cirrhosis after 24 weeks of Harvoni?

[harvonitoo]

Here is a question that I wish someone could answer me...I have been great on Harvoni and I only have a month left, my viral load is undetectable and my liver functions are back in the normal range, kind of high but still not as bad as they used to be (!)   AST (SGOT) 37  ALT (SGPT)  30

Should I still worry about my liver getting worse and worse or are the better liver functions a sign the the cirrhosis won't get worse if I'm completely cured of hep c?

[Lynn K]

Just found this for another thread might as well post it here too

From our friends at the AASLD

http://www.hcvguidelines.org/full-report/monitoring-patients-who-are-starting-hepatitis-c-treatment-are-treatment-or-have

Summary Box

Recommended follow-up for patients who achieve a sustained virologic response (SVR).

For patients who do not have advanced fibrosis (ie, those with Metavir stage F0-F2), recommended follow-up is the same as if they were never infected with HCV.

Rating: Class I, Level B

Assessment for HCV recurrence or reinfection is recommended only if the patient has ongoing risk for HCV infection or otherwise unexplained hepatic dysfunction develops. In such cases, a quantitative HCV RNA assay rather than an anti-HCV serology test is recommended to test for HCV recurrence or reinfection.

Rating: Class I, Level A

Surveillance for hepatocellular carcinoma with twice-yearly ultrasound testing is recommended for patients with advanced fibrosis (ie, Metavir stage F3 or F4) who achieve an SVR.

Rating: Class I, Level C

A baseline endoscopy is recommended to screen for varices if cirrhosis is present. Patients in whom varices are found should be treated and followed up as indicated.

Rating: Class I, Level C

Assessment of other causes of liver disease is recommended for patients who develop persistently abnormal liver tests after achieving an SVR.

Rating: Class I, Level C



full text of comments

With the advent of highly effective HCV antiviral regimens, the likelihood of achieving an SVR among adherent, immunologically competent, treatment-naive patients with compensated liver disease generally exceeds 90%. Of patients who achieved an SVR with PEG-IFN  and RBV treatment, more than 99% have remained free of HCV infection when followed up for 5 years after completing treatment. (Manns, 2013) Thus, achieving an SVR is considered a virologic cure of HCV infection.

SVR typically aborts progression of liver injury with regression of liver fibrosis in most but not all treated patients. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Because of lack of progression, patients without advanced liver fibrosis (ie, Metavir stage F0-F2) who achieve an SVR should receive standard medical care that is recommended for patients who were never infected with HCV.

Among patients with advanced liver fibrosis (ie, Metavir stage F3 or F4) who achieve an SVR, decompensated liver disease (with the exception of hepatocellular carcinoma) rarely develops during follow-up, and overall survival is prolonged. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Patients who have advanced fibrosis or cirrhosis continue to be at risk for development of hepatocellular carcinoma after achieving an SVR, although the risk in these patients is lower than the risk in persistently viremic patients. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Patients with cirrhosis who achieve SVR experience increased survival (compared with patients with cirrhosis who are untreated or in whom treatment fails), but still may be at some risk for hepatocellular carcinoma; thus, they should continue to undergo regular surveillance for hepatocellular carcinoma despite the lowered risk that results after viral eradication. (Bruix, 2011) The risk of hepatocellular carcinoma among patients with advanced fibrosis prior to treatment but who have regression to minimal fibrosis after treatment is not known. In the absence of data to the contrary, such patients remain at some risk for hepatocellular carcinoma and should be monitored at regular intervals for hepatocellular carcinoma.

Liver fibrosis and liver function test results improve in most patients who achieve an SVR. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Bleeding from esophageal varices is rare after an SVR. (Morisco, 2013); (Morgan, 2010); (George, 2009); (Morgan, 2013); (Singal, 2010) Patients with cirrhosis should receive routine surveillance endoscopy for detection of esophageal varices if not previously done and these should be treated or followed up as indicated. (Garcia-Tsao, 2007)

Patients in whom an SVR is achieved but who have another potential cause of liver disease (eg, excessive alcohol use, metabolic syndrome with or without proven fatty liver disease, or iron overload) remain at risk for progression of fibrosis. It is recommended that such patients be educated about the risk of liver disease and monitored for liver disease progression with periodic physical examinations, blood tests, and potentially, tests of liver fibrosis by a liver disease specialist.

Periodically testing patients with ongoing risk for HCV infection (eg, illicit drug use, high-risk sexual exposure) for HCV reinfection is recommended. Flares in liver enzyme test results should prompt evaluation of possible de novo reinfection with HCV through a new exposure (see Management of Acute HCV Infection). Antibody to HCV (anti-HCV) remains positive in most patients following an SVR. Thus, testing for reinfection with HCV is recommended and should be performed with an assay that detects HCV RNA (eg, a quantitative HCV RNA test).


Basically the damage stops here but as you have cirrhosis you will still need to be monitored for the possibility of cirrhosis complications although that is greatly reduced and especially for liver cancer with blood work to include AFP and abdominal ultrasounds at 6 month intervals to monitor for early signs of liver cancer. Our risk of liver cancer is also reduced but th erisk still does exist for those with F3 fibrosis or F4 cirrhosis

I have just 25 days to go also of my 24 weeks I will be taking my last Harvoni and Ribavirin on May 4

Good luck to you

[harvonitoo]

Thank you for your very helpful reply and best of luck to  you too! 

[MEG]

Lynn, your posts are so full of valuable information that I wish there was a way of indexing them..

Thank you doesn't seem adequate---but, thank you and may you be rewarded/blessed with the gift of a cure...holding you in my prayers...xoMeg.

[Lynn K]

Thank you so much Meg wishing you the same as well

24 Harvoni to gooooooooooooo!

[MEG]

2 and 4 are multiples of each other....just sayin'

;-)

Meg.

[atomic dog]

Lynn, You've been through hell and high water it seems, and are always here for us. Much appreciated. 4 weeks and counting? I wish you all the best.

[Tpropane]

My heart pounded when I read the subject but after Lynn's words of wisdom, I feel better. It is what it is and without HCV in the mix, 2x a year ultrasound testing for HCC seems a wise thing. I'm 12 weeks (nearly halfway) on tuesday. Thanks Lynn and you are nearly there. We will certainly be better off HCV free!
Best to you all,
T