Has all of you had biopsy before treatment?

Hi,

I'm new here. Have been reading posts for a while and startet treatment on the 6th of January. I am on the triple treatment with Victrelis.

I was first diagnosed with hep c in 1993. My blood tests have  always been pretty normal, low Alat and Asat + low viral load. My viral load when I started treatment was 100 000.

I have never been asked to take a biopsy. My question is: it seems that "all" of you have had a biopsy before starting treatment? I asked my doctor and he said that I probably don't have any scarring because of my low/"normal" blood tests through the years. I asked if I could get an ultrasound and I hope I will get one.

Is it true, what my doctor says, that I probably don't have any scarring of the liver? Can he know this based only the blood tests?

I had my blood test at 4 weeks treatment (riba + interferon lead in) last Friday and will get the results on Friday. Am really looking forward to hear what they have to say.

My hb was at 12 when I started tx, and after two weeks it was 10.3. A week later it was 9.8.

Can the doctor tell the lenghth I will have to be treated based on the results of this first test at 4 weeks?

(sorry for bad English...I'm from Norway :))

Good luck to everybody in here - I'm so thankfull that I found you folks!

[1oftheclub222]

The best way to really tell what shape your liver is in is to have a biopsy done.  The blood test ressults are not really reflective of the damage to your liver.  We have one member who had 750,000 vl and was in cirrhosis already.  Some people have blood work that doesn't look so great and have very little damage to their liver.  The best way to be sure is a liver biopsy.

You said that you are treating already?  You have a 4 week lead in?  So i am guessing that you have genotype 1?

[willbb]

Hi.. A few things in regards to your post.

  is it true, what my doctor says, that I probably don't have any scarring of the liver? Can he know this based only the blood tests?

Unless the blood markers he is talking about are the "fibrospect or "fibrosure" your doctor would have no way of knowing the degree of liver damage you may or may not have.
.While it is true that some of the blood markers will be out of reference range when there is very advanced fibrosis for the most part the regular liver enzymes test(ALT &AST) give no indication of liver damage.
Biopsy is the most used method to diagnose ,however in Europe I believe fibroscan is also used extensively.
However because you have started treament the amount of fibrosis at this time is a moot point ,as the eradication of the virus will cease the scarring from this cause.

Can the doctor tell the length I will have to be treated based on the results of this first test at 4 weeks?

No..Treating with Vic ..how long you will treat will be based on the 8 week test.if you are UND. at that time and still UND at week 24 then the total therapy is 28 weeks(if you have not treated before)

If you still have virus at week 8 and are UND. at week 24 as long as it is <100 at week 12 then you will treat for 48 weeks.

It is good they are watching the HGB. closely ,as it seems to be dropping quickly and either a Riba dose reduction may be necessary or the introduction of the rescue drug procrit..

Congrats on getting started and good luck..
Will

[Bovary73]

Thanks for your answer. Yes, I have genotype 1a. I had a 4 week lead in with Riba + Interferon and started with Victrelis on last Friday. I also took blood tests last Friday and wonder if the results can tell anything about the length of tx: 28 or 48 weeks of total tx.

I will ask again this Friday to have an ultrasound. I hope it can show how my liver is doing, maybe not as good as a biopsy but better than nothing.

[crigger]

I had biopsy in 2001 and in 2007. I wish I had one just before starting treatment after reading Advocate post about her husbands rapid decline.  All my lab values were pretty close to normal but that is not the bast indicator.  Now they do not want to do one

[1oftheclub222]

was there much difference in the 2001 biopsy and the 2007 biopsy?

[can-do-man]

There are some signs in blood tests that can lead a doctor to guess when it comes to one being cirrhotic. Platelets being the main one. I'm guessing by your name that your not even 40 yet??? If so that alone would make one guess your not very far advanced....... Of course this is just guessing where a biopsy would really tell.

