Need Help Interpreting Liver Biopsy Results

[Tallblonde]

Okay guys...I need your help interpreting my pre-treatment liver biopsy.  As a reminder:  I'm a 44-year-old active, healthy female, Genotype 1a, Viral load as of 10/1 was 15,700 IU/mL.

Final Diagnosis
Liver, Needle Biopsy - Consistent with Chronic Hepatitis C Virus Infection -- Chronic Hepatitis, Grade 2 of 4, Stage 1 of 4.

H&E and special stained sections are examined.  The needle biopsy of liver is adequate.  Trichrome stain is unremarkable and shows no significant fibrosis.  PAS stain after diastase is unremarkable.  Iron stain is negative.  Fatty change is minimal.  Intracytoplasmic hyaline is not identified.

Received in formalin in a single segment of cylindrical tissue measuring 0.7 x 0.1 x 0.1 cm, tan-pink and of a soft consistency.  Totally submitted in one cassette.

So, what do you think?  Is this good?  If you were in my shoes, would you proceed with treatment?  Does this seem to clear up any of the mystery of the possibility of autoimmune hepatatis co-exisiting with HCV?  All feedback/comments/suggestions will be greatly appreciated!!

Susan

[TatMan1966]

Buddy, you dont know how right you are. You could have not said it any better. I have tried to stay nuetral for others posting they are excited about tx, but it ruined me. I dont want to discourage, but at the same time, I feel that had I not pursued treatment on both occasions (interferon/ribaviron 2000 and peg-interferon/ribaviron) I would have been better off physically, mentally and emotionally.

Before the first treatment in 2000, which was non-pegulated, I slept well, worked happily everyday and had very limited health problems. After failing in 5 months because of mental problems, I contracted dermal and pnuemonial MRSA, had a 6.5 hour surgery removing 3 abcesses from chronic sinusitis, have other chronic infections (lymphs always swollen) and literally no immune system. My viral titre shot way up after 6 months of being "virtually cured" (they changed the meaning of "cured", so if your viral titre is under what they consider "chronic, supposedly you fall under this catagory and are "cured" if you are not symptomatic) and I was worse than before. My muscle rigidity is wide-spread and hypertension is insane now, whereas before it was minimal, and I was one of the 2% that go insane. They said I cannot go on tx ever again. Oh, did I mention I had the most responsive genotype? 2B?

After a liver biopsy in 2006, and having my enzymes over 60 and a scary loking tumor marker numbers, I ended up back on the tx- why they did not say no, I have no clue, but I kept quite which was stupid of me. This was now pegulated, so it lasted longer. I had to only inject once instead of three times a week. To make a long story short, after hitting an elk going 65, and having back problems, I chucked myself off a loft balcony in my house with an electrical cord around my neck. I still dont remember anything other than realizing what I had done after I was suffocating. The cord broke (thank god) and I herniated my disk. This is how severe this drug can affect someone. Again, only 2%, and thats next to nothing, but still I was one of the ones....hell of a gamble. Again I had to stop tx after 4 months.

I was trying to be neutral. I  dont want to scare anyone or influence anyone, but at the same time, I do want to share my experience and warn people that it may have the opposite affect. If I had known what I know now, I would have never touched chemo. I believe that it made my condition worse, that it came back.....agrily. My immune systen is shot. I have vaculitis, edema, fibromyalgia (muscle rigidity) djd/ddd, had had multiple surgeries for removing cysts, and infection I cannot get rid of and have MRSA, both dermal and pnuemonial. I can only achieve stage II sleep.

Think long and hard before you decide and dont do it out of fear. Look at what the cure rate is and whats the definition of cure. Ask if it can worsen your symptoms. Look at the studies they have been doing on ongoing low-dose treatment and how it increases cirhosis/ hepatic necrosis and periportal tension. For some people, it is just not right and make sure about depression history. Even if you are a happy camper like me, you can still go totally crazy....and the worst part, you have no clue you are doing it. Thanks Bocata, you could not have said it any better.

