Fibrosis Blood Test

[steven_myers]

I scored a F0 on the fibrosis blood test my doctor ran 3 months post Harvoni. The resident who gave me the results claimed that the fibrosis blood test is not accurate at all. This baffled me as I was very pleased with the result.

Does anyone have any information on the accuracy of the fibrosis Blood test? I'm curious because the doctor I see won't be able to do a fibrosis ultrasound test for another 9 months.

[Lynn K]

The Fibrosure test is most accurate at minimal damage F0 and signifigant damage F4 and less accurate in mid range F2.

[elias]

Hi Steven:

I'm curious what your fibrosis level was prior to Harvoni and how it was measured then?

[Lynn K]

Here is some official info it is for hep b but I expect it would be similar


https://www.ncbi.nlm.nih.gov/m/pubmed/24535095/

FibroTest/Fibrosure for significant liver fibrosis and cirrhosis in chronic hepatitis B: a meta-analysis.

CONCLUSIONS: FibroTest is of value in exclusion of patients with CHB-related cirrhosis, but has suboptimal accuracy in the detection of significant fibrosis and cirrhosis. It is necessary to further improve the test or combine it with other noninvasive modalities in order to improve accuracy.


Also

http://www.hepatitisc.uw.edu/go/evaluation-staging-monitoring/evaluation-staging/core-concept/all

UW Evaluation and Staging of Liver Fibrosis

[elias]

Anyone know  if the Fibroscan is more accurate than FibroSure (=FibroTest?) in that F2--F4 range?

[Lynn K]

They are basically equal the "gold standard" is the liver biopsy although it is also  less than perfect tool due to possible sampling error and skill of the person performing the evaluation.

Just curious why are you asking?

[steven_myers]

Hi Steven:

I'm curious what your fibrosis level was prior to Harvoni and how it was measured then?

A liver biopsy done before treatment showed that I was one stage below cirrhosis. I believe that my doctor called it stage 3.

Like I said,  I was very happy with the F0 fibrosis score from the blood test, just disappointed that the resident doctor downplayed it and said that the blood test was not accurate. If it's not accurate, then why even do it?

[Lynn K]

Well if a biopsy said you are F3 that is more accurate.

The reason for alternate methods are because the Fibroscan and Fibrosure are less invasive and at least can provide some information about extent of liver damage. Additionally, some patients because of the nature of biopsies will refuse the test. Also liver biopsies, because they are more invasive are not without risk.

[elias]

Hi again;

But if the biopsy was done before the Harvoni, and the FibroSure blood test after completing treatment, isn't it more likely that the post-treatment FibroSure score of F0 here is showing significant fibrosis regression?

I thought FibroSure's major inaccuracies were in the F2-F3 middle range , but much less so in detecting F0 or cirrhosis?

Also: FibroSure blood test separates out Fibrosis level from Inflammation level into two separate scores. For example, mine before treatment was fibrosis: .66 necro-inflammatory A3. So I'm not sure if sudden drop in level-in Steven's case here- might not be more effect of inflammation having receded? It's really a question of mine, which may have some bearing on Steven's case here.  I get my SVR 12 test later in week, so I'm trying to sort out what kind of test and when optimally to get it to see if I've regressed much after treatment

[Lynn K]

Well the Fibroscan and Fibrosure both have some value as a diagnostic tool along with other indications. For me with well established cirrhosis I did see an improvement in my platelet count it was still well below normal of 150 at 110 but a big improvement from 80 to 90 I typically had before I was cured.

I am thinking to compare apples to apples that would mean biopsy to biopsy. But really what difference does it truly make in the grand scheme of things? You are cured so you won't progress further as long as you take good care of your and your livers health as long as you don't develop HCC which is still a risk although greatly reduced. Knowing the exact state of your liver F2 vs F3 really won't make a difference in how you need to conduct your life going forwards. You had a very damaged liver at one point so even though you are cured you still need to be kind to your liver. Even if your liver does heal with time having once been F3 I would think you should treat your liver with TLC. They don't actually know what it means health wise if you should even regress to F1 from F3 of course that is good news but my thinking is you should still be careful.

