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Please Help Me Interprete Elevated Fibroscan Result (6.8KPa)
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Please Help Me Interprete Elevated Fibroscan Result (6.8KPa)

Hello Stef2011, StephenCastlgrag, and everybody,

Please help me understand my results below.

Background, I've been a Hep B carrier since at least 1988 (25 years) when I was 16 years old. I'm now 42, Asian male living in the US  - where HBsAG Quant tests are still unavailable.

I recently went for Hep B check up, and was mostly happy with the results until Fibroscan came back at 6.8 KPa.

****************************************************************************
Date: January 20, 2014

Genotype: B

FIBROSCAN - 6.8 KPa (F1 - F2 - Mildly fibrotic liver / biopsy confirmation recommended)
                                  (last Fibroscan result was 4.8 KPa approx 2 years before done in another country)

ULTRA SOUND - Normal Abdominal Ultrasound (last check was 2 years before - also normal)

HBV DNA - Not detected (HBV DNA by PCR Quant - Range is 250 - 25,000,000 iu/ml)
                
Alpha Fetoprotein - 1.66 ng/ml

ALT - 31 [previously 39 (7/2013); 22 (11/2012); 21 (9/2011) ...]

AST - 21 [previously 23 (7/2013); 20 (11/2012); 20 (9/2011) ...]

Vitamin D - 47.3 ng/ml (been taking 5,000 iu/day for at least a year)

Bilirubin - 0.5 mg/dl [the lowest result ever compared to previously 1.5 (9/2013) or 1.9 (7/2013) or 2.4 (11/2012) or    
              1.5 (3/2009) etc.]

Please chime in on why Normal ALT (31), Normal Ultra Sound, Undetected HBV DNA, but ELEVATED FIBROSCAN!

I was expecting Ultra Sound result to come back as mildly fatty liver to account for the elevated Fibroscan. But Ultra Sound is normal.

Bilirubin is lowest in all the years that I've been testing for it.

FIBROSCAN: This is the first and only commercial Fibroscan facility in Los Angeles since Fibroscan was approved by the FDA in April of 2013. The doctor interpreting my Fibroscan result specializes in Hep C and HIV research and trials who admitted that he was not a Hep B specialist and advised me to see another Hep B Director at a major LA hospital. I have not been able to schedule an appointment with this Director yet (earliest appointment is over 40 days away).

I look forward to your comments and input. Thanks in advance.  

Wish you all the best health!

  

38 Comments Post a Comment
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Avatar_m_tn

try to improve your overall diet with organic food and see if next reading gets below 5kpa, also check if you can get oxidative stress tests in some US lab

if hbvdna is always und and alt less than 30 the damage should not be from hbv

also try to find how to test hbsag, it is very possible you have it low and pegintf could get rid of hbv
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Avatar_m_tn
Hi Stef2011,

Appreciate the quick reply. I will try to improve diet with organic food and oxidative stress test and update this thread as available.

Should I try to obtain HepTech products to speed up the recovery and lower Fibroscan? Any other supplements or changes that you're aware of that could help with lowering live stiffness?

How long should I wait before retesting Fibroscan for a followup? Not inexpensive, but peace of mind is priceless.

I definitely look into HBsAg quant. Currently looking for way to draw and ship blood to another country for testing.
  
Regards.
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Avatar_m_tn
Also, is Fibroscan 6.8 KPa borderline dangerous? Thanks.

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Avatar_m_tn
I think in your case, considering you past record 6.8 Kpa would better correlate to F0-F1 fibrosis rather than F1-F2.