[Bocata]

I'm, male, 59, and found out two months ago, that I have hepatitis C.  I have no symptoms, and a recent ecography shows a normal liver.  Of course I stopped drinking, although I didn't drink much to begin with, and I continue going to the gym 4 days a week for cardiovascular and resistance training, like I have since 1983.
I imagine that I contacted this in the early 1970's, because I do remember sharing a needle on one occasion when I was "experimenting" with cocaine.
I have the feeling that no treatment is the best treatment because of the adage, "you don't fix something that isn't broke", but I'm open for suggestions.

[Tallblonde]

Your link didn't take me anywhere, but I did a couple of searches and found this on the HCV Advocate website:

Pregnancy Can Be Good for Women with Hepatitis C:

"Pregnancy and subsequent delivery may help women with chronic hepatitis C clear the virus from their blood, new research suggests.

Hepatitis C is a liver disease caused by infection with the hepatis C virus (HCV), which is spread through contact in some way with contaminated blood. In most patients, the virus is never completely cleared from the body and, after many years of infection, serious liver problems, such as scarring and cancer, can occur.

The new findings, which are reported in the Journal of Medical Virology, are based on a study of 22 pregnant and 120 non-pregnant women with chronic hepatitis C.

In the pregnant group, two women permanently cleared HCV from their blood after delivery and one women temporarily cleared the virus, Dr. Masashi Mizokami, from Nagoya City University Graduate School of Medical Sciences in Japan, and colleagues report.

In contrast, in the non-pregnant group, one woman cleared HCV permanently and another cleared it intermittently.

Considering the size of both groups, this means that 14 percent of pregnant women cleared the virus, compared with only 2 percent of non-pregnant women.

"The mechanism by which pregnancy and delivery influence HCV (blood levels) is not well understood," the authors note in their article in the Journal of Medical Virology. However, it may be relate to differences in how the immune system works during pregnancy compared with other times.

Taken together, the findings suggest that "pregnancy and (delivery) may improve the prognosis in women" with chronic hepatitis C, they add."

I assume this is the article you were trying to lead me to.  Thank you SO much!!!  I'm going to try to locate the full research article in the Journal of Medical Virology and discuss it with my GI and Reproductive Endocrinologist.  Thanks again for brining such encouraging news to my attention!

Susan

[GwithHepC]

Hi:

If it helps, I have read a few times recently that pregnancy can have a protective effect against hepatitis c.  Here is a link to some more information:

http://64.4.26.250/cgi-bin/linkrd?_lang=EN&lah=cc2776b3370eab7175a88f8a1bb662d8&lat=1067312270&hm___action=http%3a%2f%2fwww%2ehcvadvocate%2eorg%2fnews%2fnewsRev%2fNewsRev%2d23%2ehtml%2341

Don't know how to insert a hyperlink here, just copy and paste the whole link above into your browser.  Good luck whatever you decide.

[Tallblonde]

Thank you both for empathizing with my situation.  At age 44, I certainly don't have the luxury of waiting 48 weeks during treatment and then another 6 months (minimally) to "de-tox" from the meds before trying to achieve a pregnancy.  

I really think we'll tempt fate a tiny bit and give this pregnancy thing 6-12 months at the most.  But I have to believe my HCV has played some role in my five miscarriage during the past 30 months.  I can't back that up with any research I've found, but it makes sense to me on some level that my body is trying to fight off the "invaders" and probably mistakes the embryo as one of them.  Hence the reason for the early miscarriages.  If we do get pregnant and miscarry again, that's it for us.  Treatment will become the #1 priority.

Again, thank you both for your thoughtful, supportive posts.  I wish you the very best.