For me even if I should have my platelets return to normal and they are confident I am no longer cirrhotic I just can't go back to life as though I never had cirrhosis.

My Fibroscan before treatment was 27 my one year post treatment Fibroscan was 33 I did not request a Fibroscan at my 2 year post treatment follow up.

[Sergey]

In my understanding (it may be wrong), noninvasive tests (like Fibroscan, Fibrotest/Fibrosure etc.), usually, much more validated in situations before treatment with positive PCR, than after SVR. In studies, results of noninvasive tests were compared with results of "gold standard" biopsies for HCV-infected people - and cut-off values for noninvasive tests were established for different fibrosis stages. After SVR, situation may be different - and relying on values of Fibroscan or Fibrosure after SVR may be misleading.

[Mugwump]

Interesting discussion here. I would like to point out that there is good evidence that the cirrhosis blood test in question here can very easily be skewed by diet. In fact the movie "Super Size Me", which is now free on youtube goes into how Morgan managed to Bjork his liver readings in a few short weeks to the point where it was down right dangerous.

I have a feeling that those of us who moderate our diet and reduce fat, starch and sugar consumption post treatment will fair the best. In my case it is a bit of an issue of the pot and kettle but here is hoping that I get a handle on this aspect of having a liver which has a chance to recover now that the main issue is dealt with!

I do suffer from Atkins disease as I call it though and the over consumption of tasty pork, beef and chicken products seems to be making it harder to get to grips with things. I guess if I had the physiology and climate lifestyle of an Eskimo an Atkins diet that my wife insists upon currently might work. 

It is entirely possible to have normal weight and a fatty over-sized liver because the liver is the first organ to store excess fats but is also the first organ to lose fat when you reduce consumption. So a change in diet and exercise to a more sensible regime, even if only for a short period of time, is known to improve liver functions almost overnight! This is why some tests are less reliable at diagnosing with precision the F levels.

Cheers
Eric 

[I fightis thetitis]

Here is how my GI explained the FibroSURE test to me before tx.

Started me by saying "I have Good news and bad news."

Conclusion: Pre Harvoni I was F4 - A3. That Fibrosure test got me approved treatment.
 
There are 6 parameters measured.
Cirrhotics typically have high parameters on biopsy..
So the FS blood test was designed to measure those same blood markers that show up elevated in cirrhotics without an actual liver sample to view.

HOWEVER, he did mention they are not always 100%.. He had seen them way off, and accurate.
In my case he suggested that the FSure test dx of F4 is prob accurate since I had Hep c for 4 decades. He suspected I have "beginning" cirrhosis.

Since SVR, 4 of my parameters went down, but my Alpha-2-macroglobulin and bilirubin went up. SO who knows..

Since the science is not accurate I like Lynns attitude.. Kinda like so what..
I don't think "F" any grade would change how I take care of myself.
Hep C took my liver to the edge and I will take care of "babe" (liver nickname)  with TLC!

Your SVR! Congradts!!

Best always,

Greg

[elias]

I'm of the opinion that it does help to know the F score. We don't yet know which of the lifestyle modifications often mentioned are really helpful with this. Dietary recommendations often do change from year to year. Also individual variations I'm sure do exist in this. So what's good for one person might not be so far all. So in this sense it helps to get an F reading for baseline

There's also the issue of ongoing surveillance by ultrasound , which those with lower F scores do not require.

Greg mentioned Alpha-2 macroglobulin. The elevation in that one parameter was likely what drove my pre-treatment level to F3. The others were not as far off. So i do wonder if a Fibroscan might not have given me a "better" score.

Question: For those wanting to keep track of their  F score, how soon after SVR 12 is achieved does it make sense to do a post-treatment re-assessment of this?

I'm off to get my SVR viral load soon, so want to know when to  ask for this, if I show undetected

[Lynn K]

Hi Elias

I tested with Fibroscan one year post treatment. My result went from 27 pre to 33 post an increase of 6. Not sure if that is clinically signifigant or not but unless my doctor wants to do a fibrosis check I am not going to bother with it again. I did not have one done at the 2 year post treatment mark. I will be instead looking at my platelet count as that is an indication of decrease in portal hypertension which is causing my spleen to slightly enlarge and in turn sequester platelets. So I am looking for signs of physiological revisions in the cirrhotic structure. I am also hoping to see a reduction in my edema so maybe  someday I can stop taking a diuretic. My platelet count went from 90 pre to 110 post treatment.

