Questions from Readers and Answers by Medical Experts
on Treatment and Care for Chronic Hepatitis C Virus (HCV) Infection

My husband has Hep C. We have had all the tests including a liver biopsy last week. He has been diagnosed with genotype 1 and is in stage 1 fibrosis with minimal liver damaging. His doctor did not recommend treatment at this time because it is in stage 1. He recommends treating when it goes into stage two. Is it common to wait until it progresses into stage two or three or is it best to treat it when it is in stage one? Should we have a second opinion?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

There is some debate among experts about the optimum time to treat chronic hepatitis C. Some physicians favor waiting until there is a moderate degree of inflammation or other evidence of liver damage before treating. In part, this is because of the number of side effects associated with therapy, i.e. risk/benefit analysis. Others favor treating almost everyone to prevent further damage from occurring. Most of the data suggests that the response to therapy is similar until there is advanced injury (stage 3 or 4 fibrosis).

Since the answer to your question is not straightforward, it is important that you discuss the details of your husband's situation with a physician who is knowledgeable in treatment of hepatitis C and that you are both comfortable with the approach that is recommended. Sometimes second opinions are useful in helping to formulate the right questions to ask yourselves or to simply get another viewpoint.

I am 32 years old, male from India. I have being living with HIV since 1995. I was diagnosed with HCV in 2004 with genotype 1b. Till now I have not started ART for HIV treatment. I started my HCV treatment from 10 th August 2007 on peginterferon alpha-2b [PegIntron] and ribavirin capsules. Before the start of the HCV treatment my HCV RNA quantitative viral load count was 3 million. After completion of 12 weeks on treatment, my HCV viral load result has only come down to 1 million. My doctor has advised me to stop the treatment, as the results suggest I am a non responder.

I would like to put up a few queries:

1) Are there any options available for treatment of non responders. If so, how effective are they?

2) If I don't receive treatment, what are the health complications?

3) How do other non responders manage their health without treatment and what is the progression of the virus?

5) Compared to level before HCV treatment, for the non responder, will it worsen?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

If If the level of virus declines less than 10-fold after 12 weeks of treatment, there is less than a 2% chance of sustained remission. For that reason, most physicians do not recommend continuing treatment under these circumstances. At this point, there are no new drugs that have been approved to treat hepatitis C. There are several in trials. Hopefully, new medications will be available for this type of situation in the next few years. Occasionally, Infergen (consensus interferon) is used to treat non-responders. The results with this approach are very preliminary at this time.

Is it possible to quantify the risk of neonatal transmission of hepatitis C in a 38-year-old woman whose obstetrician wants her to get an amniocentesis? Her most recent HCV viral load was 752,000 IU/ml. I've read there is probably some risk of transmission, but there are too few published studies to quantify risk or conclusively say there is risk of vertical transmission.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

I do not think it is possible to quantify the risk. There is certainly some degree of risk of infecting the fetus. Risk factors for transmission to the infant at birth include use of fetal scalp electrodes and prolonged rupture of membranes. It is clear that amniocentesis has the potential to cross maternal blood into the amniotic fluid.

My husband started treatment with Pegasys [pegylated interferon] plus ribavirin for hepatitis C on 9/14/07. The first shot he had, he developed all the flu-like symptoms. He takes 5 pills a day and 1 shot a week. He is into his 7th week of shots. The last week he has been having severe migraine headaches. Other than that, besides being really tired, he is doing fine. My question is, I have spent days on the web and cannot find a lot of information on headaches associated with Pegasys. Do you know of a website or information about when a headache from this treatment is serious? Is it common to have severe headaches? What can he do?

Answer by Ronald Baker, PhD
Ronald Baker is publisher and editor in chief of HIV and Hepatitis.com

Following are some of the most common side effects associated with pegylated interferon plus ribavirin therapy:

- Flu-like symptoms, including fever, chills, and muscle aches
- Fatigue
- Upset stomach, nausea/vomiting
- Headache
- Irritability
- Loss of appetite
- Difficulty in controlling blood sugar levels (which may lead to diabetes)
- Skin reactions (such as rash, dry or itchy skin, temporary hair loss, or redness and swelling at the site of injection)
- Trouble sleeping.

