Post-Interferon Treatment Questions: Liver Health and Next Steps

Q: Post-Interferon Treatment Questions: Liver Health and Next Steps

Hello Mr. <br>Wang! Dear Doctor： I just completed a 25-week interferon treatment in November 2006. <br>I started treatment because I am a carrier of hepatitis B, so I have regular follow-ups every six months for blood tests and abdominal ultrasounds. <br>Before the end of 2004, m

Questions after completing a six-month interferon treatment?

Hello Dr.
Chen: I recently completed 25 weeks of interferon treatment in November 2006.
I started treatment because I am a carrier of hepatitis B, and I have been undergoing regular follow-ups with blood tests and abdominal ultrasounds every six months.
Prior to the end of 2004, my liver function was normal except for a slightly elevated bilirubin level around 3.
Due to work, I began follow-up examinations at a medical center in Taipei at the end of 2004.
After multiple tests, by April 2006, I found that my SGOT and SGPT levels fluctuated between 70-100, and I also tested positive for hepatitis C.
The doctors at the hospital recommended a liver biopsy, which I underwent in mid-May this year.
The results indicated early-stage fibrosis in my liver, and the doctor suggested a six-month course of interferon treatment for hepatitis C to control the ongoing inflammation and damage to my liver.
During the treatment, I had two blood tests: the first in late July showed SGOT: 75, SGPT: 54, bilirubin: 3.0; the second in late October showed SGOT: 108, SGPT: 100, bilirubin: 3.1.
When I returned for a follow-up, I asked the doctor what I should do next.
The doctor said that the interferon treatment was completed, and I should have blood tests every three months and ultrasounds every six months.
I would like to ask Dr.
Chen: 1.
I did not have a viral load test (none was done before treatment); can I assess the effectiveness of the treatment solely based on liver function indices? Or is there another way to determine the effectiveness of the treatment I received? 2.
Are there any other more aggressive treatment options that I could consider? Thank you, doctor!

Mr. Wang, 30~39 year old female. Ask Date: 2006/12/11

Dr. Chen Jianhong reply Gastroenterology and Hepatology

Hello Mr.
Wang! Dear Doctor: I just completed a 25-week interferon treatment in November 2006.
I started treatment because I am a carrier of hepatitis B, so I have regular follow-ups every six months for blood tests and abdominal ultrasounds.
Before the end of 2004, my liver function was normal except for a slightly elevated bilirubin level around 3.
Starting from the end of 2004, due to work reasons, I underwent follow-up examinations at a medical center in Taipei, and by April 2006, multiple tests showed that my SGOT and SGPT levels fluctuated between 70-100, and I was also found to be a carrier of hepatitis C.
The hospital physician then recommended a liver biopsy, which I underwent in mid-May of this year.
The results indicated early fibrosis in my liver, and the doctor suggested a six-month course of interferon treatment for hepatitis C to control the ongoing inflammation and damage to the liver.
During the treatment, I had two blood tests: the first one at the end of July showed SGOT: 75, SGPT: 54, bilirubin: 3.0; the second one at the end of October showed SGOT: 108, SGPT: 100, bilirubin: 3.1.
When I returned for a follow-up, I asked the doctor what to do next, and he said that the interferon treatment was completed, and I should have blood tests every three months and ultrasounds every six months.
I would like to ask Dr.
Chen: 1.
I did not have a viral load test (neither before nor after treatment).
Can I assess the effectiveness of my treatment solely based on liver function indices? Or is there another way to determine the effectiveness of my treatment? ◆ Since you have both hepatitis B and C, it is essential to conduct HBV DNA and HCV RNA tests both before and after treatment.
Without these reports, it is impossible to know whether your hepatitis is caused by the hepatitis B virus or the hepatitis C virus.
Initially, you can assess the effectiveness of your hepatitis C treatment from your SGOT and SGPT levels.
In July, your SGPT decreased, but in the second test, it rose back to 100, indicating that the treatment effect is not very good.
Of course, having viral load test results would provide additional indicators for assessing treatment efficacy.
2.
Are there any other more aggressive treatment options I can consider? ◆ It is still recommended to first determine which hepatitis virus is causing your condition before proceeding with further treatment.
Therefore, please have HBV DNA and HCV RNA tests done first.

Reply Date: 2006/12/11

More Info

Hello! Thank you for your detailed inquiry regarding your liver health following your interferon treatment for hepatitis C. It's great that you are actively monitoring your condition and seeking further understanding of your treatment options.
1. Assessing Treatment Efficacy: After completing a course of interferon treatment, it is crucial to evaluate its effectiveness. While liver function tests (like SGOT and SGPT) provide some insight into liver health, they are not definitive indicators of treatment success. The primary measure of treatment efficacy for hepatitis C is the viral load, which is assessed through a test called HCV RNA. This test quantifies the amount of hepatitis C virus in your blood. Since you mentioned that you did not have a viral load test before or after treatment, it would be advisable to discuss with your healthcare provider the possibility of conducting this test. A sustained virologic response (SVR), defined as undetectable HCV RNA 12 weeks after completing treatment, is the goal of hepatitis C therapy and is the best indicator of a successful outcome.

2. Next Steps and Further Treatment Options: Given your history of chronic hepatitis C and the initial fibrosis detected in your liver biopsy, ongoing monitoring is essential. Your physician's recommendation to continue with blood tests every three months and ultrasound every six months is standard practice. However, if you are concerned about the effectiveness of your previous treatment or if your liver function tests remain elevated, you might want to explore additional treatment options.
Currently, direct-acting antiviral (DAA) therapies are available and have shown high efficacy rates with fewer side effects compared to interferon. These treatments can often lead to a cure for hepatitis C, even in patients with advanced fibrosis. Discussing the possibility of transitioning to a DAA regimen with your healthcare provider could be beneficial.
3. Lifestyle and Supportive Measures: In addition to medical treatments, maintaining a healthy lifestyle is crucial for liver health. This includes avoiding alcohol, eating a balanced diet rich in fruits and vegetables, and engaging in regular physical activity. Additionally, some patients find supplements like milk thistle (silymarin) helpful for liver support, although the scientific evidence regarding its efficacy is mixed. Always consult with your healthcare provider before starting any new supplements, especially since they can interact with other medications.

4. Regular Monitoring and Follow-Up: Given your history of liver disease, regular follow-up with a hepatologist or a liver specialist is vital. They can provide tailored advice based on your specific situation and help you navigate the complexities of hepatitis management. If you feel uncertain about your current treatment plan or if your symptoms change, seeking a second opinion from another specialist can also be a prudent step.

In summary, while liver function tests are a part of monitoring your health, they should be complemented by viral load testing to accurately assess the success of your treatment. Exploring newer antiviral therapies could provide you with more effective options. Regular follow-ups and maintaining a healthy lifestyle will also contribute positively to your liver health. Please feel free to reach out if you have more questions or need further clarification!

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