Dear XXXXXXX,

Thanks for contacting XXXXXXX

Before I can suggest you anything I need to know few things more from you.

1. What was the dose of peg interferon and ribavirin used.
2. Which peg interferon as given: pegasys or viraferon-peg.
3.What is your weight and height.
4. Your PCR was negative at 12 weeks of treatment. In such a scenario ideally treatment for genotype 3 is given for 24 or 48 weeks. In your case I understand it was given for 68 weeks. Was there any reason for prolonging the therapy.
5. Was any liver biopsy done before starting the treatment.
6. What were the viral load readings at start of therapy and after 1 month of therapy.

Please get back with answers to these questions, then probably I will be able to suggest something.

With best wishes,

Dr Dinesh Singal

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Dear XXXXXXX,

Sorry for being late in replying to you.

I reviewed your blood reports. Your physician treated you in a right manner. Your RNA was negative at 24 weeks, hence he prolonged your treatment. Unfortunately you relapsed after stopping treatment at 69 weeks. It is well known that if HCV-RNA stays positive at 12 weeks of therapy, there is very less likelihood of having a sustained response that happened in your case. Though I will say that it was right decision to take a chance and give you a prolonged therapy, though it didn't work in your favor.

One of the reasons for poor response in your case can be related to your high BMI, your weight is much more than should be at your height. You should work towards reducing your weight. This will also be helpful in delaying damage to your liver as well as may be useful if further treatment is considered for you.

Good thing in your case is that ultrasound shows liver to be normal. Since a liver biopsy was not done we don't know how much damage has been done to liver. To know the amount of damage to liver is important as if the damage is less then you should not worry much. This can be known by doing a liver biopsy or alternatively a test called fibroscan.

There are few things that can be done in your case:
1. You should seriously consider losing weight, as obesity promotes non-alcoholic fatty acid, this can contribute to liver damage in addition to HCV infection.
2. You should avoid alcohol.
3. Avoid taking any hepato-toxic drugs.
4. Consider getting a liver biopsy or a fibroscan done to know extent of liver damage.
5. As for drugs, at the moment there is no new drug available for HCV other than Peg interferon and Ribavirin. In your case there is no use of repeating treatment with the same medicines. For genotype 3 there is a new drug still under clinical trials. Initial response to this drug in failure cases is reported to be quite promising. You can wait till this drug is marketed.

Hope my opinion helps you.

Best wishes,

Dr Dinesh Singal

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Dear XXXXXXX,

Thanks for contacting again.

Losing weight is not easy, but if you try you may be able to lose some weight. The best way will be to reduce your fat and sugar intake to minimum. This will reduce your calorie intake. At the same time you should exercise, brisk walk or jogging to utilize your calories.

Hope these measures help you.

Best wishes,

Dr Dinesh Singal

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