As for heptech I personally think it is very risky to take. Hopefully heptech at least does not make any harm to you. In my opinion their  Heptech project failed and they are trying to get rid of their expired stock by any means.  
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Avatar_m_tn
Others have given you excellent advice. In your post, you did not say whether you are under treatment and since when? Undetectable hbvdna does not automatically mean F0 fibrosis. Usually fibrosis took a while to accumulate and progress, equally, it will take a certain period of time of very low or undetectable hbvdna, accompanied by normal ALT indicating no inflammation, for fibrosis to regress.
Fatty liver can also contribute to fibrosis. I am not sure whether Ultrasound can accurately determine fatty liver. May be you should check your cholesterol levels, BMI, etc to be certain.
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Avatar_m_tn
heptech is just natural food in dried form and it has no expiry (dried food has no expiry, dont remember the exact word in english for this process but in the end it is dried to become endless in durability), so the dangers are null

6.8kpa starts to be a big step from previous reading, after 7kpa the risk of hcc is increased and therapy would be needed if hbvdna was detactable
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Avatar_m_tn
you may try fibroguard but the changes n diet are the most important

what is your bmi, cholesterol and metabolic tests?
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Avatar_m_tn
are you taking any medicines
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Avatar_m_tn
the correct word is lyophilized, it is a process that can keep substances for 15-33 years, few studies have checked durability among these very long dates.despite this in some countries you have to set a shorter expiry date

another interesting study i saw commissioned by US army is about chemical drugs, most chemical drugs have durability of decades and remain fully active after expiry while others don t, they dont become harmful but lose potency.since they did not list the drugs it is dangerous to use chemical drugs after expiry
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Avatar_m_tn
All chemical drugs which content active ingradants which degrades after period of time and form impurities so shelf life of drug is decided on stability of that drug which generly 24 months or 36 months. after that we cant use that drug product as it loses its potency.but some drug substance are active after expiry and its is called as retest date after that date we have to analyse that drug once again and extend its expiry for certain period it may be 3 year or more
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Avatar_m_tn
http://www.health.harvard.edu/fhg/updates/update1103a.shtml

http://articles.mercola.com/sites/articles/archive/2000/04/02/drug-expiration-part-one.aspx

This is a dilemma many people face in some way or another. A column published in Pyschopharmacology Today offers some advice.

It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.
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Avatar_m_tn
this said i will not try any drug after 10-15 years from exp date, especially because most are free in my country
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Avatar_m_tn
About Hepthech

Probably substances can last for 30 years, but it depends on the condition of the storage. If you put it in vacume it may be the case. As for Heptech all of it except for PPC contain natural antioxidants that got spoiled when in contact with oxiged and humidity. Although the bottles are sealed and filled with cotton some air gets gradually under the lid. One of my bottles got rotten and I could see it visually because the pilles become spotted and changed colour. Heptech confirmed it and even changed the bottle. Moreover they told me that they destroyed all 2009 batch this summer.
Also they told me that someone stole old stock and now selling it to old custommers. So be alert if you get such an offer from Cal.
Nonetheless I ordered a new lot directly from heptech and I received all the bottles from old 2009 batch  again and Heptech refuse to replace it.
So I would agree with Andrey that heptech is a failed project selling outdated stock. I do not advise paying to any of them upfront.
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Avatar_m_tn
this is bad news, i cant comment on this since i stopped it around sept 2013 since then the only problem was on heptoshield pills that easily got broken
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Avatar_m_tn
Heptoshield is probably the only one that has no problem. Since it is 100% PPC each capsule has a solid shell. They are fragile I agree, a few pills in a bottle are usually broken but it is not a big deal. The other three components have two part soft shell easily disassembling, the air can get in and out as soon as it gets into the bottle.
So my advice is to put the cotton to fill the space inside the bottle close it firmly and keep in fridge for any unsealed bottle.
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Avatar_m_tn
what about fibroguard, do you have data on sealed bottles with lyophilized substances.this is the best product of their line and i'd keep using it in the future from time to time for reservatrol, curcumin content
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Avatar_m_tn
I saw their Redox bottle rotten, as for the fibroshield I think that since the bottle is sealed identically some air gets inside too.
They told me that they discontinued old formula and added 300mg of high purity Schizandra. I was supposed to receive 6 bottles of it but got 2009 old bottles that they deny to exist, a bunch of thieves.
Actually I am not sure that the new formula exists either I asked a few times for product sheets or pictures but never received them, the website has no new products either, actually it was not updated for years.
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Avatar_m_tn
Dear StephenCastlecrag and everybody,

Since becoming aware of the Hep B carrier status, I've never undertaken any treatment. There were no symptoms. However, I just wanted to become more vigilant with this disease since about 2009, and hence more testing and self-education.

