jm/jm

[tktn]

does a sonogram allways follow after the 6 mths svr or is this precautionary?
i also had a cbc profile that included a afp. hep 1b cleared by 12 weeks biopsy low inflamation but had
5/6 don't really know stage.im sure looking for possible liver tumors. you know you fight 48 wks treatment then your hit with another scary issue.
hope everybody is doing as well as possible. you know it is what it is and we have to keep on keeping on.
God Bless every one.
tk

[jmjm530]

Trinity:  It's the inconsistencies in your posts that confuse me.
Sometimes you had stage 3-4 and sometimes 0-1.
----------------
Well, we do agree on one thing and that is you are confused. Very confused. I never said I was stage 0-1. Not "sometimes", I simply never said it, because its not true.

And if by now, you still can't understand why someone with a normally functioning liver should still be tested for HCC post SVR, then I'm afraid you'll just have to be confused on that as well. Tried my best.

[Trinity4]

Jim, you are turning this around.  It's the inconsistencies in your posts that confuse me.
Sometimes you had stage 3-4 and sometimes 0-1.  You made the statements about normal liver and what your doctors think.  I didn't bring Dr "D" into the mix. Whether I argee with the reduction of fibrosis after SVR is not the point.  I simply wondered why a person would have so many tests after SVR when a team of medical advisors are telling them they have a normal liver.  I made may remark based on your previous posts, not what Dr. D said.  I don't care what Dr. D thinks, it's not relevant to this conversation.  You answered - that's all I need.  

[jmjm530]

Just to wrap this up because I'm outta here for a bit -- my posts re liver, SVR, and it's relationship to liver normalcy -- were based on conversations with both my treating hepatologist and a consulting hepatologist. Dr. Dieterich, here in our professional forum, considered by many to be a top hepatologist, appears to agree. The fact that you or your doc may disagree is fine, and you've made that point before, so why keep posting to me on this issue? I suggested before that if you disagree with Dr. Dieterich on this point, to post to him directly in the professional forum. After all he is the doctor who is saying this, I'm just telling you what the doctors have told me.

-- Jim

[jmjm530]

Yes, I agree with what I wrote in both of those posts. Nothing I said suggests that you shouldn't screen for HCC after SVR, which I do.

As to the phrase "normal" for all practical purposes, this reflects my docs opinion which is consistent with what I believe Dr. Dieterich posted in the professional forum.

I wasn't able to readily locate Dr. D's post, but you mentioned post here in this thread here, so perhaps you can re-post what he said for the group. It is apparent that not all doctors agree on this point but I was careful to point out this is what my liver specialists said and I respect their opinions.
-------------
by Trinity4


, Jul 15, 2008 09:00AM
To: nygirl
I don't know why Dr. D made the statement on his forum that if you have mild (Childs A) cirrhosis or anything less in the fibrosis score, after SVR it should all go away.  Your liver should return to normal.  I do not agree with that statement and a lot of people on this forum have used that as a gauge when considering drinking and how it will effect them.  Even my doctor who is not a hepatologist made it very clear damage NEVER totally reverses itself.  His speciality is hepatology transplants and I believe he would know something about that.  As you said, logic is the prevailing factor in all of this.  The hell we all go through just to get rid of this disease is based primarily on preventing further damage to our liver - why anyone would want to take a chance of jeopardizing that is beyond me.
Trin


http://www.medhelp.org/posts/show/570141?post_id=post_3160317

[Trinity4]

by jmjm530


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, Jul 26, 2008 08:59PM
To: Fantasy
Like your son, I contracted Hep C around the age of 20 and then treated 38 years later at age 58. During those 38 years I progressed from stage 0 (no liver damage) to around stage 3 (signficant liver damage).

Because I am now SVR (cured) I can reasonably expect my liver damage to revert back a couple of stages, perhaps to stage 1. In fact, a Fibroscan four months post treatment showed me at a low stage 2.

Since your son started at stage 2 (moderate liver damage) I think it's reasonable to believe he may revert back to stage 1 (or better) should treatment be successful.

My liver specialist now considers my liver to be "normal" for all practical purposes. So based on that, your son's liver should be even better than normal with SVR.

