Author Topic: Reversibility of Hepatic Fibrosis and Cirrhosis--Is it all Hype? (Read 18773 times)

KNW · « **on:** November 03, 2015, 03:58:38 pm »

Has anyone read any of these articles? There are several new trials in rats, but I have not seen human trials.

gnatcatcher · « **Reply #1 on:** November 03, 2015, 04:55:47 pm »

KNW, here's the forum thread that contains links to articles about human trials: http://forums.hepmag.com/index.php?topic=3221.0

beto · « **Reply #2 on:** November 03, 2015, 05:45:26 pm »

Hey KNW,

I have posted a bunch of stuff as have others. Always, we have to keep our heads and a grain of salt. Gnatty lead you to a thread and I started one on this subject...there have been others. Most of the studies that I have seen have followed SVR cirrhotic hep c & B survivors from interferon and also alcohol related cirrhosis. There was also one; "Cirrhosis Regression in Hepatitis C Patients With Sustained Virological Response After Antiviral Therapy A Meta-analysis" http://www.medscape.com/viewarticle/839337_3...this looks encouraging/ I do have others.

If true, it appears the greatest tool available is to cure the disease, or remove the burden that caused fibrosis in the first place. I have heard a lot of testimonials that show dramatic changes, however, I have no way to verify them. However, one of the best I have heard came from someone who claimed to be part of an ongoing study of harvoni (or, modern drugs) cured individuals. I have not yet followed up on this study, however, if I do I will post what I find.

Mugwump · « **Reply #3 on:** November 04, 2015, 04:24:21 am »

My GI commented about this and told me the great thing about the human liver is the fact that once the insult is done and the causes of accelerated degeneration are mitigated, the liver can work quite well even if it is quite stiff and cirrhotic. He explained that many individuals who were cured of HCV early on with interferon go on to live a perfectly normal life provided fatty liver disease or some other problem does not get them.

The problem with this view of things is that most of the individuals that cleared with interferon years ago had very little damage and were not as advanced in the downward spiral of cirrhosis as some of us who did not clear with the older treatments. So those of us who are confirmed F4 will have to wing it as far as what to expect post treatment. Harvoni and the other new meds are changing the game to say the least.

So post treatment we should not see a decreased quality of life if the cirrhosis was compensated and our meld scores will in most cases just stay the same or in the best cases improve.

I am going for my annual ultra sound in a week or two and hope that my big fat cirrhotic hunk of tissue that has endured much insult is at least not any larger or angry than it was before Harvoni TX.

My liver was read at 25 with fibroscan and the tech did a long scan with over 15 reference shots to confirm the level of density. So there is no doubt that I am F4.

There are better ultra sounds coming very soon for the liver. My wife, who works in Medical Imaging, feels that very soon new enhanced scans with deep density sensitivity is going to be the standard for definitive diagnosis and monitoring of cirrhosis. So in the next few years it will become easier to determine the levels of liver damage.

beto · « **Reply #4 on:** November 04, 2015, 11:14:03 am »

mugwump

Please let us know how the scan goes. Fingers are crossed for you. On a thread I have going on this subject a gal reported that her husband and she were both cured with Harvoni. She mentioned that her husband was at an F4-25 and currently (about a year or more after cure riding around 8.5. Just a report, however, if true...or, if the scans were solid, encouraging. Again, it was a report from a member...

She stated that they realized that fibroscans can vary. She did also say the their Doc was amazed.

For my part the idea of my condition to not get worse and stay at the status quo, would be wonderful in and of itself. However, I have always been one to shoot for the best possible outcome and will always look for ways to improve. Most of us did not expect to oneday have an outright cure for C.

I am looking forward to hearing back from another 'poster' who is in a study on this right now. In the meantime, I will take encouragement where I can get it? a big

gnatcatcher · « **Reply #5 on:** November 04, 2015, 11:27:45 am »

Mugwump, yes, please let us know. Interesting that Canada says 1 ultrasound/year for your "big fat" FibroScan 25 liver, whereas the USA protocol for my normal-sized FibroScan 19.5 liver is 2 ultrasounds/year. -Gnatty

KNW · « **Reply #6 on:** November 04, 2015, 11:42:26 am »

I too am interested in this new scan, I am in the business of metals testing and the advancement in UT and XRAY technology have been unbelievable.

beto · « **Reply #7 on:** November 04, 2015, 12:09:57 pm »

Gnatty,

Good to hear from you...I missed you. We used to be like best buds yo.

Anyway, I have to pay out of pocket for fibro scans...my insurance won't. Ironically, they will pay for biopsy...go figure. My one and only biopsy sucked. I got this wierd shoulder pain. For some reason that is where the pain refers to. Also, the idea of a big ass needle between two ribs is a bit unnerving as well.