As you can see from this list, headache is one of the most common side effects of pegylated interferon and ribavirin therapy. The first line of defense would be to take ibuprofen (Advil, etc) or acetaminophen (Tylenol, etc) to relieve the headache. If this does not help, ask your doctor to evaluate the possibility that your husband is indeed experiencing migraine headaches. In that case he/she can prescribe one of several commercial products to treat this condition.

I was diagnosed with HIV in December 2006 with a viral load of 860,000 and a CD4 count of 280. I went on HIV drugs (Kaletra & Truvada) and now my viral load is 110 and my CD4 count is 790. I found out at the end of February that I have hep C genotypes 1a and 1b with an HCV viral load greater than 5 million. I had a liver biopsy in March and found out I was a stage 3, grade 3, but had no symptoms of having hep C. I then had immune reconstitution syndrome with MAC and my neck swelled and I had to have surgery. Then it swelled on the other side and we are treating it with ethambutol and clarithromycin. It is under control, but they say the bacteria are going to take a while to get out of my system. I saw the liver doc on Tuesday and he said that he doesn't want to treat the hep C just yet because it will lower my white blood cell count and hinder the healing of the neck swelling.

My question is, how will I know if my liver is getting worse? Is that a good idea, not treating the hep C? Should I get a second opinion? My ALT sand AST levels have always been in the 60s, however, with the last 2 blood tests they were high 200s on August 13th, and then high 100s August 24th. The liver doctor said this is normal. I guess I am worried about my liver continuing to get worse while we are waiting for the neck to get better. I am already at a stage 3, grade 3 liver disease. What would stop it from going to stage 4 while we are waiting? The infectious disease doc says I should be on the meds for another 5-6 months. Any light you can shine would be helpful.


 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Hepatitis C progresses over years, not weeks or months. Although you will probably need treatment at some point, timing the treatment is important, since there are side effects of the treatment that could make some of your other conditions worse. Your doctor appears to be monitoring the situation carefully. Some degree of fluctuation in ALT is to be expected and does not always indicate worsening of liver disease.

I just had a test done to determine whether I was infected with chronic hep C or just exposed at one time. I tested positive. My viral load is 151,000. I am very scared and upset. I have researched a lot about hep C. My labs have consistently been normal for liver enzymes such as ALT and AST. I feel great and never drink, nor do I use drugs. My doctor suggests I get a liver biopsy. I have tried to get an answer. Is 151,000 a high viral load? I have tested positive for hep C antibodies since 2000 when I was 21. I am 28 now and I am female, which I understand works in my favor. Any info on HCV viral load would be much appreciated.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

A viral load of 151,000 IU/ml is very low, but clearly indicates the virus is still present in your system. It is quite possible that you have very little liver inflammation or damage. A biopsy would confirm whether that is the case. People with a very low viral load often respond well to treatment. You will need to discuss with your doctor whether treatment is needed.

Hello, just diagnosed with hep C 1A with an HCV viral load of 6.45 million copies. I have not seen a gastro doctor yet. I am very afraid as I have a friend who tried 3 treatments with none of them working and one caused neurological damage. She was in a couple of clinical trials. I live in Virginia. What would you suggest as my next step? Do not know how I got this, although I have had many friends/relatives with hep C and lived with 3 people who had it.

All I can think is that I am going to die; all I can do is cry, which isn't helping the sinus infection I have. Also have just been diagnosed with diabetes, high blood pressure and low platelet level which was 74 but has now risen to 126. Already had low thyroid which I am being treated for. Thank you very much for any information you can share with me

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The sustained response rate from pegylated interferon/ribavirin treatment for people with genotype 1A hepatitis C is about 45-50%. The presence of advanced liver disease (cirrhosis) or significant obesity reduces the response rate somewhat. Neurological injuries due to treatment are rare. It is important to maintain tight control of diabetes before and during treatment. There are a number of side effects of treatment which you will need to discuss with your doctor prior to making a final decision about being treated.

