Hepatitis A Ab positive due to interferon? Should I concern it and how to treat it?

[Sam2022]

Taking interferon 0.5ml/week since last mid August, I had blood test recently and found Hepatitis A Ab positive. other issues associated with taking interferon include low WBC(2.6 vs. 3.4), low Neutrophils (1.0 vs. 1.4) and high AST (45 vs. 40), ALT(58 vs. 44). I called my specialist and he told me should not concern Hepatitis A Ab positive since there is no chronic state and no consequence. I did some research and it looks like Hepatitis A Ab positive is contiguous but will eventually get rid of the infection on its own. Does anybody has the similar experience as me? I am JAK2+ ET patient starting in 2019. I started hydroxyurea in March 2021, and stopped almost after 6 months than switched to interferon. My platelets number dropped from initial 950+ to ~275 recently. Any medication or treatment which can mitigate the liver damage due to interferon? Thanks lot for your great suggestion and sharing your experience.

[EPguy]

Hep A can cause liver damage. INF, less often, can also. Two separate things possibly going after the liver seems not good. Has your Dr considered stopping or reducing the INF till the HepA gets better?

I saw possible evidence of liver/kidney help from NAC supplement, I will post soon more detail. I don't need to fix anything there and the effect was mild if there was actually one at all. But in a recent post here we have a discussion that NAC may reduce one of the benefits of taking INF, allele reduction. I may stop taking it. We get one and give one, nothing is easy or clear.

healthunlocked.com/mpnvoice...

[Sam2022 in reply to EPguy]

Thanks for the suggestion. My hematologist said no worry on Hep A positive since it has no chronic state. He didn't say whether I should reduce INF or extend the injection interval. I am taking 90mcg/10day now and will reduce to 75mcg/10day since my platelets count is ~275. will report my development here later.

[EPguy in reply to Sam2022]

My concern in this situation would be, while the HepA is temporary, this short period of liver risk could act with INF in a worst case to cause lasting liver damage, while with only HepA or only INF any damage would be less likely to get as bad.

My medical advice is to seek more medical advice since you concerned about liver risk. If I had these conditions, I'd follow Hunter's suggestion to see qualified experts to monitor this risk.

[hunter5582]

Sorry to hear about the Hep A. It really is tricky to manage additional illnesses like this when already dealing with the impact of a MPN and the treatment. This is a difficult balancing act since the PEG-IFN and the Hep A both can affect the liver.

I am thinking I would follow the advice given to to by the hematologist. I would consider getting a second opinion from a MPN Specialist. I am assuming you are already seeing a hepatologist. If not, definitely do that.

When I was on PEG, I achieved a complete hematologic response at 45mcg every 7 days. One suggestion I would consider discussing with your MPN Specialist is a lower weekly dose to see if you tolerate that pattern better. Not sure if it would help, but may be worth discussing.

Hope you recover and feel better soon.

[Sam2022 in reply to hunter5582]

Thanks, Hunter. I agree that the best solution is to find balance by reducing PEG dose and monitor it. Hopefully, the right amount of PEG can find balance. I will report here after 2-3 injections. Best

[Solyesh]

Sam - just posted on this subject as well. I was originally HU but did not tolerate it well and switched to Peg. My specialist started me at a fairly high dose of 180mg every two weeks which brought my numbers into range almost immediately...after about 4 months I received significantly out of range numbers on liver function (ALT (GPT) of 127 and AST (GOT) of 50 (bilirubin and LDH both in normal range) this was definitely attributable to the Peg. So I went off Peg for month (2 injections) and the liver numbers normalized (unfortunately both my platelet count and my WBC increased immediately). We have re-started the Peg at half the dose I was on previously (so down to 45 mg/week). I will have my next reading in a couple of weeks to see if liver numbers stay within range and if platelets and WBCs start to fall again.

Would definitely discuss with your hematologist/MPN specialist as both Peg and Hep A can hit the liver.We are all trying to hit the right balance...one thing my MPN specialist did tell me was that I might have to "live" with slightly out of normal liver numbers as a side effect of the Peg (but hopefully not with readings like the ALT of 127....also means that I have basically given up alcohol (which is not a bad thing except for the once in a while desire to have a great glass of red wine (the specialist said that once in a blue moon would still be fine) - but more importantly for me to strive to get to the right balance to meet care objectives and then see what we can modify...

[Sam2022 in reply to Solyesh]

Thanks. Glad to hear you were able to minimize the damage by reducing PEG dose. I am thinking reduce my current 90mcg to 45mcg and monitor the liver function and platelets. Hope your platelets and WBCs still stay in the normal range with reduced PEG dose. Good luck and I will let you know how is my response after reducing PEG dose.

[EPguy]

Looking at your ALT and AST, these are in normal range vs my provider's ranges. Important question is whether your Dr will do more regular CMP (metabolic panels) while your HepA is active. I would insist on that, if it stays ok, I would be ok with that if no other concerns. Has you Dr discussed this?

[Sam2022 in reply to EPguy]

Yes. thanks for the advice. I routinely do CMP every 3months when I see my hematologist. The AST normal range is 0-40 and ALT is 0-44 in my provider (labcorp) chart. So my ALT and AST are slightly higher than the recommended high range. I expect it will fall into normal range once I reduce the PEG dose. Let's see