Please see if you could use my past data to better advise me. Thanks so much.

******* Results as of January 20, 2014 (Latest):

Cholesterol: Total 148; Triglycerides 148; HDL 44; LDL Calc 90; VLDL Calc 14

BMI: 23.6 (151 lbs, 5'7")

UlTRA SOUND: I requested the US sound results on a CD and will be asking a second radiologist in town for a SECOND opinion/reading to confirm. Will update here.

Genotype: B

FIBROSCAN - 6.8 KPa (F1 - F2 - Mildly fibrotic liver / biopsy confirmation recommended) (last Fibroscan result was 4.8 KPa approx 2 years before done in another country)

ULTRA SOUND - Normal Abdominal Ultrasound (last check was 2 years before - also normal)

HBV DNA - Not detected (HBV DNA by PCR Quant - Range is 250 - 25,000,000 iu/ml)
                
Alpha Fetoprotein - 1.66 ng/ml

ALT - 31 [previously 39 (7/2013); 22 (11/2012); 21 (9/2011) ...]

AST - 21 [previously 23 (7/2013); 20 (11/2012); 20 (9/2011) ...]

Vitamin D - 47.3 ng/ml (been taking 5,000 iu/day for at least a year)

Bilirubin - 0.5 mg/dl [the lowest result ever compared to previously 1.5 (9/2013) or 1.9 (7/2013) or 2.4 (11/2012) or 1.5 (3/2009) etc.]


******* Results as of March 2009 (first visit to Hepatologist -  first complete results; Fibroscan was not available as a choice)

AST:                              24
ALT:                               25
Hep A AB:                      Reactive
Hep B Core AB:              21.40 (Reactive)
HBsAG:                         Reactive
HBsAG Confirmation:      Reactive
HBsAB Quant:                <3 (Negative)
HBeAG:                         Negative
Hep C AB:                     Negative
HBV DNA by Quant:       <250 (Undetected)
Bilirubin:                        1.5
Ultra Sound:                  Normal abdominal

****** Results as of Sept 2011 (follow up checkup)
AST:                             20
ALT:                             21
Bilirubin:                       2.3 (high)
HBV DNA by Quant:     1761 IU/ML
Total cholesterol:           159
Triglycerides:                140
HDL:                            57
VLDL Calc:                  28
Alpha Fetoprotein:        1.67
Ultra Sound:                 Normal

****** Results as of Dec 2011 (French hospital)
AST:                           16
ALT:                            17
Bilirubin:                     0.85
Alpha Fetoprotein:       2.97 ng/ml
Ultra Sound:                Normal
Fibroscan:                  4.8 KPa
ANTICORPS ANTI-HBs:   3.9 UI/l Titre (Negative)
HBeAG:                     Negative
HBeAB                      Positive
HBV Viral Load:         1.68E+02               IU/ml
                                 2.23                      log

****** Results as of Oct 2010
AST                           24
ALT                            24
Bilirubin                      1.5
Alpha Fetorprotein      1.73
HBeAg                       Negative
HBV DNA by Quant    Not detected

Appreciate any input.

        
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Avatar_m_tn
Stef2011,

Please see if you could read my Metabolic panel to see me some insight. Cholesterol panel already listed above. Let me know if you will need Blood Panel.

Thanks.

**** Jan 2014 Complete Metabolic Panel:

Glucose:                                     98   mg/dL      65 - 99
BUN                                           15   mg/dL      6 - 24
Creatinine, Serum                        0.80 mg/dL     0.76 - 1.27
eGFR if nonAmerican                   112  mL/min/1.73  >59
BUN/Creatinine Ratio                   19                  9 - 20
Sodium, Serum                            141   mmol/L  134 - 144
Potassium, Serum                       4.6    mmol/L  3.5 - 5.2
Chloride, Serum                           102   mmol/L  97 - 108
Carbon Dioxide, Total                    27    mmol/L  19 -28
Calcium. Serum                           9.9   mmol/L   8.7 - 10.2
Protein, Total Serum                     7.4   g/dL       6.0 - 8.5
Albumin, Serum                           4.5   g/dL       3.5 - 5.5
Globulin, Total                              2.9   g/dL       1.5 - 4.5
A/G Ratio                                    1.6                 1.1 - 2.5
Bilirubin, Total                              0.5  mg/dL      0.0 - 1.2
Alkaline Phosphate                      76   IU/L          39 - 117
AST                                            21                  0 - 40
ALT                                             31                  0 - 44
          