I am 43 years old with hepatitis C. I have been diagnosed with fibrosis grade 3/4. I am suffering from extreme anger and rage attacks. Sometimes I have anxiety attacks in the middle of the night while I am sleeping. I have really lost any sense in life; my relationship with my husband is about to end -- we just got separated. I have no patience at all. I can't tolerate anything anymore. My question is whether the antidepressants Cipram [citalopram, also sold as Celexa] or Cipralex [escitalopram, also sold as Lexapro] are OK for me to take or if it is harmful to the liver? Looking forward to hear from you.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

I was not sure from your email whether you are on treatment with interferon and ribavirin. If so, you should discuss this with your doctor, since some of your symptoms may be side effects of the medication. In general, medications such as the ones you mentioned are safe to use in people hepatitis C, with or without hepatitis treatment. You should discuss this issue with your doctor at your earliest convenience.

I run an HCV online support group. I research for info to answer questions from members about the disease. One question I cannot find the answer to is: What is considered an undetectable [HCV] viral load? I've heard that anything under 600 copies is considered undetectable. Thank you for your time and input.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The lower limit of detection for most HCV RNA PCR tests is now 35 IU/ml. There may be some tests that are not as sensitive, but that is the limit for the best tests.

My husband and I have both tested positive for hepatitis C antibodies. I have not undergone any further testing yet. I am scheduled to have a viral load count done. My husband has been confirmed with chronic hep C genotype 1a. His viral load is 1,000,000. He also had a liver biopsy done and the results were inflammation level 1 and scarring level 2. They recommended that he start treatment and we agree. He is starting next week.

I have researched the subject relentlessly. For me, I am not so worried. I always have maintained normal blood work for my AST and ALT, etc. I feel great, and from my research it does appear women usually progress slower than men. Neither my husband nor I drink, smoke, or do any recreational drugs. We do not take any prescription drugs either except for suboxone [buprenorphine/naloxone]. I have read that HCV genotype 1a is one of the worst ones. That they only can "cure" 30-50% of patients. Is this true and if so, what are our options to make my husband's chances of success greater. Also, will taking suboxone hurt him while on treatment? Thank you for your time.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

More recent studies suggest that the response to pegylated interferon plus ribavirin in genotype 1 patients is approximately 40-50%. The most important determinant of success is taking all the doses of medication as directed. People who skip doses or do not take them when directed have a lower response rate. Avoiding alcohol and maintaining a "normal" weight are also important. I am not aware of any adverse effects of suboxone.

My husband has genotype 1a hep C with a viral load of 650,000. He is scheduled to start treatment in November with Peg-Intron plus Rebetol [pegylated interferon alpha-2b plus ribavirin]. His nurse practitioner put him at stage 2/3 without a biopsy due to low blood platelets. She said her best guess by looking at his blood test results is that he is beyond fibrosis and into cirrhosis. His blood platelet count is 112,000.

Looking at his other tests they look within range. Only ALT is 114, AST is 93 and is the only thing out of range. Also, she said if his platelets drop below a certain point she would discontinue the meds. I asked about Procrit [erythropoietin] or other meds to help so he could stay on treatment and she said there would be nothing to help other than taking him off meds. We would like to get a second opinion and would like information for doctors and hospitals in Louisiana for people with low income/no income/no insurance.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Without a biopsy, it is difficult to "stage" someone. There are proprietary combination lab tests (FibroSure) that can provide a rough indication. There are reasons other than liver disease that the platelet count may be low. If the platelet count drops significantly during treatment, the dose of pegylated interferon can be lowered. Procrit has no effect on the platelet count. It will only increase the hemoglobin and hematocrit. Unfortunately, I do not have any information about physicians in Louisiana. You may want to contact your local health department about this issue.

Can someone who has the hepatitis C antibodies in the blood transmit it by breastfeeding?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Several studies have shown that it is safe for mothers with hepatitis C to breastfeed their babies. Hepatitis C is not transmitted in breast milk. However, try to avoid any open cuts or cracks in the skin.

