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DEAR DR. ROACH: I am a 59-year-old woman who was recently diagnosed with hepatitis C and cirrhosis. I have never been a drinker. I was treated with Harvoni for three months. I understand the medication is intended to cure the hepatitis C. What about the cirrhosis? My doctor hasn’t explained any of my long-term effects from taking this. – C.J.
ANSWER: Hepatitis C is a common infection of the liver. It is caused by a virus, which can be transmitted by blood and blood products, as well as through sharing needles for injection drugs. It is rarely transmitted sexually.
Anyone with a history of injection drug use, who received blood transfusions or organ transplants before 1992, or who received clotting factors before 1987 should be tested, as should anyone with a known blood or sexual exposure to someone with hepatitis C. The Centers for Disease Control and Prevention also recommends testing all adults born in the United States between 1945 and 1965, anyone who is HIV-infected, who received hemodialysis or was incarcerated.
The treatment you have taken (Harvoni) is a combination of ledipasvir and sofosbuvir, and has an excellent cure rate. The cure rate is 99 percent in people who had never been treated before and who did not have cirrhosis. Even people like you, with cirrhosis, had a cure rate of 94 percent with 12 weeks of therapy in the trial that got the medication approved.
Cirrhosis is liver damage and scarring as a result of liver disease. Once it has developed, it is not reversible; however, a successful cure of the hepatitis C virus greatly reduces the risk of further damage, specifically reducing the need for liver transplant and the rates of death, liver cancer and other liver-related complications.
These medications are so new that I can’t estimate how much lower your risk of further damage to your liver is post-treatment; however, there is little doubt that your likely successful treatment will substantially improve your expected length and quality of life.
But, since you still have cirrhosis, you will need to take some important precautions. These include continued abstinence from alcohol, careful monitoring of prescription and non-prescription medications, avoiding raw shellfish and making sure your immunizations are up-to-date. You should keep asking your gastroenterologist questions until you are satisfied. I recommend you make a list of questions to ask, and bring a friend to help make sure you understand the answers you get.
DEAR DR. ROACH: Should your blood pressure go higher as you age? Is the top number or the bottom more important? I don’t like medicine, and my blood pressure was 145/82, but the top number sometimes goes to 150-158. – J.S.
ANSWER: Both the systolic (top number) and diastolic blood pressures are important, and the difference between them is occasionally important (for example, a blood pressure of 160/60 is more worrisome than 160/85). Blood pressure does go up with age, but even in people over 60, the recommendation is still to get the BP down below 150, and I try to aim for 140 if there aren’t too many side effects. It often takes several tries to find a regimen that gets the blood pressure where it should be without affecting quality of life.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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