How fast can the liver regenerate ?

I have an odd question to do with how fast the liver can regenerate itself.

I've read in here that liver damage can occur in Hep C b/c of the liver constantly having to fend off the virus.

I have TX'd with Peg Intron and Rib with no significant results (1 log drop after 12 weeks) but my Dr. thinks I should treat again whenever Telaprevir is released Her suggested treatment is a combo of all three this time (Int/Rib/Tel). She thinks this might be successful (on the other hand she though int/rib might be successful too).

I have had Hep C since I was 22 and I'm 50 this year. I have a  low viral load (at least that's what I was told-less than 800,000 IU per ML) and have had this for 27 years. I drink rarely (2-3  times a year 1/2 bottle of wine and I smoked until I was 45).

I wondered whether the liver can regenerate (or heal) itself somewhat if enough of the virus is killed off during treatment and if it could heal itself somewhat wouldn't that be sort of like starting over with a liver that is not  damaged ?

Thanks

[Marc1955]

This is not an odd question at all. In fact, a major study was conducted among non-responders like yourself to see if a constant low dose of interferon would suppress the virus enough so that it would slow the progression of the illness.

Unfortunately the research suggests that unless you clear the virus you can't have enough regeneration of your liver function to affect the progression of the illness. So the answer to your question is no. You can't suppress the virus enough without clearing so that you are starting over with a clean slate. An unsuccessful treatment will have little impact on long term prognosis.

You shouldn't be too skeptical about the new drug combination. Many of us are hoping that they will provide a path to clearance for folks who did not respond to the current therapy. So far, there is research to back up some optimism.

The only way to know about the current state of your liver is to have a biopsy. Have you had one recently so do you have a sense of where things stand?

[applez]

Nope, I'm scared to I guess. My liver enzymes have always been in the normal range but then I'm also told that means nothing.

I see my specialist in 2 weeks and might ask her for one. Is it painful ?

[m_strings]

Hope you don't mind me jumping in this conversation.  My liver biopsy was a piece of cake!  I was worried about it, too.  The meds I was given via IV made the procedure almost completely pain free.  You have to be careful not to do much activity for about 24 hours afterward and no heavy lifting.  My wound was about the size of a needle mark - very tiny.  It was covered with a bandage.  I haven't heard any negative stories about biopsies on this website.  Best to you!

[jdwithhcv]

My liver biopsy was uneventful, no pain and no problems.  Except for the fact that it was my birthday that day, I have no complaints.

jd

[meakea]

My liver biopsy was uneventful also.  I received no sedation or anesthesia of any kind (except for the skin numbing shot at the biopsy site) and the entire procedure (which was over in no time) was was no big deal.  

[applez]

If all a biopsy proves is how sick you are. If you already know you're sick what's the point ? Let's say  I find out I have cirrhosis how does that help me ?

[m_strings]

Treatment options & prognosis vary depending on your level of liver damage (and other factors as well).  My guess is that your doctor will need this information to treat.  There are also different dietary considerations for someone with cirrhosis as opposed to beginning stages of liver disease.  If you found out you had cirrhosis, yes, you would have to deal with the anxiety that goes along with knowing what you have.  However, knowledge can be powerful.  Cirrhosis isn't an automatic death sentence.  My guess is that you would be more vigilant about looking into your treatment options and following a plan of action if you knew exactly what you were dealing with.  And if you found out you didn't have cirrhosis, wouldn't that also give you some valuable information about how slowly this virus has been attacking your liver and about perhaps an option of not having to rush into another treatment right away?  Just something to think about.  

[meakea]

I guess it's all about what you're comfortable knowing and not knowing.  For me, my doc suggested the liver bx but, if he hadn't suggested it, I would have asked for it.  Personally, I don't deal with the unknown very well.  

Also, knowing the stage of liver damage (or no damage) makes a huge difference for some people in whether or not they go for treatment now or wait for better treatments in a few years.

[HCA]

A 'low' vial load is <400000 not<800000.
A sustained virological response is predictive of fibrosis reversal.
If you are asking if unsuccessful treatment bestows a histologigal benefit the answer is no.
You should have biopsy-if you are saying 'ignorance is bliss' then that is not a sustainable position.

[Marc1955]

Try not to get too upset – don't get your day wrecked – one of the things about discussion boards is that people use different tones of voice and sometimes can come across as prickly.

But listen, seriously, based on what you've said about your age and habits, you have no reason to have great fear that you currently have serious liver damage. Many people at your age who have had the illness the same amount of time have slight damage. Don't let worry paralyze you and don't think you're necessarily going to have a bad outcome. It may very well not be true.

The biopsy is pretty painless and here's why it's important that you get one: If it turns out you have a low level of liver damage, then your smartest course of action will be to sit tight, live a healthy lifestyle, and wait for new more effective treatments in a few years.

If it turns out you have a higher level of liver damage then you'll need to think about treating sooner, which would likely involve trying to find a trial of the new medications.