I look forward to the scans improving.

gnatcatcher · « **Reply #8 on:** November 04, 2015, 03:46:08 pm »

beto, I've been around, averaging about 3 posts/day -- they just must've been on threads you don't frequent, and vice versa for your posts.
Bummer that your insurance won't pay for FibroScans. At my hepatology appointment on May 13 (to ask to get on Harvoni), they said they had just gotten their own FibroScan machine a week or so before -- did I want to do it right then and there? Spouse and I asked whether we needed insurance pre-approval, and they said they could get "post pre-approval" (no kidding!) My insurance has never asked me for a penny for the FibroScan, but I had a high copay for the ultrasound -- so high that I asked to do future ones in my PC's building, where I'd pay half as much.
Ah, yes, shoulder pain when the actual problem is elsewhere. When I had a pulmonary embolus, the pain was only in my left shoulder for the first day or so -- I'm lucky it didn't kill me before I realized something new was going on. The reason I wasn't suspicious is that whenever I eat rich food (which I rarely do), at some point the pain in my left shoulder tells me "not another bite."
My next ultrasound is 11/16; I doubt they'll see anything all that different, since my previous liver ultrasounds all looked deceptively good.

KimInTheForest · « **Reply #9 on:** November 04, 2015, 04:05:38 pm »

Quote from: beto on November 04, 2015, 12:09:57 pm

My one and only biopsy sucked. I got this wierd shoulder pain. For some reason that is where the pain refers to.

Long ago, in a galaxy far away… I once read that the nerve serving the liver inserts to the spinal column at the same point as nerve serving right shoulder. And so liver distress can result in referred pain to right shoulder. Prior to being diagnosed in 1995, I had 3 years of mysterious and seemingly unrelated symptoms, one of which was frequent but inexplicable pain in right shoulder. After being diagnosed and researching all things liver, I came across that tidbit about the referred pain in right shoulder being due to nerve insertion points along vertebral column.

kim

Mugwump · « **Reply #10 on:** November 04, 2015, 05:52:04 pm »

Thanks everyone for the encouragement. My scan will be with a newer ultra sound but not with the latest enhanced ones because they are just starting to be produced. Fortunately here in Victoria we have some newer equipment and the scans are very good at picking up problems that are more fine grained.

The BC Cancer Agency is very good because of all the work done by the Terry Fox foundation and the corresponding donation levels for advanced diagnostics which has helped greatly to keep the key diagnostic equipment and research up to date.

The main thing that they will be checking for is the bile duct area and vascular networks to see if there is any dangerous changes to these structures.

If I do not hear anything back this simply means that there is no reason to worry. If there is any problems I will get a call and most likely an extra trip to my GI will ensue.

The standard here for post and ongoing HCV testing is a two year CRC test, an annual complete abdominal ultra sound and biannual complete liver panel tests.

This makes sense because if you are clear of the virus you are still at a greater risk of HCC and CRC. Also if you are cirrhotic the annual ultrasound will pick up any changes to the key vascular network including the bile ducts, spleen, kidneys, stomach and intestines and especially rule out ascites and other problems that can occur due to cirrhosis.

The newer CRC test is not as much of a hassel as it once was and if done correctly is much more accurate than the older tests. Provided you don't mind putting a little stick into a turd floating on a piece of paper in your john. Last one I did I plugged the toilet messed up the test and had to get another kit and start all over again.

Lynn K · « **Reply #11 on:** November 04, 2015, 06:53:42 pm »

From what I understand the cirrhosis protocol to monitor for HCC is abdominal ultrasound along with an AFP blood test (tumor marker) every six months.

I also need an annual upper endoscopy to monitor for the return of esophageal varicies.

Aren't you folks having the AFP blood test and at least a screening upper EGD to check for the presence of varicies?

On my diagnosis with cirrhosis my doctor also had me get the hep A and B vaccines as well as the pneumonia vaccine.

Mugwump · « **Reply #12 on:** November 04, 2015, 07:50:51 pm »

Quote from: Lynn K on November 04, 2015, 06:53:42 pm

From what I understand the cirrhosis protocol to monitor for HCC is abdominal ultrasound along with an AFP blood test (tumor marker) every six months.

I also need an annual upper endoscopy to monitor for the return of esophageal varicies.

Aren't you folks having the AFP blood test and at least a screening upper EGD to check for the presence of varicies?

On my diagnosis with cirrhosis my doctor also had me get the hep A and B vaccines as well as the pneumonia vaccine.

