Hepatitis C: Not Good Candidates for Treatment?

DOCTOR'S VIEWS ARCHIVE

Topic: Hepatitis C, June 2000

Dr. Lee:
Who are NOT candidates for treatment?

Dr. Edward Block:
Well, there are some absolute and some relative contraindications to treatment. (Contraindication means factors that render treatment in this person too risky).

Absolutely people who are drinking alcohol are not candidates for treatment. Excess alcohol consumption reduces the response rate. (Alcohol also aggravates liver damage). Furthermore, there are problems with depression, and problems with compliance. We are not optimistic that this group of patients are going to be able to follow this difficult course of treatment.

We have also learned that people with renal (kidney) insufficiency or advanced kidney disease may have problems with treatment. These people have to be considered individually and carefully as they can have very serious side effects to treatment, particularly to the ribavirin pill.

There are some relative contraindications because certain people would have possible problems with treatment. They are:

1. Patients with seizure disorders, although if these seizures are controlled generally treatment can be initiated.
2. Treatment can aggravate depression, thus we have to be careful in patients who have had problems with depression or suicide risks in the past.
3. Patients with coronary or heart disease might develop angina (chest pain) if they become too anemic with ribavirin treatment. I guess the best recommendation there would be is that any decision to treat this group of patients would be done in conjunction with the advice of the treating cardiologist.

Dr. Lee:
And you also mentioned pregnancy as a no-no.

Dr. Edward Block:
Pregnancy is an absolute no-no, as I mentioned earlier. This can cause birth defects.

(Birth defects can occur even if the husband is undergoing treatment at the time of conception. Thus if either sexual partner is undergoing treatment, every measure must be taken to prevent pregnancy and continued up to six months after treatment).

Dr. Lee:
But generally speaking, sexual activity is not thought to be important in the transmission of this virus.

Dr. Edward Block:
No, that is true Dennis. There is probably some small risk of transmission here and certainly it would be prudent to tell our viewers that if they are known to be Hepatitis C positive and are single that they should take appropriate precautions, such as the use of condoms.

The more difficult issue is how to counsel husbands and wives. My best advice is that if you have been living successfully with some one for many years and that someone is diagnosed as having Hepatitis C, yet you are still infection free, then sexual activity should continue unchanged.

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