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FIBROSIS
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FIBROSIS

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20Curriculum%202009/Interactive%20Virtual%20Presentations/Advanced%20Liver%20Disease.aspx


Right now Clinical Care OPtions has an excellent slide presentation  called “Fibrosis and Advanced Liver Disease.”  Clinical Care Options is a site where medical practitioners can get continuing education hours .  You have to register and it is free. As a patient I have received a lot of good information about Hep C.  They have an excellent CORE presentation of Hepatitis C and send email alerts (if you want them) for any new presentations.  This one focuses on fibrosis.  It is about 50 slides with an audio discusssion.  It is interactive in that they ask several questions during the presentation that you can try to answer.  It takes about 20-30 minutes and is well worth it.

Some of the highlights, if you can’t focus that long (I rememeber those days).

-  Only 20 % of people who get Hep C end up with cirrhosis
- Of those 20% with cirrhosis, 25 % , will end in liver failure and that equals 4% of the total Hep C population
- A good explanation of portal hypertension (which I never understood before)
- A good graph that shows that the viral load (HCV RNA) has no correlation with the degree of fibrosis
- A good chart that shows that  serum ALT levels cannot accurately predict degree of fibrosis or cirrhosis
-A good discussion of noninvasive procedures available to predict liver disease disease including a discussion of elastography – and ultrasound trandsucer which can look at 1/500 of the liver instead of the 1/50,000 in a needle biopsy – (these tests are ineffective at dx significant fibrosis but effective at excluding cirrhosis)

Here’s a question for you
Which is not a risk factor in the progression of liver disease
1.  inflammation
2.  history of diabetes
3. Steatosis
4. Alcohol intake
5.  HCV genotype

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15 Comments Post a Comment
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223152_tn?1346981971
Answer ....................... 5.  HCV genotype.  Did you get it right?

More from the slide presentation

fibrosis score under or at 1.9 ----- 29.6% chance to reach cirrhosis in 10 years
fibrosis score 2 – 2.9 .....................42 % risk to reach cirrhosis in 10 years
fibrosis score 3-3.45.....................100% friends.  100% chance to reach cirrhosis in 10 years.

Inflammation score
0-1      .05 change each year
2-3       .19 change each year
over 4    .37 change each year

There is also a good discussion of steatosis and insulin resistance and how these negatively impact liver disease
-Daily cannabis use accelerates liver disease
-alcohol increases the run to cirrhosis

Good news – improvement shown in fibrosis at week 72 .....IF SVR – A REDUCTION IN THE METAVIR SCORE.  

There is more and I hope you will fnd the time to take this course.  The more I learn about fibrosis and cirrhosis the better I am able to make decisions concerning my hepatitis C

frijole
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Avatar_f_tn
Thanks, that looks interesting and informative.  I will check it out.

jd
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223152_tn?1346981971
Thanks.  I see so many questions on this issue I was hoping to get up a running discussion on fibrosis and its progress.

for example, my biopsy is grade 1, stage 1-2.  I am 61.  According to information in this program, there is a 29.6% chance that I will reach cirrhosis by the time I am 71.  I have already failed treatment once.  How much should I push to retreat?  I fully intend to reteat as soon as the PI's hit the market -- I intend to be the first one at the pharmacy counter with my prescription.  But why????   Is this really the prudent thing to do?

I have heard before that the inflammation and fibrosis can go south in a heartbeat -- that the progression is not linear and that one never knows when the inflammation and subsequent fibrosis will increase.  However, this presentation talked of reaching a "stable" condition.  It didn't go into detail, but that would seem to be where I am.  I have probably had C for close to 40 years, yet my immune system seems to have kept it at bay.  Nonetheless, I appear to have an old and tough strain.

just curious questions I ask myself

frijole
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Avatar_f_tn
I am SVR, thank God, but I was  grade 2-3, stage 2-3 when diagnosed.  I have also heard the progression is non-linear.  I was shocked by the diagnosis and the state of my liver.  My cancer surgeon had visualized the entire liver just 3 years before during surgery and at that time did not note any damage, so my fibrosis must have progressed to stage 2-3 fairly rapidly.  I wonder if the chemotherapy acted to accelerate the liver damage.
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223152_tn?1346981971
cancer and then hep C -- boy you got dumped on.  Congrats on your SVR.  Cancer free too????   Are you still draining the drugs out of your system?  It seemed to take a long time for me.  I had neuropathy in my toews for quite some time, but it did finally go away.

  I was afraid the tx for hep C may have destabilized  the healthy relationship my immune system seemed to have with my 3 millions little hep buddies but everything seems to be status quo.  It would probably be fool hardy for me to treat again, but I do think I still will eventually.
frijole


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92903_tn?1309908311
Thanks for posting this Oh Beanie One.

I'll get in there to watch it eventually - have to find my password forst :(

Did you happen to notice whether they talk about post SVR regression at all?
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Avatar_n_tn
no way Senora -  I'm planning to show up with sleeping bag and camp outside  the door the week before. Maybe we should start an approval-date-pool.
Thanks for the post ( full of stuff I'd rather not know..)