Yes we have the vaccinations. And I will go for the endoscopy just to confirm that there is no problem with varicies. Yes the tumor marker testing is on the blood panel but I think it is only annual if you clear the virus. It could be that my GP will order extra tumor marker tests if I request it. I am advised to see my GP every six months so I guess that my cirrhosis and corresponding liver panel is being monitored every six months.

I confess that after the first treatment failure I was quite lax in seeing him but I tried to put the HCV out of my life by ignoring it until it came back to bite me in the arse in 2013 and advanced to full blown F4.

A carpe diem attitude did help me survive the dragon I am sure.

I will speak to my doc about it but they don't do much proactively and extra testing is routinely rejected financially at the provincial level as a cost saving measure. What they are finding up here is that CRC is becoming more common especially in the population that had exposure to HCV. That is why most GIs are becoming more concerned about doing the CRC screening more frequently in baby boomers. They had to push the provincial government to get more wide spread CRC testing and there was a media push to educate the public about the importance of cheap colo-rectal screening.

gnatcatcher · « **Reply #13 on:** November 04, 2015, 08:01:47 pm »

Lynn, I've been having the AFP blood test for a few years. Whether I'll be getting an upper EGD will depend on whether, when I see the hepatologist in January, he believes the FibroScan F4 or the FibroSure F2. There are a couple of reasons why my FibroScan score may have been inaccurately high.
As for the hep A and B vaccines, the A worked the only time I took it (and continues to protect me), but I have had two complete rounds of the B vaccine to little avail -- my Hep B core antibody total goes back to being nonreactive at some point. The hepatologist said some people just can't seem to stay vaccinated against Hep B. I'm current on both pneumonia vaccines. Have you had the new one that protects against the strains the regular one doesn't?

Lynn K · « **Reply #14 on:** November 04, 2015, 11:02:19 pm »

Yes I had he Prevnar13 a couple of months ago.

I have not been checked to make sure the Hep b vaccine took.

From what I read in the AASLD protocol for follow up care for cirrhosis post hep c cure I just see 6 month abdominal ultra sound and AFP upper endoscopy are required and any additional blood testing as required

And then we will see if the cirrhosis improves or not with time

Best to all

Mugwump · « **Reply #15 on:** November 05, 2015, 04:01:41 am »

As far as whether or not reversibility of cirrhosis is possible here are the studies and they all indicate that it is possible post treatment to see reasonable reversals after successful treatment and SVR!

I did the leg work and looked up everything I could find. And LYNN YES it is possible to see improvements in vascular conditions caused by HCV and cirrhosis.

It is still common to hear "cirrhosis is not a reversible condition" but it looks that even fairly advanced liver disease can be reversed after removing HCV from the equation. SOOOOOO YIPEE!!!!

http://onlinelibrary.wiley.com/doi/10.1111/apt.12044/full
Pol S, Carnot F, Nalpas B, et al. Reversibility of hepatitis C virus related cirrhosis. Hum Pathol 2004; 35: 107–12.

http://www.ncbi.nlm.nih.gov/pubmed/19072828
George SL, Bacon BR, Brunt EM, Mihindukulasuriya KL, Hoffmann J, Di Bisceglie AM. Clinical, virologic, histologic, and biochemical outcomes after successful HCV therapy: a 5- year follow-up of 150 patients. Hepatology 2009; 49: 729–38.

http://cid.oxfordjournals.org/content/52/7/889.long
Shiratori Y, Imazeki F, Moriyama M, et al. Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy. Ann Intern Med 2000; 132: 517–24.

http://www.ncbi.nlm.nih.gov/pubmed/18794559
Mallet V, Gilgenkrantz H, Serpaggi J, et al. Brief communication: the relationship of regression of cirrhosis to outcome in chronic hepatitis C. Ann Intern Med 2008; 149: 399–403.

http://onlinelibrary.wiley.com/doi/10.1002/hep.23528/full
Bruno S, Crosignani A, Facciotto C, et al. Sustained virologic response prevents the development of esophageal varices in compensated, Child-Pugh class A hepatitis C virus-induced cirrhosis. A 12-year prospective follow-up study. Hepatology 2010; 51: 2069–76.

Lynn K · « **Reply #16 on:** November 05, 2015, 04:21:29 am »

Never said it wasn't possible but not everyone will improve from what I have read.

Just got my ultrasound results liver enlarged 19cm spleen enlarged 15cm that doesn't sound like really good news but at least no sign of liver tumors.

gnatcatcher · « **Reply #17 on:** November 05, 2015, 04:37:44 am »

Lynn, how do those enlargement numbers compare to previous ultrasounds?