I am a 45-yer-old Caucasian female who acquired HCV in the early 1980's. Diagnosed in 2005, genotype 1A. Liver biopsy = Grade 2, Stage 3, Bridging fibrosis. Pre-diagnosis I was a daily wine drinker. Non-responder to Pegasys & 1,000mg/day ribavirin. I then had eight phlebotomies due to high iron levels and being heterozygous for hemocromotosis. Lowered iron from 200+ to 8.

Because I wanted to double-up on the interferon, I was told about and put on Infergen, 15 mcg daily & 1,200 mg daily ribavirin. Viral load of 660,000 went down to 2,000 in the first four weeks and non-detectable at 12. Fatigue and mental side effects are rough but manageable (with antidepressants).

My question: what is the advisability of going down to 9 mcg of Infergen daily for the long duration of the 48 weeks of treatment? Any research on 15 microgram Infergen every other day? My doc says for clearing the virus (esp. in initial non-responders), the bottom line is large and daily doses provide the biggest benefits. In your opinion is the same true for sustaining the response and ameliorating the liver? If I can handle it, should I stay on 15 mcg of daily Infergen? Many thanks. Free medical advice is hard to find and much appreciated.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

There is not a lot of data on Infergen and none that I am aware of comparing daily vs every other day treatment. The one study published regarding interferon/ribavirin non-responders compared 9 mcg daily versus 18 mcg daily for 8 weeks followed by 9 mcg for 40 weeks.

Ribavirin 1000-1200 mg was given daily in both groups. There was no difference between these two groups, so the higher dose "lead-in" therapy was no better than the 9 mcg daily from the outset.

You will need to discuss the advisability of decreasing the dose with your doctor, particularly in light of side effects. It is important that you continue for 48 weeks if possible to have the highest chance of a sustained remission.

I was recently diagnosed with Hep C and my viral count is 9 million. My doctor has referred me to a specialist but I can't get in to see him for a month and a half. My doctor thinks this is OK since we figured I've had the disease for about 22 years (IDU). Shouldn't my primary care doctor have a liver biopsy done before I go to the specialist? I'm not sure of my genotype yet, the test hasn't come back. Also I have read that the higher the viral count is, the less chance I have for getting rid of it. Is this true and what chance do you think I have to get rid of it?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

A liver biopsy may be indicated, but the decision to do a liver biopsy is made by the specialist, not the primary care doctor in most situations. Although a low viral load is associated with a "better" chance of sustained remission, there is not much data about differences in response with levels above 600,000 IU/ml. The genotype is also a good predictor. Genotype 2 and 3 respond better than genotype 1. The most important factor is compliance with treatment--not missing doses of medication, avoiding alcohol and avoiding obesity.

Hi, I've been reading about the Telaprevir studies and it sounds great. My husband has hep C and is interested in Telaprevir. A few questions.....is it available in the US? Is there a way to be part of the research, since our insurance dropped him when he was diagnosed? Anything would be helpful.

Answer by Ronald Baker, PhD
Ronald Baker is publisher and editor in chief of HIV and Hepatitis.com

Telaprevir is still in relatively early stages of clinical (human) testing. At best, the drug will not be available commercially for about 2 years. Once the Phase 3 trials begin enrollment (by end of 2007?), your husband can explore the possibility of joining a study.

Be sure to stay in touch with your doctor about the opening of the Phase 3 trials and also periodically review this and similar websites that are following the development of telaprevir.

Is there a hope that I can get rid from my hepatitis C? I am worried. When I started pegylated interferon with ribavirin, my viral load was 271,871 IU/ml. After one month of treatment, it dropped to 161,323. After the next month, it was 87,303, and after the third month, it was 50,347 IU/ml. I read that if there is not a decrease in viral load of 2 log after 3 months or so, then I am not responding to the treatment. Is there no hope for me to get rid of my hepatitis C?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

You are correct that less than a two log (100 fold) decline in the level of virus makes the chances of a sustained remission very low (< 2%). Because of that fact, most physicians do not recommend continuing treatment. There are many new drugs in development for chronic hepatitis C. Some should be available within the next 2-3 years.

