Would a liver biopsy be advisable?

   Greetings.

I am a 57 year old male with a little paunch.  (6'1", 205 lbs.).

Almost nine years ago I discovered that I had Hep C.  I successfully underwent interferon/ribivirin treament (pre peg-intrferon).  Since then, I have been tested annually and my enzymes are just fine.  I also had the RNA by PCR test done for about the first years after treatment and was found to be virus free.  I don't have that test re-done anymore because of the expense.

Prior to the treatment I had a liver biposy done.  The score was:
Chronic Hepatitis, HCV
Moderate activity, grade 3
Bridging fibrosis with nodularity, stage 3.

I can provide the microscopic description, if you would like.

Since all this time has passed and I do enjoy a daily glass of wine, or two, I was thinking about having another liver biopsy done.  I would like to know if my liver has gotten better, worse, or is the same.

Would this be advisable?

Thanks,

Sammy

[copyman]

this is a question for a good hepatologist. me personally, i would get a liver biopsy every 5 years and PCR just for the first 2 years. not sure if i would drink alcohol "every" day if i was stage 3. please let us know what the doc says or if you get a biopsy what the results are, this could help alot of us here that want to know about the liver healing itself after being "cured". best of luck

[FlGuy]

I hope to be in your situation some day, having been hcv-free for several years.  I understand your curiosity to find out what condition you liver is in.  But, if you had the biopsy, and whether it was stage 1 or stage 4, what actions would it drive for you?  The bx is an invasive procedure and not without risk.  Instead I'd see a hepatoogist, as Copy suggests, as have the necessary blood tests to determine all the other valuse that are indicative of liver condition.  Then, if a bx is warranted, I'd think about it.  Curiosity in not a medical reason.  Or, take the opportunity to consider non-invasive assessments like Fibroscan

[desrt]

I've been undetected almost five years and just got my second sonogram during that time. The first, at one year post-tx showed steatosis (I was geno 3) and I'm curious to see if anything has changed. I have no plans for any more biopsys, unless my gastro feels it's needed, but I only had mild fibrosis going in.

[Trinity4]

Your initial dx sounds exactly like mine only you were younger than me when you first found out.  Glad to hear you cleared and hope to God things continue on the upward path for you.  I will start treating very soon.  Just recently found out about my condition.  I have stage 3 with bridging fibrosis as well and doc is hopeful liver will not advance to stage 4 if I treat sucessfully.  I drank throughout my life-sometimes in excess, especially after going through a divorce.  I am convinced  this probably contributed to the excelleration of my liver disease.  I have not touched a drop in months but I at this point I owe myself every opportunity to get better.  I agree with FIGuy as to what actions would drive it for you.  I sense on this forum everyone seems to know without having to say what can potentially lie down the road for us.  Each individual is different.  Personally, I get info overload and start to worry way too much so best for me take the low road approach.  But you know what they say "inquiring minds have to know" so whatever you chose I'm sure it will be the best approach for you.
Take good care
Trinity  

[cat33]

Sorry but I feel differently . I had 2 biopsys within a week and a half. The first one was done wrong . They got a lymp node and part of my colon. The second one got some liver. I am at end stage no symptoms. MELD score of 10. and have been for my eveluation at one of the best clinics around. Even though I am at end stage I was told I would still start at bottom of list. So if there's any doubt in your mind get started now. I'd have another biopsy any day If I thought anything had changed.  cat33  " drinking is mind over matter and it doesn't matter to me" And even though I never drank much. When they mentioned Hepatitis a year ago that came to a screeaching halt. I remember being in the hospital as a child in incubation for over a month with hep.A and I couldn't even begain to immagine that again. Although life is very grim these days. cat33

[jmjm530]

I was also around stage 3 when I treated. Now SVR for 1.5 years and no plans to have a biopsy, nor was I advised to have one. As FLGuy suggested, unless your doc finds something to suggest having a biopsy, why have an unecessary invasive procedure? Fibroscan is one alternative if you really have to know. So far I "don't have to know" so have passed on Fibroscan as well. Periodic follow-ups with a good liver specialist would be my advice for post treatment.

-- Jim

[mremeet]

If I were in your shoes I'd get the biopsy. You did have stage 3 which is pre-cirrhosis, you are a bit older and so the healing process that usually occurs after ridding yourself of HCV occurs a bit slower than in younger people, and of course as you mentioned you do drink alcohol regularly (although the amount you mentioned doesn't really sound excessive, unless you were being "euphemistic" in describing your alcohol consumption). But daily, consistent consumption of alcohol, even if a relatively small amount with a stage 3 liver would cause me to want to see how I'm doing in terms of fibrosis reversal - considering what's at stake, a reality check is in order. Fibrosis is supposed to wane and at least partially reverse after successful eradication of the HCV virus. But it doesn't always happen with everyone who SVR's, some seem to hold their pattern at whatever level of damage they had when they successfully treated. And since regular alcohol consumption is in play, the possibility of fatty liver is also in the picture (i.e. not just fibrosis). It would be advisable to find out if you happened to be one of these non-regressive fibrosis and/or fatty liver people. And if you did turn out to be one of those people, if I were you I wouldn't drink a drop of alcohol ever again. Speaking for myself, I recently wrapped up my treatment 6 months ago with an F1 liver. I plan on having a fibroscan in a few years to see what's happening with my liver too. I drink beer on a regular basis and I just want to make sure that the amount I drink isn't doing more damage than I think it is. The only way to really know that is to take a peek at the liver after some time as an SVR who still imbibes from time to time.

Lastly, just out of curiosity's sake, dontcha just wanna *know* if your liver has gotten better since being cured?? After all I've been through in the last 24 years (since being infected) with the side effects of HCV, the liver damage, the awful treatment, and then the final victory in the end (SVR)...I'd just like to see definitive proof that my liver truly has healed after knocking the virus out for good.

[nygirl7]

I would have my liver enzymes monitored on a pretty regular basis, hopefully that would give you some insight into a sudden raise and fibrosis.  Stage 3 can't be treated like even stage 2...pre-cirhhosis is a scary place to be.  I certainly think there is nothing wrong with getting a biopsy, I'd love to get one and I'm only 10 months post..I want to see where my own liver is going after 72 weeks of treatment.