All the best luck with his post tx 3 month PCR. But even if he isn't lucky, statistically he still has a ways to go before he has significant liver damage -- and very hopefully by that time the newer drugs will be on the market to take care of all that.

-- Jim

[Trinity4]

by jmjm530


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, Jul 15, 2008 12:05PM
Hopefully we can untangle the "repair" issue from the more emotional "alcohol" issue.

From all I've read and heard, the SVR liver will most probably repair itself to a state that is "normal" for all practical purposes. As to *totally* repair itself, that may be too much to ask of any liver over the age of 20 -- HCV or not -- given all of the daily insults, including diet, pharmaceuticals, cleaning fluids, environemental toxins, etc. Fortunatly, the liver seems to function quite well in most cases except with decompensated cirrhosis, so a "totally" repaired liver is somewhat mute. What SVR confers in most cases is a stoppage or regression of fibrosis. And assuming you're not decompensated, this should be a result we all should be happy and live normally with. My liver specialist said I have no restrictions, period, as compared to if I never had HCV.

[drofi]

Liver International
Volume 27 Issue 2 Page 186 - March 2007

Development of hepatocellular carcinoma in patients with chronic hepatitis C who had a sustained virological response to interferon therapy: a multicenter, retrospective cohort study of 1124 patients

S. Kobayashi et al.


Background:
Interferon (IFN) improves hepatic inflammation/fibrosis and reduces the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CH-C). However, HCC develops in some patients who have a sustained virological response (SVR) to IFN therapy. We designed this study to establish a follow-up protocol for patients with CH-C who have SVR to IFN therapy.

Methods:
We retrospectively studied 1124 patients with CH-C who received IFN.

Results:
HCC developed in 3.5% of patients with SVR to IFN. As compared with SVR patients without HCC, SVR patients with HCC were predominantly male (P=0.003), older at the initiation of IFN therapy (P=0.002), and at a more advanced histologic stage of disease (P<0.001). However, three of the 13 SVR HCC patients had mild fibrosis. The mean interval from IFN therapy to the detection of HCC in SVR HCC patients was 5.8 years and did not differ significantly from that in non-SVR HCC patients (P=0.304). Although most patients with HCC received curative therapy, the prognosis of some SVR HCC patients was poor, probably because of insufficient follow-up, resulting in delayed detection of HCC.

Conclusions:
SVR patients with CH-C who are elderly, male, or have an advanced histologic stage are at a high risk for the development of HCC after IFN therapy. We recommend that SVR patients should be observed carefully for more than 10 years after the completion of IFN therapy, even if they only have early fibrosis.

[jmjm530]

Maybe you're referring to a recent thread where someone quoted Dr. Dieterich in our Expert Forum saying something like the liver often returns to normal after SVR?

If you want to direct me to a specific post where I used this word -- and I'm sure I have in various contexts -- I'll be happy to explain what I meant.

As far as "awful lot of trouble, etc" -- as I mentioned, my current doc doesn't feel such an agressive schedule is necessary but studies do suggest that HCC is more prevelant once you had Hep C than in the general population. This does not mean that your can't  function "normally" but simply means that your odds of HCC are greater. Therefore the recommended screening.

Hope this clarifies.

-- Jim

[Trinity4]

You have stated in previous posts that your team of specialists advised you that your liver had returned to normal capacity after your SVR.  Why would you need such close follow-up if they advised there is no longer any problems having reached SVR and fibrosis reduction?  Isn't that an awful lot of trouble to go through if you have been advised you liver is back to normal?

[jmjm530]

Yes, it's a precautionary screening for HCC (Iiver cancer) as our chance of getting it -- even SVR -- is greater than the general population.

My previous liver specialist suggested alternating Ultrasounds, MRI's and CatScans -- every six months for life as a precaution. My current liver specialist suggested I cut out the CatScans (radiation exposure) and just alternate ultrasounds with MRI's, but he didn't seem to think I needed them on such an agressive schedule as the first.  The reason given for the different procedures is that each one takes a slightly different kind of picture, i.e something may show up on one that doesn't show up on another. Right now I'm alternating ultrasound and MRI maybe every 8-12 months. If something strange shows up maybe I'll throw in a Catscan. Frankly, I don't lose much sleep over HCC and worry more about my heart and cholesterol which are probably 100 times more likely to kill me.

-- Jim