I am a 26-year-old guy with hep C (genotype 4). I was on Pegasys and ribavirin for one year. By the end of the treatment, my viral load was undetectable. I had my complete blood work done again on May 3rd (six months after completion of treatment) and the viral load was undetectable, also my ALT and AST levels were normal (AST=24, ALT=34). On Jun 8th I had more blood work done (my doctor referred me to another hepatologist, as I moved to another place, so he asked me to go for the blood work again).

My viral load is undetectable but my AST and ALT levels are very high (AST=234, ALT=78). I don't understand what exactly is going on. Do I need to start my treatment again? Do the AST and ALT levels increase by that much with in a span of one month? I read in one of your answers that if the virus does not come back after 6 months of treatment completion, the patient is cured. I would like to know whether I am cured or not and what kind of treatment I need to take

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

If the HCV RNA was negative when the ALT was elevated on the second test, it is unlikely that the cause of the ALT elevation is hepatitis C. There are many other things that can cause abnormal ALT. You will need to see your doctor to determine what is going on. It could be a different hepatitis virus or a side effect of a medication.

My daughter has hepatitis C. Her daughter is 11 years old. Is she too young to get vaccinated for hepatitis C?

Answer by Ronald Baker, PhD
Ronald Baker is publisher and editor in chief of HIV and Hepatitis.com

Unfortunately, there is no vaccine for hepatitis C. However, your granddaughter could receive vaccination against hepatitis A and hepatitis B. In the US, this is usually done through a school program. You should consult with your doctor about this issue.

I just found your site today for the first time. It is nice to read current information about hepatitis C.

I am seeking information on post-treatment rehabilitation for rebuilding physical and mental strength with a realistic time line. What are normal expectations regarding a time line to get back to normal (whatever normal is--I don't seem to know anymore--I hope soon it will return)? I have never been this weak and I so much want these drugs out of my system and to be healthy again. Even though the treatment was very rough for me, I didn't even consider non-treatment. I do have to say that the clinical information I read pre-treatment was vague in regards to the extent and intensity of the treatment. I read information that patients had written and thought that they may be exaggerating a little (I'm a very realistic person). However, as my treatment progressed, I could relate to what they were saying. I want to prevent health decline as I grow older. I will be talking to my doctor about this at my next follow up appointment but would appreciate any information that you may have.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

If you have genotype 2 and the virus is undetectable on treatment, there is a good chance for a sustained remission after treatment is discontinued. Most patients begin to improve in strength and other symptoms within a few weeks after the conclusion of treatment. The time required to get back to full health varies from person to person. Some of the weakness may be due to anemia, which is a side effect of treatment. It sounds like you have had many other stressful events to deal with during treatment. These can certainly make it more challenging. Your doctor can provide more detailed information for you about this issue.

I contracted HCV from a blood transfusion in 1987 (never IDU'd and don't drink). My liver enzymes are AST 18 and ALT 26 (normal 0-40) GGT 31 (normal 0-60). My primary checks a couple times a year, and they are always normal. Does this mean my liver is OK? My primary referred me to a gastro doc, but he refused to see me because of a conflict of interest. I am a 1a with a VL of 2,420,000 and no doctor. Can you tell me where there is a good hepatologist in Maryland? Also from what I have read my viral load (along with the genotype) is too high to be a good responder? I'm feeling lost without a doctor and I have lots more questions.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

My office is at Johns Hopkins Bayview Medical Center. I suggest that you ask your primary physician to refer you to Hopkins. Your viral load is high, but we still treat most people with hepatitis C in this range, unless there is a contra-indication.

I heard that it's best to stay out of the sunlight while on Ribavirin because it can cause a severe skin reaction. Is this true?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Ribavirin can cause a rash and in some individuals this may be exacerbated by exposure to intense sunlight or other UV light such as tanning beds. Usually a good sunscreen with UVA and UVB protection will prevent this. Most of my patients do not have any problems. If you have difficulties, you may want to discuss it with a dermatologist.

I will be taking Infergen after experiencing a relapse. I never reached SVR. I looked up "Infergen" on WebMD, and there is no information available other than that it is a generic name for interferon alfacon 1. What is this medication and do you know what are the side effects?