Susan

[quak]

I am very sorry to hear about all your troubles regarding motherhood and HVC.  I'm 45 yrs old and have 4 kids and had a bx of inflamation and grade 1.  I decided to go on tx and just finished last month.  I would spend all my money and time on getting pregnant and than worrying about hep c.  Best of luck and I'll be praying for you.

Lori

[LvdByGod]

i had been going in for invitro too when they found out i have hcv. mine is much worse than yours. stage 3 grade 3. i was told the meds to make me produce eggs could not be used due to damage to liver possibility.and that i should treat the hcv first because of it's stage. but, you have a pretty normal liver by the sounds of it. be sure to check these  fertility meds with your GI to be sure you won't sustain unessesary damage to liver. the other thing i learned was that this hcv tx is so bad for your reproductive system. and you must wait for months after treatment is finished to begin to try to have babies. they say not to have children for at least 6 months after tx is finished. but, that scares me. what if some of it's effects are still in me when i finish the tx and the waiting period and then the baby could have defects or something. so if i were you, with my liver in such good condition i wouldnt treat my hcv until after i had my child(ren). thats just me. as long as you keep getting biopsys every few years to see where your at. the last thing i wanted to say is that i believe hcv can be a problem to having success at pregnancy. i think i read this somewhere. but, i'm not positive. i do know that people with hcv can have children because there are many here on this board. perhaps it just makes it more difficult because the body knows somethings wrong. my husband and i got a consult from a expert on high risk pregnancies. it was so informative and i learned so much more than i could write here. that dr knew about hcv and getting pregnant and infertility. that was the best decision we made to see him. i was refered to him by my primary physisian. be blessed in your future mommyhood, one way or another. we are seeking adoption at this time and when i'm off tx perhaps we will try infertility tx. ??? sandi

[Tallblonde]

Erin,

I can't thank you enough for taking the time to respond to my questions.  It's very exciting to think that I could possibly continue with my plans for motherhood.  A month ago, I thought my life was over.  What a wild ride of emotions since first getting the diagnosis.

But it's still a decision (to treat or not to treat) that my husband and I have to weigh very carefully.  I'm the sort of person who likes to solve problems as quickly as a can.  I think we'll probably look at giving this thing 6-12 months.  If I'm not pregnant by then, maybe we need to abandon our plans of giving birth to a child and move on to treatment (and adoption, perhaps).  

My thanks to everyone who responded to my post.  Your perspectives, based on such hard-earned experience, means a lot to me. I wish all of you the very best as you move closer and closer to recovery.

Susan

[GI.PA]

With such mild findings on biopsy, I think persueing your goal of motherhood is perfectly appropriate.  Your biopsy can easily be repeated in a few years, and for most there will be no progression.

I dont know of any connection to your miscarriages and the Hep C and without any data I would be extreamly hesitant in using it in your equation to treat or not to treat.

I am a physician's assistant (PA) in gastroenterology.  I primarily see Hep C and am responsible for the treatment in our office (our MD's really dont get involved).

GI.PA

[willing]

to echo Erin's recommendations here's the last NIH consesus conference statement on <a href="http://hepatology2.aasldjournals.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=fullfree&id=ajhep03600s3#head4">who should be treated</a>. Mild liver disease is a fibrosis score of 0 or 1 on 4 point scale.
This is a regular question on ths forum and you'll get lots of opinions. My two cents is to wait. Even if better drugs aren't available by the next biopsy there is quite likely to be progress in determining whether tx will work for you. Another option is to do 4 weeks and work with a GI who'll test VL often enough to apply the new kinetics-based predictors (see the "injections" thread below). IMHO tx is harsh but worth it - it's relapse that really sucks..

[Revenire]

You received a very good biopsy report.

My advice would be to beat this now -- the odds are best to win now.

I don't think anyone can say when you 'received' HCV, certainly not your doctors. The disease is USUALLY slow moving but can progress fast in a minority of cases.

I understand how badly you want to have a child and you probably know that you won't be having one if you start tx until -- oh, six months to one year after stopping tx because of the risk of birth defects.