And yes a 4 week test can tell you alot about how long you will have to treat, being you started with a very low viral load there is a very good chance you could be und at week 4. If so then with adding the vic you would be looking at only 28 weeks total......... Good luck and welcome here to the funny farm.:)

[nygirl7]

Wow. There is a whole world Liver damage before Cirrhotic. (sorry iPad spells oddly am home sick today).

I was diagnosed at stage 3 with a low viral count. It had nothing to do withmy perfectly clear ultrasound. That only shows if you have tumors (liver cancer?) or then cirrhosis.
Since you are already treating, go for it. Dont miss a med dose, take them as prescribed and beat the he'll out of the disease. That is the bestt thing you can do, regardless of whatever a bx would say. Kill the disease.

But yes I am a giant fan of the biopsy (bx),
Good luck! You have gotten good advice listen to the guys. We are here for you.

Deb

[nygirl7]

And yes, we are the funny farm. So, have fun. And don't be afraid to ask Anything! Those of us who bet this ( or are about to shortly) have heard I all.

Really, that's the great thing about this forum. Friends meeting friends and understanding.

Ok sick butt shutting up now.

[orphanedhawk]

I didn't have a biopsy the first time I did treatment but I already had cirrhosis.
It doesn't matter since you are already on the meds.
All that counts is clearing the virus.

Best of luck becoming hep C free!

[flcyclist]

"But yes I am a giant fan of the biopsy"
------------------------------------------------------------------
You're a Giants fan??  Whoda figured.  Oh wait.......  You're iPad is confusing me.  :o))

[joey48]

never  had biopsy doc said by blood work alone gave him enough info to to bypass biopsy ,and i was typ 1 also. and would need tx , i chose incivic and at this point at 4rth week und , going in this fri for  6th week , i think that it wood be a wast of time for myself to have something done that  dont matter, getting this hep gone is what i want what damage is done is done and from this tretment it should help with the future scarring and help with healing of old scarring  im no doctor  but im just thinking  one step at a time keep your mind on the wonderful life ahead    good luck    [joey48]

[suezeeque]

This is not a statement, but a question...  Don't those with cirrhosis have to treat longer than those without?  Even with the new PIs?  If so, wouldn't a biopsy be indicated prior to treatment and if not done then, after treatment started to know that?

I didn't have a biopsy prior to starting treatment but I did have a FibroScan.  Normal liver enzymes, low viral load, F1.  However, I know that at the time my FibroScan was done my VL was under 200,000.  Before I started treatment (about 6 weeks later, or so) my VL was just under 1 million.  HCV positive for approximately 30 years.

[willbb]

That"s a good catch Sue.After my post above I thought about that and was going to re-post.however got busy and didn't get to it.
You are correct ..with Inci .it is recommended that patients treat for 48 weeks as it "may" improve chances of success and with Vic as Bovary is it is definitly recommended that all chrirrotics do 48 weeks.


Possibly being in Norway at this juncture doing a FS would be beneficial.

Again Sue...good catch..
Will

[orphanedhawk]

I've heard it's not good to have a biopsy with cirrhosis due to the condition of the liver.
I'm sure Hector know the exact reasoning.

And yes, even on SOC, they recommend  longer tx when you've got cirrhosis.

[can-do-man]

How is cirrhosis diagnosed?
The doctor will start with a physical exam and questions about your symptoms and past health. If the doctor suspects cirrhosis, you may have blood tests and imaging tests, such as an ultrasound or CT scan. These tests can help your doctor find out what is causing the liver damage and how severe it is.

To confirm that you have cirrhosis, the doctor may do a liver biopsy. This means he or she will use a needle to take a sample of liver tissue for testing.