Lynn K · « **Reply #18 on:** November 05, 2015, 04:50:57 am »

Dunno gotta look for an old one. I don't have those on line. I do remember they don't always put numbers sometimes they just say mild to moderate enlargement. Also a small amount of Ascities but I have been seeing that for several years now

beto · « **Reply #19 on:** November 06, 2015, 12:17:03 pm »

FYI- I got a fibroscan yesterday and if the are no glitches I have reversed from f-4 to F0-1. I am taking a wait and see approach, of course. The technition was sure that everything was working properly and was totally confident in the scan. I was there to qualify for a study...I did not because my numbers were below the cut off (6.5) that is down from 14.5. I hope it's true. From what I have seen and heard from individual accounts and studies, I believe we can remove the word "hype" from the conversation to something like "cautious optimism"

KNW · « **Reply #20 on:** November 06, 2015, 12:42:50 pm »

Beto,
Great news always liked the word optimism better than pessimism. Glass is half full right?

beto · « **Reply #21 on:** November 06, 2015, 01:02:35 pm »

KNW

Right on my friend...let's keep our eye on the prize and belief in our heart...I so want everyone to get well...

gnatcatcher · « **Reply #22 on:** November 06, 2015, 01:07:07 pm »

Wow, beto, it sounds more like your cup nearly overfloweth!

beto · « **Reply #23 on:** November 06, 2015, 01:14:48 pm »

Honestly Gnatty,

I actually felt a little guilty as crazy as it sounds. Truly a "somebody pinch me" moment, along with the incredulous "no way". If this holds, it is a lottery.

gnatcatcher · « **Reply #24 on:** November 06, 2015, 01:25:29 pm »

not crazy at all -- sounds like a cousin to survivor's guilt. A lottery, yes, but then so is life. I'm very happy you're in the winner's circle.

beto · « **Reply #25 on:** November 06, 2015, 02:09:09 pm »

well...still have my fingers very crossed...

beto · « **Reply #26 on:** November 06, 2015, 02:57:14 pm »

OK, my new thing is researching reliability of fibrosis testing.

here is one on FibroScans;

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071883/

gnatcatcher · « **Reply #27 on:** November 06, 2015, 03:45:45 pm »

Thanks, beto. I'm thinking of taking the summary with me to my Jan. F/U.

dragonslayer · « **Reply #28 on:** November 06, 2015, 03:47:10 pm »

Nice study reference, Beto.. thanks for the link. Let me know, in your research, if you find a valid direct comparison between the reliability of the traditional biopsy vs that of fibroscan! Thanks again.

Mugwump · « **Reply #29 on:** November 06, 2015, 04:12:48 pm »

Quote from: beto on November 06, 2015, 02:57:14 pm

OK, my new thing is researching reliability of fibrosis testing.

here is one on FibroScans;

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071883/

There is no reason why machines in the future cannot do both a wide scan and a density pulse, thus use the combination of the two types of scans to determine the levels of cirrhosis for patients with liver deterioration.

The tech that did the fibroscan here was my hep nurse who is specifically trained to use the equipment. Even though I am overweight she was very skilled in getting the depth of the pulse right for me. It was interesting watching her do the scan and how the level of the pulse shock wave is varied for the depth readings. She explained exactly how the device worked because I showed interest in the device and joked with her about how I could do the same thing with fire crackers and fish finder.

Fibroscan is similar to what they do in the oil and gas industry with small charges of dynamite and sensors and what some oceanographic devices like commercial fish finders do.

The scan that I am going for this time is not a density Fibroscan but is very important for determining the state of the major blood vessels and relative sizes of the organs. My GI explained that it is much more important to have a full abdominal ultra sound post treatment that is capable of picking up things like tumors and vascular troubles and then have it done on a regular basis. Another Fibroscan will only happen if there is no gradual improvement in my blood work or if my function tests worsen post treatment indicating possible liver failure or if I chose to pay for one.

My liver panel tests were fine this time around so it looks like I am in the clear. I should have the RNA results in about another week. So I will post it to the 24 week Harvoni thread with that result along with some special stuff.

Now to seriously work on getting rid of some fat that is bogging me down because I could not exercise for longer periods for about 6 years!!!... That is the real blessing of getting rid of HCV once and for all, our liver functions should now be good enough to exercise for longer periods of time again. One of the major problems with cirrhosis long term is that you slowly lose the ability to metabolize and burn off fat efficiently.

Cheers
Eric

beto · « **Reply #30 on:** November 06, 2015, 05:49:42 pm »

mugwump...hope your test and EOT go better than expected... and thanks for the info

peace

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Author Topic: Reversibility of Hepatic Fibrosis and Cirrhosis--Is it all Hype? (Read 18773 times)