Progession of Liver Disease While on Treatment

[FloridaMouse]

Looking for input on what ya'll might know about the progression of Liver Disease while on treatment.   My quick scenario is that I just finished 72 rounds of treatment on 4/21/09 and relapsed on 5/28/09.  This was my second attempt at treatment.  The first attempt was 48 weeks, I relapsed 5 months post and got right back on board with the second round.  At the time I started round 2 was classified as Stage 3/4, Grade 3 (I'm a geno 1a, infected in 1985).   My ultrasounds were typical with nothing remarkable.   I had an ultrasound in January, as always, typical nothing remakable.  I had an ultrasound 2 weeks ago and it came back "subtle change with evidence of cirrhosis".  I'm considered a "slow responder" even though I have 2 log drops by week 12, I don't clear until sometime between weeks 13 and 24.

Thanks for any input, links, knowledge on  the issue of progression of liver disease even while on treatment.  I've always heard that as long as you are treating you are giving your liver a break.

Mouse
(I'll be headed off to Shands at the University of Florida on 7/21/09)

[susan400]

Yes, I saw Dr. David Nelson. I like and respect him alot.  And also, with my 4 biopsies I've had, even after 10 TX's, since I haven't cleared and all, (don't know if that makes any difference) but, I have had progression of my fibrosis, unfortunately.  I started off at barely any detectable fibrosis.  By biopsy #3 I was up to bridging.  3 yrs after biopsy #3, I had #4 and there was no change in my bridging, it had remained the same despite the fact that I'd had 2 TX's in between that time.  So, I'm still with the bridging as far as I know.  It's been 2 yrs since my last biopsy.  When I was last staged and graded was back at biopsy number #3...  They did not stage or grade me on #4.  So, I am assuming that I am still a Stage 2, Grade #3.    I suppose they'll want to biopsy me again in another yr, or sooner, if I go into another trial that requires it.  I hate getting them though.  I sure wish you the best of luck in beating this beast!  Susan400

[FloridaMouse]

FlGuy,

I've already seen Nelson once.  He's the one that put me on the 72 week treatment.  So that is indeed who I will be seeing on July 21.

Thanks for link Smaug.

Mouse

[smaug48]

Check out this recent thread:

http://www.medhelp.org/posts/Hepatitis-C/New-study-presented-at-DDW-re-fibrosis-reversal-after-SVR/show/966068?personal_page_id=1341&post_id=post_4528385

[newleaf09]

The studies are all over the place on regression of fibrosis but they all agree to get a really good regression, the virus must be removed.  Even then, most improve, some stay the same and a few actually get worse.

The way my doc, an infectious disease specialist, explained it to me, Interferon kills infected liver cells.  A new cell is formed to replace it.  If there's no more virus to re-infect, those new, healthy cells have a chance of sticking around.  If the virus is not cleared, it just infects the new liver cells.  That would explain the lack of progression while you are in TX.

As frijole said, stay away from the maintenance doses of interferon.  That was the HALT-C study about stopping fibrosis.  Results showed that it was not the interferon itself that stopped or reversed fibrosis, it was clearing the virus.

[FlGuy]

At one point I was going to head to Shands.  I did a little foot work.  Seem like on of the more knowledgeable ones is Dr. David Nelson.  Have also read him at a participant in studies and reseach.  I think a few other on the forum (maybe even Susan 400) checked in with him at one time or another.

[frijole]

The biopsy I had a year after treating and relapsing showed no improvement in my liver.  It was not that bad to begin with --- grade 1, stage 1-11/2-- but the post treatment biopsy was the same.

I think the treatment stops the progress while you are treating, but the inflamation and scarring continue where they left off pre treatment.  Unless you clear and stop the inflammation, damage continues.


Another thing to consider--- the studies done using low dose interferon (without ribavirn) to help the liver have shown that it is not beneficial.  Would you like a link?  I am sure I can dig one up.

friole