I have been testing my liver ensyzmes regularly every 6 months since I found out I had Hepatits C in 1997. We are assuming that I contracted the virus from blood transfusions I received in 1983 and 1984. My liver function tests have consistently been normal and the only test I've had for cirrhosis is a FibroSure which indicated none detected two years ago. I know it's possible to have cirrhosis and continue to have normal liver function tests. Recently I have been having a problem with my hypoglycemia with more episodes and my last labs indicated a high C-Peptide (range was 0.8 - 3.1 and mine was at 9.2). Could it be possible for me to have cirrhosis all this time and that could be the reason for the hypoglycemia episodes getting worse. I might also mention that every Viral load test (PCR) I've had done has been under 400,000 IU/ml(I've had a total of 4 now over the past 10 years) and my genotype is 1a. I really have a hard time where I live finding a doctor who is truly educated on Hepatitis C and is concerned with the overall well being of the patient who has Hep C. Most of them act like it's no big deal. It's a very big deal for me. I've recently changed my diet to a liver healthy diet, which is not far from what I was eating anyway. I also take 4 times the dose of Milk Thistle and Selenium along with other Hep C recommended supplements. I have elected not to receive the treatments because I have been considered asymptomatic and the side effects from treatment are far worse than the symptoms I currently don't have. I also understand that my genotype is hard to successfully treat. I'm hoping I can hold out for a better treatment or possibly a vaccine before I have serious problems. I'm almost 45 years old and also hope that, Lord willing, I'll be able to enjoy my grandchildren for a while longer. Thank you for any help or advice you might be able to give.
There are several comments to make:
- Fibrosure is one of several non-invasive tests to look for fibrosis. These tests perform well at the wide ends of the spectrum of disease. In other words, they are usually pretty accurate at defining mild disease and advanced disease. They are not as good at discriminating in between. However, if you had a reassuring test, I would be quite surprised that now you have cirrhosis. I think that would be unlikely.
- You have low viral load/genotype 1 infection. I consider those patients in a different category than high viral load patients since low viral load patients have a better chance of responding to therapy.
- I would consider therapy and check a viral load at 4 weeks. If there is no detectable HCV RNA, then you have an excellent chance at cure. If you don't have a good response, and you are having significant symptoms, then you can simply stop.
- On the other hand, if your fibrosure test is accurate, you can probably wait for better therapies. However, these are also going to be combined with interferon most likely in the near future. With a low viral load though, I still think you have a great chance of responding with or without new drugs.