            

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Avatar_m_tn
all those tests not needed and many of the important ones obsolete:

hbvdna sensibility is 10iu/ml, sensibility at 250iu/ml is not accetable (maybe 20iu/ml can be ok too)

hbsag qualitative like your test is useless, you need architect or elecsys for hbsag quantitative in iu/ml

after we have these two tests we can suggest if it is best pegintf mono, sequential tdf and then pegintf add on or monitoring

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Avatar_m_tn
also genotype needed
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Avatar_m_tn
i think the point with heptech is to know if lyophilized products packed like that from 2009 are ok
we should inquire fda or similar institutions in US that take care of this, the product is registered so they should be able to tell us
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Avatar_m_tn
As for me I have personally tried Heptech but I did not see that much result. The only thing I have noticed is my urina nasty smell and colour. For last three month I had been taking heptech products my fibroscan Kpa did not move at all while it was constantly slowly going down on interferon mono, when I added heptech decline stoped.

Steff I surely know you regressed cirohis when taking heptech but you completely changed your diet and way of living so it is very hard to say how much heptech is responsible for your histology imporovement!

Maybe other members can report their heptech experience?    
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Avatar_m_tn
Thank you for your reply and data. I am completely ignorant about indicators for fatty liver. Looking at your hbvdna and ALT data, I can see why treatment is not needed. So I am at a loss to explain why the increase in your Fibroscan score. I can only suggest that you repeat your Fibroscan test in a few months time. Some literature indicates fasting/non fasting can influence Fibroscan score, also operator can influence the result.
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Avatar_m_tn
Also one day I have recieved a letter from Cal (heptech sales manager). He offered me to set a distribution line for Russia. Their offer was to sell me big quantity of their products with reduced price. His idea was to save on freight cost when you ship large quantity. I rejected this offer because was not interested. But now looking at Rome70 experience I think the only thing they wanted is to get rid of big quantity of their expired products at once.
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Avatar_m_tn
yes my regression was made of many things, not only heptech for sure, i also had gcmaf and the religious diet change is also a must...

since the discovery of gcmaf activating stemcells i think this was the main thing responsible, heptech took a very long time on their trials which cannot be explained by 1.5years, too fast.but the action of gcmaf is also dependent on inflammation status, vit d and diet, so i think it was a mix to make the fast result

one thing is certain, fibrosis cannot regress without diet changes or being bmi>25, this is a fact on nucs trials
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Avatar_n_tn
The results you received from Heptech is very strange as I lowered my FibroScan 3.8 points in 6 months, and will test again in September.
My last two orders were all new product. I have also asked the office for an update on their clinical trials and have not received any feedback yet. I will update everyone once I hear somethng. I have been very pleased with the results.
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Avatar_m_tn
I was also offered a distributorship opportunity by Cal, which i declined after i had made several purchases.
However, overall i have felt better taking those products tnam doing without them.
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Avatar_m_tn
I ordered from Advance Life Research a few week before I decided to take IFN in 2013. When the products arrived (cost me $450 all up for the whole set), the manufacturer date was 2009 year of production on the bottom. We are in mid 2013. WTF??

I decided not to take any because I do not want to interfere with the IFN treatment. And also because of the year of production. Not expired but 4 years old. It's a joke for such an expensive products. Plus all the bottles looks dusty and old like on shelves for years.....



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Avatar_m_tn
why is 6.8 interpreted as F1-F2 ? My result is the same and its in F0-F1.
If you google up the Fibroscan tables it should be F0.
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Avatar_m_tn
I too would love to learn more here.