It is very important info and as a number of folks have said, it's a fairly minor procedure.

Good luck and please try to use the board for advice. There are many people here who have faced similar issues. There are also many people here who are truly sick and have been through hell with this thing. Many of us are on treatment so we're a little wacko some of the time. But we do genuinely want to help.

[RCM829]

Sorry but I agree with HCA on this one. This is not a part of your life that you should be sweeping under the carpet. His advice could potentially save your life.

[Virusbuster]

I agree with HCA, too. If a biopsy scares you, perhaps a fibroscan is an alternative? Albeit not as certain, it's non-intrusive.

[meakea]

As Marc said, don't assume your liver is in bad shape just because you've had Hep C for 20-some years.  I've had Hep C my entire life (54 years) and I was very fortunate to lean that my liver biopsy last year was Stage 1/Grade1.  I also know of a 17 year old girl who just found out that she got Hep C from her mother at birth only she wasn't as fortunate as me -- her liver is at stage 3 already.

One cannot guess what stage their liver is at with this ambiguous disease Hep C.  If you are the type of person who is comfortable not knowing that is totally fine -- everyone has their own comfort zone and no one can take that away from you.  My intention is not to try to push my comfort zone on you but a liver biopsy, in my opinion, is a good idea

[Mr Liver]

It's actually a two-sided question, not one. The two dynamics involved are virus and host.
If you have an IFN-resistant virus ( geno 1 or 4 ) and an inadequate immune response  you could reasonably expect the damage to occur faster than your liver can regenerate . In contrast a less resistant genotype and a good immune response can result in a slower progression.

Sometimes after a failed treatment a sustained biochemical response is achieved. This is the next best thing to a cure. Liver functions return to normal and blood values fall generally within the acceptable ranges. In this setting the ALT/AST holds great value. This determines ongoing viral activity. This occurrence is a  state of near equilibrium---the liver regeneration can keep up with the ongoing damage enough so that disease progression is much less accelerated.

If you have clinical signs of cirrhosis and/or have made a decision to treat regardless of any biopsy findings, a biopsy is not only NOT necessary, it is NOT recommended. Barring those two scenarios the most accurate way to assess damage is through biopsy.
However, nodular surface features on the liver consistent with cirrhosis can be determined through ultrasound to a very high degree of accuracy and it is non-invasive. It does not work well for staging other lower levels of fibrosis, however.

Waiting for the new drugs is what I'd recommend also. Its highly unlikely that waiting 2 years would lessen your chance at clearing. On the flip side, it is much more likely that waiting will result in greater overall benefit for you. Best of luck going forward.

ML

[Willy50]

I've met people who treated and maintained that they did see benefit although they failed and did not treat full term.  They based this on how they felt and succession of symptoms they had pre-tx.  Unfortunately there are others who make up the opposite of this group who felt fine pre-tx but had symptoms afterward.

I think that I am hearing people tell you that you need some evaluation as to your liver staging.  I agree.  IF you have too much fear of a biopsy, then start with a fibrosure test.  They are cheap (a simple blood draw) and the results are considered by many to be 85% the accuracy of a biopsy.  The results will also be complementary if one was to add a biopsy following.  They cost about 3-400 dollars (US) but insurance brings em down to an affordable price.  I did one in 2005 and came in stage 1.  When I got my biopsy in 2008 I came in 1/6 ishak, so in my case the results were in agreement.  Lets say though you were to take the blood test (fibrosure is not the only brand) and you came out on the other end of the scale...... I surely would want a biopsy.  You should not be flying blind here (IMHO).

I myself am waiting for Telaprevir or possibly even longer since it appears that I can.  Unless you get tested you don't truly know where you sit.  By the way...... recent posts on this board have suggested that IR (insulin resistance) can sometimes play a part in slow/no response.  You might read a few threads and see if this could play a part in your response pattern before attempting TX the next time.

best,
Willy

[CoWriter]

"HCA: Thanks for wrecking my day with that little tidbit of bad news I didn't really need to hear. You sound well educated so why couldn't you figure out that informing me of this 'cheery' news wasn't such a good idea ? Or that someone who is clearly apprehensive about getting bad news doesn't need to have it thrust in their face ? Jerk."
---------------

Shame on him for telling you the truth.  I think you should put him on time out.


"I wondered whether the liver can regenerate (or heal) itself somewhat if enough of the virus is killed off during treatment and if it could heal itself somewhat wouldn't that be sort of like starting over with a liver that is not  damaged ? "
---------------

Regression is sometimes possible even if Tx fails.  One study showed regression of cirrhosis (of 1, 2 or 3 points) in 46% of people who obtained SVR......and in 16% without SVR.

However, we're talking about Tx for 48 or 72 weeks....not 12 weeks.  

And now I'll go join HCA in the "time out" room....LOL

Co


Source:
"Sustained virological response is associated with reversibility of cirrhosis in chronic hepatitis C patients"

NATAP http://natap.org/