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What is the probability of me progressing to cirrhotic liver disease and the need for transplant?
Dear Dr. Chung,
I am a 47 yr old E.R. nurse infected with Hep C. It was discovered after a routine screen due to a blood splash to my eyes at work in early 2000. I have probably have had this virus for between 20-30yrs.( I estimate my exposure may have been in late adolescence as well. I was screened negative for hep B around 1989 and immunized against it on my job. I have always been asymptomatic, never had elevated liver enzymes to my knowledge. I am genotype 1a. My liver biopsy revealed grade 1 /1 stage 1/1 (I think thats how it was expressed.) I was treated by a liver specialist with interferon combo therapy-1200mg of ribaviron/daily and Interferon 5 mil units tiw for 48 weeks. The virus became undetected after 6 mos of therapy but returned to it's pre treatment state of greater than 1 million after 3 mos. I had a very tough time on the combo which I know many other people share. We played with the dosage a little during treatment due to anemia and thromocytopenia. I also developed thyroiditis and lost about 25-30 lbs over the course of my treatment. I have now been diagnosed with Graves disease as the hyperthryoidism persisted. This all said, my question is after all this time what is the probability of me progressing to cirrhotic liver disease and the need for transplant.? My doc is recommending the pegalated form, once the Grave's is resolved. I am starting to think that maybe the cirrhosis will advance when my immune system weakens as I age. Does this sound right? Do you think that I am in the category of NOT developing advancing Liver disease ? Do you recommend another course of treatment. I am otherwise healthy with no other medical problems. (although these are certainly enough!) Thank you for your time and consideration.
  Dr Chung Writes-  
You are in a very positive category, given your benign liver biopsy findings after 20-30 yrs. if you were treated for 6 months, responded then relapsed you may wish to be treated for 12 months with PEGcombination therapy. your chances at sustained response are quite reasonable.
  Dr. Chung      
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