I assume you decided not go for the BC/relapser trial. Good move, I think there's a good chance that by also throwing  Alinia/SAMe and a statin  into the blender it might be worth betting on 24w.
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Avatar_m_tn
Quoting frijole"

"Good news – improvement shown in fibrosis at week 72 .....IF SVR – A REDUCTION IN THE METAVIR SCORE. "
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179856_tn?1333550962
Michael

You know I love what you just posted :)

Deborah
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223152_tn?1346981971
Hey, goof -- cut to the near the end of the presentation (if you find your password -- lordy, thank goodness mine is memorized in there or I would be lost) and there is a chart called "Improvement in Fibrosis at week 72 following start of SVR"  (I don't think it means 72 weeks of treatment, just 72 weeks after atarting treating).  The charts makes me dizzy --- one upside down and one right side up -- but 1 whole point drop in the Metavir score at week 72 if you reach SVR.  One the same page - if I am reading right -- 50% of the  SVR patients did improve.  There is some other stuff in the presentation which I think is hopeful in terms of what I would call stable cirrhosis.

willing -- let's start this pool.  I had it all worked out based on ejoli's start date in the BOC trial --she has 42 weeks to go + 24 weeks post +  12 weeks for FDA approval -- that puts it at the end of 2011 -- I am going to say December 15th - WHat do we ante up?  

The clinic did not get the Boceprevir r/r trial (AGAIN!)   Said they filled the trial and did not use their site.  A woman left a message about a PI trial coming up in July (don't know what PI) but it is a stand alone -- no SOC.  I didn't call her back yet, but she said she would call when she knows more.  Be expecting a contact from me.  I wouldn't even consider it without talking to you first!!!!!  I don't think it would be worth getting PI resistent.

Mike and Deb
Whooppee is right!!!!!!!!!!!!!!!!!

frijole - bean
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Avatar_m_tn
my fibrospect index score is 73/ Metavir F2-F4 87.9% F1 8.9% and FO 3.2%

So my Hepatologisat said I am septal and bridging fibrosis F-2_F-3 and Cirrhosis F4.
said Advanced End Stage.  Finished Tx nearly 4 years ago.  Thought all my symptoms were lingering sides-wrong!
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Avatar_m_tn
Why do you feel it would be foolhardy to treat again? Because of the possible destabilization of the immune system you mentioned? - or the neuropathy?

And how long did it take for the neuropathy to subside? I'm fighting mine off with supplements and exercise, but it seems to be progressing a bit. Seeing GP today, then hopefully neurologist.
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223152_tn?1346981971
franke,
I read your profile and treatment sees to have sucked out your life force.  I can't answer you as to why your scores are still so low.  What shape were you in when you treated?  I sympathize with you and hope things get better. If you look in the archives there are some pretty good threads on vitamin supplements for fibrosis reversal.   Sorry I can't help you in reading your fibrospect scores but perhaps someone will come along that will.

drang
I think that I  do want to treat, but that it might be foolish given that I am in good health and have no outward signs of liver damage unless it is my tiredness every evening and I am not convinced that would change with treatment and that I seem to be very stable.    Looking at one of the charts in the fibrosis presentation that I linked , there is a 70% chance I will not reach cirhhosis in 10 years at which time I will be 71.  If I live that long, I will already have outlived my mother and dad only lived to 78. -- those are factors to consider.  The surgeon who did my two biopsies said my liver was better than most people my age and discouraged my treating.  My high-powered hepatologist in Dallas is of the watch and wait opinion.  I am not afraid of the neuropathy although I didn't like it much.  I think it took a good six months to regain all feeling in my fingertips and toes (not toews _criminy my typing is cr@p) after tx.  I still do think I will tx when the PIs are available.

frijole
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Avatar_n_tn
>what do we ante up
not sure - maybe the winner gets a high-quality transcript of all Goofydad's jokes to help them through tx.

As I understand it ejoli is participating in the BC/relapser trial, not the BC/phase-3 tx naive (which will have full data by June'10). I would expect Schering to file for approval on the strength of its tx-naive data so I'm guessing submission by August and approval by Feb 22.

It's hard to know what's age and what's tx/hcv related. I just saw a neurologist for worsening neuropathy in my feet but beyond mentioning a correlation with hcv there doesn't seem to be much  scope for intervention. And your assessment of options  seems right on point as far as I can tell. In fact you could quite reasonably wait for the 2nd gen PIs and/or combo PI tx (which would  reduce ifn time dramatically).

I'm ahead of you on the fibrosis curve (somewhere between 1.5 and 2.5 depending on who I ask, but more likely closer to 2.5 ) so can't wait that long.
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223152_tn?1346981971
You are correct that ejoli is in the relapser trial with Pegasys and Riba.  I guess I assumed that they would need to finish all trails before applying.  If not, that is great.  Still, I wonder about Telaprevir.  It seems that they still haven't figured out how to reduct the rash that some people get, and I think it is significant, from what people have said.  

What do you think will be standard of care with the first generation PIs -- the regular mix - INF and RIBA and the PI added to it?  I am trying to imagine what treatment will entail at first.  You think the second generation might drop the INF altogether?  I am really interested to see how this plays out.

Have you had a biopsy since you stopped treatment?

Boy, I will have to start working on "goofy threads"....................
frijole
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