageable, then your brother would be encouraged to continue on.

Finally, diabetes in itself is one risk factor for steatohepatitis, which can contribute to liver disease.

I hope this is helpful. Dr. M



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