Whatever you decide, good luck.

Scott

[DH Bill]

I'm male 54, 1b, viral load 315.000. My biopsy showed minimal damage like yours. Had hcv since 1967. My doc said I could do tx or not it was my decision. If not, do biopsy every 3 years. I chose to do it and give it a try cause I wanted this dragon out of me. He said even if treatment didn't work I would probably die from something other than hcv maybe even old age as I've had it so long and it is progressing slowly.
I'm 12 weeks into tx now. Will find out in about a week if I'm responding.
If you know you've had it a while you may want to wait for something better to come along like GI.PA said.
For me I may have done more damage to myself worrying about it since I was dx in 1998. There was not much in the way of treatment then and look how far they have come in just 5 years.
It appears you are in a situation that you need not be in any hurry even to decide and I believe your doc will leave it up to you. PLEASE RELAX AND CHILL
Bill

[GreatBird]

For what its worth, those are my numbers and I've decided not to treat at this time but to wait for something better to come along--especially since I have no symptoms. I'm fairly certain I've had hepC for at least 30 years (does anyone know how long its been around in the US?)

Erin is a Physicians Assistant. It is indeed a blessing that she comes here and answers our questions.

From a completely non-medical point of view (and an unsolicited opinion), I'd urge you to follow your heart and do your best to have a child. I wouldn't give my two for anything (except occasionally). :)

GreatBird
...who is a shortish brunette...

[Tallblonde]

Erin,

I'm still relatively new to this board, so I'm not completely up to speed on who everyone is.  It's been my impression from reading some of your posts that you're a doctor. A gastroenterologist?  Am I right about that?  If so, I want to really extend my gratitude to you for being so generous with your time and professional expertise.  

Your comments about my liver biopsy results have given me a tremendous sense of relief.  These results were just faxed to me by the Cleveland Clinic an hour ago, so I haven't had any opportunity yet to discuss them with my GI.  

Here's another question for you.  Do you think my HCV has any connection to the five miscarriages I've had during the past 30 months?  I've had four natural conceptions and one via IVF-donor egg and all ended in early miscarriages.  I know that "advanced maternal age" is a likely culprit, but I can't help but wonder now about the effect of HCV.  

Even prior to my biopsy this week, my GI recommended that I delay treatment and pursue my dream of becoming a mother.  But at my age, I'll probably have to go the IVF-donor egg route again, and that means lots of drugs like lupron, estradiol, progesterone, etc.  I'm worried that hormones and such could exacerbate my HCV.

Do you have an opinion to offer on this?  My husband and I are desperate to become parents, but we don't want to risk my health in the process (or worse yet, put any future chid(ren) at risk for  having a seriously ill mother or NO mother).

Would love to hear what you think.  Thanks again!

Susan

[GI.PA]

Your biopsy findings are very mild

Grade 2 of 4 (this is your inflammatory score).  The lack of findings consistant with autoimmune Hep rules this out as a co-existing liver disease.

Stage 1 of 4 (this is your fibrosis-cirrhosis score). Since no fibrosis is noted, you are on the lowest end of this spectrum.

To treat or not to treat with this biopsy is completly patient dependent.  If your only exposure point was 20 years ago, this would argue for a very slow slow progression of disease.  If your known exposure was only 5 years ago, this would argue for average progression rate.  If your exposure to Hep C point is unknown, it is at least helpful in confirming you have plenty of time to make this decision.

The other piece of info this helps your with is if you decide to treat, your biopsy would indicate that being aggressive may not be advised.  For example, if you were so sick that it was affecting work/life to a severe degree.  Or if your counts were going crazy causing the addition of several thousand dollars of supported medication, my inclination would be to stop treatment based on the benign nature of your biopsy.

Without treatment, I would re-biopsy in three years and have this discussion all over again (hopefully with even better meds available).

GI.PA