Blood tests that assess liver function
Measuring the levels of certain chemicals produced by the liver can help evaluate remaining liver function. Blood tests may be used to measure:

•Albumin and total serum protein. Albumin is a type of protein. Liver disease can cause a decrease in protein levels in the blood.
•Partial thromboplastin time or prothrombin time/INR. These tests measure blood-clotting factors that are produced in the liver.
•Bilirubin. Bilirubin is produced when the liver breaks down hemoglobin, the oxygen-carrying substance in red blood cells. Cirrhosis may cause elevated bilirubin levels, which causes jaundice.

http://www.cigna.com/individualandfamilies/health-and-well-being/hw/medical-topics/cirrhosis-aa67653.html#aa67669

[orphanedhawk]

Except in cases like mine when you've already got ascites.

[Idyllic]

I would want to know the exact condition my liver is in and I would ask. My doctor accurately predicted mine but it was nice to have the biopsy to prove it.

Having said all that, we spend a few weeks in Bergen every year and you have the best health system in the world as far as I am concerned and I think you are in very good if not enviable hands!

♥♥♥♫♫I agree exactly with what Willbb says about how long you should treat so be sure to clarify this with your doctor (it's a shameless cut & paste from his post - since it is important):♥♥♥♥♥♫♫

Can the doctor tell the length I will have to be treated based on the results of this first test at 4 weeks?

No..Treating with Vic ..how long you will treat will be based on the 8 week test.if you are UND. at that time and still UND at week 24 then the total therapy is 28 weeks(if you have not treated before)

If you still have virus at week 8 and are UND. at week 24 as long as it is <100 at week 12 then you will treat for 48 weeks.

[can-do-man]

If one is und at week 4 from the lead in before even adding the vic then you can assume a treatment of 28 weeks, the only change would be a breakthrough, which if that would happen vic or not treatment would be in jepordy

[willbb]

Agreed cando...if UND. at week 4 then 28 weeks..and actually in this case if RVR and the low VL  his doctor  may consider not even adding Vic and doing only SOC without the added exposure of the P.I.Stats from  studies show that the chance of SVR would still be the same ..for 24 weeks. Although that again hinges on min. damage.

Bovary..so lots of options to discuss with your doctor and ascertaining the amount of fibrosis would seem to be advantageous moving forward.

I will find the study that shows that RVR doing just SOC with low VL and  min. damage has exccellent chance of success and I will post it.
Will

[can-do-man]

Hey will,
Its always been pretty much the norm if patients are geno 2 or 3 a lot of doctors don't even do a biopsy since SVR rates have been so high. I wonder now if doctors pretty much rule out cirrhosis thru other testings if we don't see less of biopsies because of the now higher SVR rates with the new pi's... Not saying i totally agree but it will be interesting.

[can-do-man]

Should have added this to my last post.

Diagnosis
People with early-stage cirrhosis of the liver usually don't have symptoms. Often, cirrhosis is first detected through a routine blood test or checkup. Mayo Clinic specialists are alert to these early signs of liver cirrhosis.
http://www.mayoclinic.org/cirrhosis/diagnosis.html

[willbb]

In this study it shows geno 1"s who have low VL (<400,000) and achieve early clearance (week4 RVR) and minimal fib.  there is no significant difference in rates of SVR doing SOC only for 24 weeks or 48 weeks.

http://www.intmedpress.com/serveFile.cfm?sUID=246a4a78-2a19-4926-a77e-3011cf5e450c


Cando:Possibly....also it is my feeling that the more sophisicated the non-invasive markers get that bx. may be usedd less and less in the future..But that is just my opinion..that and a couple of bucks will get you a coffee  :)

Will

[nygirl7]

Not gonna add to the guys except to say flcyclisit dincha mean nygirl fuggidabawt it bayyybe Gmen! ;)

Like I said earlier today, what a great group.

[can-do-man]

"You're a Giants fan??  Whoda figured.  Oh wait.......  You're iPad is confusing me.  :o)) ."

Well giants are known to be "Big". :)

Hope your feeling better nybabe. Just so you know most of us here in indy was also giant fans sunday........ I guess it was a Manning thing.