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Cirrhosis and low Hep C viral load What Next!
Aug 6, 2007

Dr. McGovern,

If you could help me with this question, I would be incredibly grateful. I have had the Hep C virus my entire life(blood transfusion as infant). I am now 37 years old and I recently relapsed after pegaylated interferon and ribvarin treatment. I just found out that I am transitioning into cirrhosis! What should I do? Continue with another round of combo treatment or perhaps something else? My viral load was 20K per ml. With treatment it has dropped to 10K per ml. I guess another question is, does a low viral load mean a slower progression to end-stage liver disease?

Any answers you would I have I would be very thankful.

Living with Hope

Response from Dr. McGovern

This is a tough situation. It sounds like you were close to non-detectable but never quite got there. The answer will depend on how long you were on therapy for the first time around, your genotype, and your treatment dosing. Since I do not know your course of therapy I will make some general comments:

I would have treated you for nine months after attaining a non-detectable viral load, if your viral load decline was slower than normal.

I would have treated you with weight-based ribavirin if you have genotype 1 infection. If you have high viral load genotype 3 infection, I would consider treatment with longer duration of therapy (if you only got six months in the first place).

I would avoid alcohol and excessive weight gain since both can cause fatty liver and exacerbate your liver disease.

I would get vaccinated for hepatitis A and B if you are not immune.

I would also get serial ultrasounds and AFP for six monthly checkups.



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