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Treat now or Wait?

Dr.--

I got hepatitis 33 years ago from a blood transfusion. My ALT & AST have been above normal slightly until about 5 years ago and now are mostly normal. A biopsy done in 81 showed persistent hepatitis.

One done in 2000 shows Microscopic exam/diagnosis:

Liver (needle) biopsy: THE ALTERATIONS IN THE CURRENT BIOPSY ARE VERY SIMILAR TO THOSE NOTED IN A PREVIOUS BIOPSY (See report SPNO 98-1223, 4/28/98). THE PORTAL INFLAMNATORY INFLILTRATE IS SOME WHAT ENHANCED IN THE CURRENT BIOSPY. THE DELICATE FIBROUS SEPTAE SEEN ON TRICHROME STAIN STILL FORM INCOMPLETE NODULES OF HEPATOCYTES. NO NEOPLASM, GRANULOMA, OR SIGNIFICANT INCREASE IN IRON IS SEEN. THE PATTERN IS CONSISTENT WITH MILDLY ACTIVE CHRONIC HEPATITIS, CONSISTENT WITH HEPATITIS C. AND INCOMPLETE CIRRHOSIS.

And is almost the same as one done in 1998. (The portal inflammatory infiltrate is somewhat enhanced. The delicate fibrous septae seen on trichrome stain still form incomplete nodules of hepatocytes. No neoplasm, granuloma, or significant increase in iron is seen. The pattern is consistent with mildly active chronic hepatitis consistent with HCV and incomplete cirrhosis.The alterations in this biopsy are very similar to those noted in the biopsy done in 1998). I have genotype 2 and have never been treated. I'm trying to decide if I should go on the Peg/Ribivarin when it is approved this year or just not do anything since it is still only mildly active after 33 years. Please let me know what stage and grade do you think shows on my biopsies and your thoughts on being treated. If I do start treatment could this cause the HCV to become more active instead of helping me?

-- Thanks, M.

Dr. Rodriquez writes--

Your question is interesting.The first thing that comes to my mind is how old are you.? How can you be sure the time of infection was 33 years ago? This is important to decide if treatment is needed or not.

Genotype 2 patients have a great chance of sustained response, and the biopsy suggests incomplete cirrhosis, and without further information, these cases should be treated, as there is evidence that the disease will go on to develop complete cirrhosis. MR