Answer by Ronald Baker, PhD
Ronald Baker is publisher and editor in chief of HIV and Hepatitis.com

Infergen has side effects that are very similar to those of PegIntron and Pegasys. You can find more information on Infergen on HIV and Hepatitis.com.

I was diagnosed with HIV and Hep C in 2004. So far I've been lucky and do not have to take HIV meds yet. My question is how will the meds that I take everyday effect my HIV-HCV coinfection? I take 1mg Xanax two-three times daily with Zoloft 50mg once a day and Adderall 30mg twice a day. Are these medications harmful to me being HIV/HCV positive? I am very concerned about the Adderall, but due to chronic fatigue it helps.

Answer by Ronald Baker, PhD
Ronald Baker is publisher and editor in chief of HIV and Hepatitis.com

You should discuss the potential for harm from Adderall with your physician. In the meantime, please review the Adderall warning at the following URL: http://www.adderall.net/

I am an Albanian patient with detected HCV from a year now, genotype 1b. Started last September the treatment interferon + ribavirin and have been able to continue with full dose. Planning for a year of treatment, now my question is: how long should my treatment continue when in the 3rd month [of treatment] I was PCR negative. The doctor has referred to 9 months [total treatment time]. My ALT and AST recently are in the normal range-49, 43.

On various internet sites, I see that even when the treatment result is so good after the third month, usually the treatment continues for a full 48 weeks, and yet my doctor is thinking of 9 months. I want the best for me. The treatment is costly and the Ministry of Health has taken care of the cost, and I am afraid that the financial aspect is in consideration to cut off [the treatment] soon, with a promising result like this. The doctor did not perform a biopsy before starting the treatment and plans to do the PCR again 6 months after the end of treatment. Can you comment, please?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

If I understand correctly, you had a negative PCR at week 12 of treatment. If that is correct, the standard is 48 weeks of treatment for genotype 1b. I was not sure if you meant an additional 9 mos (correct) or 9 months (total treatment time). The only way I have seen treatment shortened successfully is if the PCR is negative at week 4.

I am a male, 5 foot 9 inches who weighs 170 pounds. I would like to know by body weight what dosage of ribavirin in mg would be standard dosage [for me] with the Pegasys interferon 180 microgram weekly cocktail. I thought 800 mg was standard (two 400mg doses per day). I have been reading most people seem to be getting 1000 to 1200 mg per day. With no serious side effects from the treatment, would a 400 mg daily dosage (two 200 mg doses per day) be considered a viable option with Pegasys [peginterferon alfa-2a]? Additional factors include chronic hep C [genotype] 2 with a 360,000 viral load and stage 2 active fibrosis, treatment-naive and scheduled for a six-month treatment [period]. I appreciate any information you can give me.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

I assume that you have HCV genotype 2, since you are scheduled for a six-month treatment. Some physicians feel that 800 mg of ribavirin is sufficient for genotype 2, whereas others prefer to use weight-based dosing (approximately 13 mg/kg), which would be 1000 mg/day (600 + 400). A viral load of 360,000 is relatively low, so the chances for sustained remission would be better than 80%.

I have been on interferon/ribavirin treatment for Hep C for 60 weeks. My viral load has gone up. My doctor has suggested a "drug holiday" since it seems I am not responding to the treatment.

What's in the future for me without [an effective] treatment? Are there action steps you could suggest that maybe my doctor has not? Right now I feel like I am standing alone with confusion and a lot of unanswered questions.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

I agree that it sounds like you are not responding to the standard medications for hepatitis C. I assume you are on pegylated interferon and ribavirin. Although more than 50% of people respond to treatment, a significant number do not. The only other treatments that are available are experimental at this time. There are some studies available for non-responders, but most require that you are off all treatments for at least 6 months. You may want to ask your doctor about any studies [of experimental therapies] that are available in your area for which you may qualify.