I will take my good news where I can get it. But I dont feel at least until many years have passed I will get any good news from fibrosis testing.

[dragonslayer]

Here is how my GI explained the FibroSURE test to me before tx.

In my case he suggested that the FSure test dx of F4 is prob accurate since I had Hep c for 4 decades. He suspected I have "beginning" cirrhosis.


Best always,

Greg

Hi Greg, 

Just wanted to question this.  Is having HCV for 4 decades dispositive enough in itself  to confirm a questionable Fibrosure diagnosis?   I too had HCV for 4 decades and two biopsies prior to treatment indicated minimal liver damage.  So the question is, how many HCV patients who have endured 40 years of infection truly have cirrhosis.

[elias]

Hi Lynn:

Drug companies are actively looking into pharmaceutical approaches to reversing cirrhosis/fibrosis. Forgot offhand the name of such candidates showing promise. So when those come around, it might be good to have diagnostic means to assess progress with those. It might be that with so many now clearing HCV that this research will focus more on post-HCV fibrsosis. Until now the focus was mostly on thosr brought on by non-viral causes

[Lynn K]

Yes that is my hope and part of the reason I am transitioning my care to the University of Washington as they are also very actively involved with research. I agree as so many are now being cured of hep c but still burdened with advanced liver disease and cirrhosis I think this will be a new area of medical research.

[dragonslayer]

Yes that is my hope and part of the reason I am transitioning my care to the University of Washington as they are also very actively involved with research. I agree as so many are now being cured of hep c but still burdened with advanced liver disease and cirrhosis I think this will be a new area of medical research.

Let's hope so. If there is a buck to be made, it will get the attention.

[elias]

We might even hear about fibrosis regression at the upcoming Intl Liver Congress by EASL which will be held next week. April 19-23

Hopefully, someone will report on that:

https://www.easl.eu/discover/events/detail/2017/the-international-liver-congress-2017

Yes. There's big money to be made in any potentially  effective anti-fibrosis pharmaceutical. But hopefully not at $1,000 a pill

[I fightis thetitis]

Hey Elias,

Perhaps I was not clear enough on my point. Knowing your F score, or your baseline is important. However, since the blood science is imperfect and there is a margin of error, whatever my score is will not change my approach to how I treat my liver.

So having the score IS important IMO. Just in my instance, whatever the blood the score, it's inconsequential as to what I put in my body. Rather an F0 or 4, I'm still making juice, low sodium, exercise and sobriety.

Hey Dragonslayer,

As you prob know, not everyone reacts to Hep c the same way. Four decades for some does not guarantee cirrhosis, others yes. Many individual variants determine  what, how and who get cirrhosis. or not..
Based on my F4 combined with the 40+ years of infection, My GI said IF I have cirrhosis he suspects it would be in an early stage. However, he never said I definitively have cirrhosis. A biopsy would be the method with which he would make that determination.     

[Lynn K]

I have read that about 20% of persons infected wothhep c will develop cirrhosis after 20 years of infection. To me it makes sense that if infected longer the odds of cirrhosis would also increase. I was diagnosed with cirrhosis after being likely infected for 30 years. Still though it does seem like it is a minority of patients who progress to cirrhosis.

But having the F4 from the Fibrosure certainly would point in that direction. Early cirrhosis would be being newly diagnosed without other indications or cirrhosis. Even my ultrasounds reference cirrhosis due to a coarsened texture on the outer surface of my liver but they are just agreeing with my existing diagnosis. Other indications of advancing cirrhosis could be an observation of ascities on ultrasound, lower limb and foot swelling from edema, an enlarged spleen noted on ultrasound, and a below normal platelet count. Beyond those early indications of advancing liver disease would be the development of portal hypertension, frank ascities (stomach bloated to the point the patient looks pregnant) the development of esophageal varicies especially if a bleed occurs, and hepatic encephalopathy (HE) and it continues down hill from there.