i met with my hepatologist yesterday. he's the Dr. who did my recent colonoscopy and tests to confirm that i have hepatitis C.
in a nutshell my doctor is recommending a liver biopsy and a one-year course of treatment of interferon and one or two other drugs. the two drug treatment has a 50% cure rate. the triple blockade includes a third drug that was approved a few month ago which he has never prescribed and boosts the cure rate to 60-70%. the two-drug cocktail makes hormonal therapy seem like a trip to disneyland. the triple blockade is even tougher. the third drug is very expensive ($40-50k for a year) and may not be covered by my insurance. interferon is self-injected into the stomach once a week.
i have been clean 22 years. so the math tells me i most likely contracted hep C in a 16-year window ending 22 years ago, which means that if i am in the 50% group that has the active virus the damage is occuring now. the doctor says i am most likely in the active virus group because of my mildly elevated blood tests.
there's another halving that occurs for people with the hep C virus. in the group that has the active virus 50% will probably never need treatment. the other 50% are at risk for cirrhosis and liver cancer. the doctor said there is no way to know which group i am in and to him it really doesn't matter.
he explained my options and what i heard was either commit to one year-treatment or ignore the disease and hope it never becomes a problem. he said there are legitimate reasons for not treating hep c. certain medical conditions preclude treatment, if you are suicidal or have grave emotional issues you should not be treated. if you can't miss work treatment may not be for you. etc. etc.
he said the compliance rate in the u.s. is between 60-70%. in other words 30-40% who begin treatment do not finish because either they physically can't or they give up because it's too tough. he said in europe the compliance rate is like 90%. he said his personal compliance rate is 100%.
he said he would not do a biopsy to determine whether or not i need treatment NOW because a favorable biopsy could give me false hope, and the condition of the liver could go from favorable to life threatening in a very short period of time in some cases. also he said he would not do geno-typing because most likely i have the most resistant strain of hep C and even if i didn't he does not believe in the six-month course of treatment. also, he said if i tested for the geno-type that was easier to treat my insurance company may not pay for the one-year treatment.
my wife wants me to be treated and i am strongly leaning toward being treated too. i went through hell with PC treatment but i feel "normal" again. but i also felt "normal" when i was diagnosed with a high volume of gleason 7 prostate cancer. i opted for the combination treatment for PCa was because my doctors felt like it gave me the best chance to beat the disease and i was strong enough to handle it.
and now i am healthy enough to handle treatment again but what a sacrifice. and what if my PSA starts rising? my wife says she belives the cancer is gone and now it's time to do everything we can to make the hepatitis be gone too.
anyhow i have another PSA test in three weeks. after i get those results i have another tough decision to make.