My Fibroscan doctor was a HepC researcher who told me he was unsure of his assessment below. He referred me to see the head HepB liver doctor at an LA hospital for a more precise determination.

He wrote simply:
"6.8 KPa (F1 - F2 - Mildly fibrotic liver / biopsy confirmation recommended)"  

It's taking about 2 months to set an appointment to see this next Dr. And very pricey too. Outside of my insurance plan just like the Fibroscan was. But this Fibroscan knowledge has been life-changing info for me lately.

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Avatar_m_tn
fibroscan is not good to see the difference between f0 and f1, anyway a value less than 6kpa is and less is no worry at all, around 4kpa would be the optimum

while if one is to check cirrhosis regression getting values less than 5kpa is very rare, so a cirrhosis regression reaching 4kpa and less is probably f0
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Avatar_m_tn
how about 6.6?
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Avatar_m_tn
you have to work on diet and keep values less than 7kpa, but that is not a value to be concerned or that indicates need of nucs therapy
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Avatar_m_tn
I had an 6.5 kPa result (there were 10 mesurements the highest 8, the lowest 5.5)...I guess the 6.5kPa is the median value?

Anyway, this was the only value written on the Results page: 6.5 kPa
Also, IQR 1.5 (don't know what that means)

The conclusion on the Results page: grade F0-F1.

Ultrasound exam found everything normal.

"you have to work on diet and keep values less than 7kpa" ...What kind of diet are you talking about?
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Avatar_m_tn
"I had an 6.5 kPa result (there were 10 measurements the highest 8, the lowest 5.5)...I guess the 6.5kPa is the median value?"

Yes, mine too was like that. The average of ten measurements. I went from 4.8 to 6.8 KPa in about 2 years, and not sure why. HBV DNA undetected and ultra sound normal at both times.


"Anyway, this was the only value written on the Results page: 6.5 kPa
Also, IQR 1.5 (don't know what that means). The conclusion on the Results page: grade F0-F1."

My Fibroscan doctor wrote "F1 - F2 - Mildly fibrotic liver / biopsy confirmation recommended." The footnotes say IQR means "scatter," one of the factors in the Fibroscan calculation. My IQR was 0.9.  


"you have to work on diet and keep values less than 7kpa" ...What kind of diet are you talking about?

That's what I've been asking on this forum. No answers yet. Perhaps because the topic has already discussed in depth before, and no one was in the mood to rehash it once more. I looked through hundreds of posts, but nothing really definitive came about.

I'd like to know what you will find too.
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Avatar_m_tn
One thing worth noting for me was that my baseline right after I was diagnosed in 2012 was 6.8 Kpa. I drank a lot of beer back then on a daily basis. I stopped drinking completely after I found out I had HBV and ate syrimarol - Sylibi mariani fructus extractum for a few months. I have redone a Fibroscan before Interferon and it was 6.6Kpa. During IFN I didn't take it so I don't interfere with treatment and now its back to 6.8Kpa.

Syrimarol is nothing on virus of course so don't think you will be cure, it just helps liver on its regular job.
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Avatar_m_tn
Yes, there are a lot of post by stef2011:
"fibrosis and compensated cirrhosis can be regressed by all the following points:
hbvdna und
healthy diet with no processed foods, no fats, no red meat, few white meat
no fatty liver
low bmi/wieght (overwieght can t regress fibrosis)

being fat and overweight increases fibrosis despite hbvdna und, all points needed"

http://www.medhelp.org/posts/Hepatitis-B/regressison-of-
cirrhosis-48weeks-etvalinia/show/1375048

I wouldn't take daily high dose supps, the reason is you cannot really know what the body really needs, and could hurt yourself even more...but maybe I am wrong.

What I found recently is Angiotensin  levels elevated in CHB patients, and correlating with fibrosis/chirrosis stage:
http://www.ncbi.nlm.nih.gov/pubmed/1748416
http://www.ncbi.nlm.nih.gov/pubmed/22277254
..so they thought that maybe, blocking angiotensin helps fibrosis and found that to be true, a lot of ARBs help with fibrosis..Also Vit D reduces angiotensin levels
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