Biopsy vs Fibroscan on CHB

[grmr]

Dear mates,

I’m CHB carriers since birth still EAG+ve after 2 ifn course (last one with TDF and then IFN add on).

Latest biopsy in 2007 showed a METAVIR 0-1 rank, normal liver almost no Fibrosis at all. Docs decided to stop tx (after 14month on TDF+ IFN) as no decrease at all in HBSAG quantity. Now we wait and see if flares occur on follow up and hopefully eag seroconversion and SVR.

We’re scheduling a further biopsy in the next year.. I asked for Fibrsocan but was told biopsy is more reliable in my case as in order te a reliable result on Fibroscna we need normal ALT/AST for 8/10 months at least.. Which seems quite unlike in my condition (alt above UNL).

Please comment on this as Fibsrocan woul be preferred to me..

Thanks to every 1

[grmr]

my ALT is now rising.. i do hope in a flare and eag conversion.. I still wonder how can I still be EAG+,. I'm aovbut 30yo and docs said many eag serocnversions happen betweeen 30/40..

[stef2011]

sorry forgot what was wrong, it was the few weeks time to be wrong then

ideally we need a marker to show us when pegintf add on is ok, i noticed they added ip10 on the trials i guess tey are checking if ip10 can be a good marker for pegintf add on.1-2 years of hbvdna und must be the minimum, trials are requiring a minimum of 12 months for now

[grmr]

no Stef you're wrong.

i started TDF first and after some weeks I had added IFN (before DNA was completely UND).. so the approach was correct,,,

[stef2011]

I think sequential PEG and TDF is better than together.

it s the opposite to be good tdf then peg add on, grmr actually had the worst combination, started with pegintf and added tdf when pegintf response started, so the little immune response started by peg was abolished by tdf

so it is known we rescue hbv cd8 response by potent antivirals tdf or etv and then add on pegintf to rescue nk and nkt cells too....i have no idea why the opposite in this combination does not work

[grmr]

normal BMI.. no fatty liver. 1 beer (33cl) week... In the latest days to be honest I had a lot of cakes/desserts/salami and some fried meals..

[Jeff912000]

what is your weight.  Do you have fatty liver?  This can cause a slightly elevated ALT.  I think sequential PEG and TDF is better than together.  

[grmr]

i'll get againg hbsag quant in few weeks and will report.

Just cchecked now, my ALT is now 50 (1-47) while 2 wks ago was 22... so scared they start rising again

[stef2011]

can you report your vitd levels, hbsag levels, fibroscan on the other thread about vit d.it ll be very interesting to put all data together and see if there is any correlation with high vit d

[grmr]

so i'll have a fibroscan soon and report here outcome.. docs exepct vey low stiffness even it dna is increasing (now 55000 iu) and ALT AST are normal

[grmr]

no sides both courses.. i was on ifn+tdf for almost 15 months..

[mustthinkpositive]

That right Sfefano. They are salesman aren't they, hospitals and doctors. Don't get me wrong, they do a marvellous job for the community and society but maybe too much self interest.

Any side effects in Interferon grmr? and how long were you on TDF/PEG?

[stef2011]

biopsy may read f0-f1 fibrosis better but only regarding the sample they take, nobody can predict if the sample is the same as the whole liver but
if alt s higher than 200 the doctors are right to use biopsy instead fibroscan

maybe the new fibroscan+ultrasound machine, which i dont remember the name, will solve this problem

i also agree that in your case therapy is useless, we can see very clear the difference between corrupt doctors in other countries and italian doctors, our point is cure hbv or cure a damaged liver and not sell antivirals, fibroscan or biopsy will tell if antivirals will ever be necessary since most never develop damaged liver despite active hbv

[grmr]

my DNA was UND after 1monto of TDF and ALT dropped form >500 to normal level during tx... I stopped TDF 3 months ago and DNA will relapse for sure...

I have Ultrasound done every 6 months and all of them are ok so far...

[StephenCastlecrag]

I am not a doctor. The purpose of treatment is not to lower HBsAg, but to lower hbvdna and normalize ALT. If these have been achieved with your treatments, then it is likely liver disease progression will be minimal and fibrosis will not advance and should regress. So I have difficulty in understanding why another biopsy is necessary A baseline biopsy is helpful because there is no previous history, so the state of the liver is often unknown and when treatment with Interferon is considered then it is prudent to make sure that liver is no cirrhotic before starting Interferon treatment.
I would ask the doctor what is the purpose of another biopsy It is true that a high ALT will increase the Fibroscan score as the liver is inflamed. But your biopsy/Fibroscan is scheduled for next year.