Hello CureHep2019,

Welcome to the forum.

There is nothing to be scared about. You have a disease. There is a cure. The two of you just need to hook up and start dating…

In your results we can see a progression over time from F0 to F1 to F2. F4 is cirrhosis and it’s taken you a decade and a half to get roughly 1/2 way to cirrhosis. It does accelerate a bit from F1 through F2 and F3 but even with cirrhosis (F4) we can treat.

If it was me I’d treat now but you do have some time. It’s more likely most or all the liver damage will resolve if we treat sooner rather than later.

GT1b is the easiest to treat and 12 weeks of any of Sovaldi+Dakliza, Harvoni, Epclusa, Viekira, Maviret or Zepatier will deliver a 95%+ cure rate.

Is there anything preventing you from treating?

Hello Paul2018,

Congrats on the cure result.

In terms of other tests, it depends on how sick a patient is and what has been done previously.

So, say I treat a patient who is not cirrhotic and relatively well and 4 weeks into treatment their LFTs are normal and PCR negative. I would not do any more tests until SVR12 and then just do a PCR and LFTs.

At the other end of the spectrum a patient with cirrhosis who was taking ribavirin would get a CBC and CMP (FBC, UEC, LFT) every 2 weeks during treatment and lots of follow up testing including AFP and ultrasound to check for HCC.

Other tests just depend on the patient and their problems.

Hello ale2271,

Thank you for your kind words. The liver biopsy is typical for early cirrhosis. Of course the cancer is not good but that has been treated so we don’t need to worry about that one, just the 3% per year chance of getting another. That we monitor with regular ultrasound.

There is plenty of cause for hope that you mother will be cured.

Hello ale2271,

Sadly not all doctors have seen the dramatic improvements that occur in patients when treated for Hepatitis C with the new medications. The vast majority of patients who are treated show significant improvements.

With your questions:

1) No stem cells are unlikely to help. The liver has lots of liver stems cells in it already – given the chance repair will start from these stem cells. In fact, cirrhosis is just where the repair process driven by liver stem cells can not keep up with the damage so instead of new liver we get scar tissue.

2) Provided normal quantities of protein are eaten (meat, chicken, fish, milk cheese) ie not vegetarian there should be enough protein building blocks to make albumin. If albumin is low this is because liver is not working well at making albumin AND the albumin is diluted by extra fluid (which can be removed by diuretics mentioned earlier)

3) This is good news. Early-stage is expected to get much better with treatment. The reason is this:

a) Cirrhosis is 2 different things. First it is bands of fibrous tissue like a 3-dimensional net like mesh. Second, “trapped” in this mesh are swollen liver cells.
b) When we treat the cause of the liver problem, the swollen cells un-swell so despite the fact the fibrous mesh remains we see much better flow though the liver
c) Over time the fibrous mesh is know to regress = repair

So it is entirely possible that

1) Cancer will be cured, and if a new cancer happens we can cure it again
2) Liver function will improve
3) So, your mother will not die of this problem and may live for many more years before some other different problem crops up (we all must die one day of something)

We should treat because then we know we have done our best. Sometimes our best is good enough, sometimes it is not, but if it is not, I think it is important to know we tried our best.

While stem cells are both unproven and (to me) a complete waste of time (because the liver contains lots of liver stem cells) liver transplants can be, and are used. With so many patients now being cured the demand for liver transplants is at a historic low so they are more available.

Hello ale2271,

If the hepatocellular carcinoma has been fully treated with radioembolisation then this should be cured. Your mother will continue to have a 3-5% annual risk of a new tumour so will require regular review but this is manageable.

Depending on your mother’s genotype the Epclusa has a 90-95% chance of delivering cure. This allows some degree of recovery of the liver. Not back to 100% but if you think about it, your mother is alive now with her current liver status, so any improvement will make her quality of life better than it is right now.

The basic approach to liver cirrhosis is to stop the damage. Hep C is one cause and this is being dealt with so we are heading in the right direction. Alcohol should be avoided at the moment as this adds to the problem.

A good diet with a variety of food is fine for cirrhosis and for health in general. Please don’t stress about this too much.

Often people with cirrhosis will be on medications like furosemide and spironolactone (diuretics), lactulose (normal a laxative but used to help remove toxins), and rifaximin – an antibiotic to prevent spontaneous bacterial peritonitis.

There is a brief outline of this at the Mayo Clinic here: https://www.mayoclinic.org/diseases-conditions/cirrhosis/diagnosis-treatment/drc-20351492

There is a much more detailed one here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017060/

I must be getting old – I did know the originals of a lot of these!

https://www.youtube.com/watch?v=O9G6mVo_AbQ

Hi Gordon,

Sorry to hear you’re doing it so tough. On the bright side you’re over the hump with the finish line in view.

Everything should settle down within a few days of finishing the medication as it washes out of your body really quickly.

I think you’ve got my private email so please feel free to drop me a line and we can catch up for a video chat – it won’t fix anything but maybe help with passing the time.

Hi G,

Sorry to hear it’s not smooth sailing.

Insomnia, specifically the can’t get back to sleep one is a well known and quite common (20%) side effect of sofosbuvir. Unfortunately, you need that drug so the general approach is to use some sleeping tablets to tide you over while we wait to get to the end of the medication.

Hep C is a neurological disease and some people do get neurological things on treatment but it’s more likely the balance stuff relates to the inner ear infection.

The chest infection and psoriasis are probably not related at all other than psoriasis tends to play up when people are stressed. What do you use to treat the psoriasis?

For the cramps you should try taking 2 magnesium tablets a couple of times a day, or just at night if that’s when then main problem happens. Generally, that will settle cramps down.