My girlfriend is currently on treatment for Hep C (interferon /ribavirin). She was diagnosed with liver cancer, three tumors and has recently been told that she is now untreatable (one tumor is quite large, located near portal vein and is inoperable, the other two are scar tissue encapsulated). My question is this:

Can you lead me to information or studies that show if it would be beneficial to her to continue on with her treatment (she's been on it for 7wks., has genotype 1 and so far has not shown any significant decrease in viral load -- realizing that chances of it working are now decreased). What we're wondering is if there is any data showing that interferon could possibly slow the progression of her liver tumors? She's currently debating 'quality' in comparison to 'quantity' with her life right now --- the specialists in Edmonton (Cross Cancer Institute) have given her a projected life expectancy of 15 to 18mos.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

There is not much evidence that interferon will slow the progression of hepatocellular carcinoma, once it begins. There was some evidence that interferon might delay or prevent development of HCC in those with cirrhosis due to hepatitis C, but that is not relevant in this situation.

There are treatments such as radiofrequency ablation, chemoembolization and others that can be tried. None will provide a cure, but may be of help in controlling the disease. You should discuss these options with her doctors.

In 1991 my blood donation screening tested positive for HCV antibodies.

- Antibody to HCV (reactive)

- Serum ALT - 40

- HBV surface antigen (non reactive)

- Antibody to HBV core antigen (non reactive)

I haven't thought about this for a long time. I was tested at the time. Doctor's said I didn't have the virus. I have been getting regular liver checks for a few years now for different reasons with no abnormal results. Would something show if they weren't looking for it?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Since you had antibody to hepatitis C (HCV) in 1991 and it is still positive, there is a possibility that the virus is present. You should have an HCV RNA level checked to see if the virus is present. If it is negative, then it is likely that you recovered. If it is positive, you should discuss treatment with your doctor.

I HAVE HEP- C, GENOTYPE 1A, STAGE 1 & 2, MY VIRAL COUNT IS 3 MILLION. I HAVE SOME DISCOMFORT ON MY RIGHT SIDE JUST BELOW MY RIBS, WHICH I DID NOT FEEL UNTIL AFTER MY BIOPSY, WHICH WAS ABOUT THREE WEEKS AGO. I'M MALE AND MY AGE IS 53 YRS. I DO NOT DRINK ALCOHOL AND I EAT HEALTHY FOODS.

I'M GOING TO START TREATMENT IN ABOUT 3WKS. I WAS TOLD I HAD THIS HEP-C ABOUT TWO YEARS AGO AND THAT I CAUGHT THIS SOME 30 TO 35 YEARS AGO, BY SHARING NEEDLES.

MY QUESTION IS: IS THERE ANYWAY OF KNOWING HOW MUCH TIME I HAVE BEFORE MY HEALTH IS REALLY POOR? BASICALLY, HOW LONG CAN I EXPECT TO LIVE WITHOUT TREATMENT?

MY OTHER QUESTION IS: HOW CAN YOU HAVE BOTH STAGE ONE & STAGE TWO? WHY NOT JUST SAY STAGE TWO?

THANKS FOR HAVING THIS WEB SITE.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Is it possible that you misunderstood and that you have stage 1 and grade 2 or vice versa? Stage indicates the amount of scar tissue on a scale of 1-4 and grade indicates the degree of inflammation on a scale of 1-6. In either case, this sounds like relatively mild disease. Progression is relatively slow in those who do not drink and do not have diabetes or obesity. It is not possible to be precise about the length of time before the disease could become more severe. Most physicians have become more aggressive about treating hepatitis C because the treatment has improved and is more often successful.

I have been wrestling with the idea of treatment for 7 years. I had acute HCV infection in 2000 and hep C genotype 1.

I am 52-year-old woman with normal ALT and AST. My liver panel blood work shows picture-perfect liver and all have been normal for 6 years. My viral load is only 30,000 at last check-up less than one month ago.

My question is: Should I postpone treatment until they have developed something more effective for genotype 1? I feel like we are so close, maybe 5 years out or so, before they develop something more effective for genotype 1 with a short duration of treatment.

Answer by Ronald Baker, PhD
Ronald Baker is publisher and editor in chief of HIV and Hepatitis.com