DEAR DR. ROACH: My 56-year-old sister has hepatitis C. She contracted the virus from a blood transfusion in a hospital in Spain in the 1980s. It is the genotype 4 (North African) strain. It was discovered about 12 years ago, and she had a biopsy that did not show any scarring of her liver at that time. We have tried to persuade her to be evaluated for treatment with the new drug Sovaldi (sofosbuvir), but she refuses, stating that her doctor tests her every year and says she is “fine and showing no symptoms.”
The Centers for Disease Control and Prevention states that hepatitis C is a progressive disease. Isn’t it the case that at any time, the hepatitis C virus in her body can activate and cause serious health problems, such as liver cancer? She is in total denial about the progressive nature of the disease and the need to be evaluated for the drug treatment by a specialist. According to the Food and Drug Administration, Sovaldi has a 96 percent success rate for people with genotype 4. How can we persuade her to see a specialist? Can I call her doctor and ask him to evaluate her? Please advise me on what I can do, as we are very concerned. — B.K.
ANSWER: You are exactly right that the new treatments for hepatitis C have completely changed the way we approach this infection. She certainly should see an expert in hepatitis C and be considered for treatment.
There are 6 genotypes (variants of the virus), with genotype 1 the most common in the U.S. and perhaps the most difficult to treat. Genotype 4 is very effectively treated by sofosbuvir and ribavirin. Unfortunately, treatment with medication is very expensive, and it isn’t yet clear whether all insurers will cover it. However, it is so much more effective than interferon and ribavirin that I think most insurers will realize that getting rid of the infection is much better than letting it potentially progress to cirrhosis, with its risk of liver failure, bleeding, bacterial infection and liver cancer.
Many people are unaware that they have hepatitis C, since it has minimal or no symptoms for many years. Anyone born in the U.S. between 1945 and 1965, as well as people with risk factors for hepatitis C (including people who received blood or organs before 1992, clotting factors before 1987, a history of needle-stick injury or injection drug use, and several other less-common risk factors) should be tested for hepatitis C.
That being said, you can’t force your sister to be treated. I hope she will decide to, since the treatments have advanced and have fewer side effects than previously. You might go with her to her next doctor’s appointment if she will let you, and bring it up with her doctor.
The booklet on hepatitis explains the three different kinds. Readers can obtain a copy by writing: Dr. Roach — No. 503, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DR. ROACH WRITES: In a column in October, I miswrote “inflammatory bowel disease” as “irritable bowel disease,” which must have made things more confusing still. The inflammatory bowel diseases Crohn’s disease and ulcerative colitis are indeed highly inflammatory processes. Irritable bowel syndrome is a disorder of intestinal function, with variable abnormalities in motility, hypersensitivity of neural receptors, and other possible causes, including changes in the gut bacteria and food sensitivities. I apologize for the confusion.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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