Question About Liver Biopsy Results

[ajw543]

A very good friend of mine was told he has HCV in April of this year.  He just got his Liver Biopsy done and came back at a Stage 2 Grade 2.  I know this is not good, but what I am trying to find out is how bad is it?

After he got his results he asked his doctor about not treating or waiting to treat.  Well his doctor’s response was “you are 39 if you want to see 50 you need to treat now”.  So I take that as Stage 2 Grade 2 being worse then I though it was.

If anybody out there could help me understand just how bad off he is I would greatly appreciate it.

[Trinity4]

www.hcvadvocate.org/hepatitus/factsheets

Age
Age is a contributing factor to treatment outcome.  Generally, people under 40 years old respond better to current HCV treatments than people over 40 years old.  This is due to a couple of reasons -  the immune system of someone who is younger is more intact and better able to help with the task of fighting HCV.  Also, the longer that one has hepatitis C, the more the virus can replicate and possibly cause damage to the liver, both of which are negative predictors to treatment response.  The is why some medical providers now believe that people should be treated early on - before any liver damage has a chance to occur.

[nygirl7]

Since we don't know the liver panel or what contributing factors could have lead the doctor to say to treat now.........I'd say he should treat now, listen to the doctor something lead him to respond in the manner he did.

If he treats only HIV and HCV then yes chances are he is a heptologist and knows what he is talking about.

2 is right in the middle...however.....just because it took 20 years to get to a 2 means you have another 20 years to get to a 4 (cirrhosis) - nobody really knows.  I'd ask the doctor nicely why he feels so emphatically about treating right now.  As Trin did say the more fibrosis you have the harder to make sure you get all the disease and the one thing is - why wait until the liver is so decompensated there is nothing left to treat?

Just my personal opinion.  I had decided if I was a 2 or greater I would treat (actually I decided I would regardless but that was sort of my rationale).  I was a 3 so at that point I really "had" to.

At least at stage 2 you can treat and have a little wiggle room in case it doesn't work. There is only a 50/50 chance in the first place and you want the best odds you can get before it is too late.

Good luck!

[Trinity4]

Jim,
Age does matter - studies indicate this is a factor in acheiving SVR.  Many studies and much data show that.

[ajw543]

I don’t know if you would call his doctor a hepatologist.  His Doctor only specializes in HIV and Hepatitis.  And considering when I do a Search for hepatologist near us and nothing comes up I believe he has the best doctor for his HCV.  Other wise he would have to be seeing a Gastro.

My friend is GT 1A with a VL over 5 million and his doctor has been talking about trying to get him into that study that is going on right now.  Don’t know if they will take him or not.  He is waiting for the person who handles treatments to call him back.

See I too thought myself that stage two was not that bad.  But after his Doctor’s comment I though I must be wrong and it must be worse then I first thought.

[jmjm530]

I doubt your friend's doc is a liver specialist (hepatologist). Tell him to get one because the doc's statement is false and IMO irresponsible. Your friend has moderate liver damage and could reasonably treat now or wait for better drugs. Of course, no one knows the future, but telling someone to treat now or they will before 50 is b*llshit. The other important thing is your friend's "genotype". Some are harder to treat than others. If your friend is geno 1, I personally would wait for better treatments. If geno 2 or 3, I could see it both ways. As to better chances of clearing the virus, age should not matter, only advanced scarring (stage 4) would matter and your friend is probably many, many years from that. Most liver specialists will tell you that liver damage is reverisble once you are cured. First thing I'd tell your friend is to look for another doctor who doesnt use scare tactics.

[Trinity4]

“Stage” is the amount of fibrosis (scaring) detectable by biopsy…
from stage one (mild) to four (cirrhosis ). Fibrosis is scar tissue that forms as a result of chronic inflammation and/or extensive liver cell death . Your health care provider uses the amount of fibrosis in your liver as one way of evaluating how quickly your disease appears to be progressing. knowing when you were initially infected with HCV is a great help in determining your rate of disease progression.

The Stage is assigned a number from 0-4:
• 0 = no scarring
• 1 = minimal scarring
• 2 = scarring has occurred and extends outside
the areas in the liver that contains blood vessels
• 3=bridging fibrosis is spreading and
connecting to other areas that contain fibrosis
• 4=cirrhosis or advanced scarring of the liver

“Grade” is the amount of inflammation , which is caused by the activity of the virus. Generally speaking, inflammation is the precursor to fibrosis .
The Grade is assigned a number based on the degree of inflammation , which is usually scored from 0-4 with 0 being no activity and 3 or 4 considered severe activity. The amount of inflammation is important because it is considered a precursor to fibrosis.

Given his age which is fairly young and moderate fibrosis I would recommend treating.  They younger you are, the less fibrosis, the better the chance of clearing the virus. Also, successful treatment means no additional liver damage will occur.  It's somewhat controversial as to whether existing liver damage will improve but regardless, he can be guaranteed no further damage with eradication of the virus.
Trin