biopsy and treatment questions

[wrayc]

Diagnosed with HCV type 1A in 2011 with viral load 800k. Just got results from fibrosure 4,700,000 Stage 4 fibrosis grade 3 inflammation. I'm being treated by GI at local hospital with a state grant (no insurance). He scheduled me for a biopsy and wants me to wait for sofosbuvir, which he says will be without interferon. At this point I'm compensated and we agree I need treatment so what benefit is biopsy, as I am nervous that it might prompt me to uncompensate. He said he was surprised I had cirrhosis since all my other labs were relatively normal except AST 85 ALT. 150 To me the biopsy risk outweighs the benefit. Also waiting to treat may not be best option since I have no insurance there is no guarantee the grant will cover the Sofosbuvir, which by the way  from my understanding does with  I A include interferon with triple with sofosbuvir ,  and ribavarin. he keeps stressing how expensive sofosbuvir is and whether my grant will cover it, then perhaps I will benefit more just going on incivik. I'm aware the differences between th DAA and the other PI with all the side effects. Im just ready to start. Knowing already I have irreversible permanent liver damage I don't want to risk losing my liver altogether by waiting, nor do I see the benefit of the biopsy.  Any advice please. Thanks.

[Advocate1955]

I agree with everyone above.  You definitely need to treat as soon as possible, since you have Cirrhosis.  A biopsy would not cause you to decompensate.  It is a relatively risk free procedure, you would be under sedation (not general asthetic), and it is only minimally invasive.  It would take a hepatologist to say whether the fibroscan is sufficient or you need a biopsy.  On the other hand, as can-do said, it doesn't really matter because you already know you have Cirrhosis.  Now the question becomes which treatment.  Incivek and Victrellis are the two current PIs.  Current triple tx would be one of the two PIs combined with Interferon and Ribavirin for 48 weeks.  It is a tough treatment, but many with Cirrhosis have done it.  If you were less well compensated, it would be more risky, because it is hard on the liver.  On the other hand, the two new treatments that are coming out include either simeprevir or sofosbuvir combined with Interferon and Ribavirin.  Apparently fewer side effects, but still 48 weeks of treatment.  I think you could do either treatment, the current triple tx, or the soon to be available new txs, but again it would take a hepatologist to say.  The wait for the new treatment shouldn't be very long, maybe a month or two we hope.  Not sure about the questions regarding insurance coverage and grant funding, but sofosbuvir will require interferon and ribavirin for G1's.
Advocate1955

[wrayc]

thanks, my platelets were normal

[wrayc]

exactly my thoughts

[ppmguy]

          i personally would not make a decision on tx, with the info you provided.  i would want more evidence of cirrhosis.  your dr said,  "all your other labs are relatively normal except alt and ast.  i have trouble with the concept of fibrosure, since the findings are based on blood values that are variable, day to day (my opinion)

[willbb]

I believe  the "fibroscan " has now been aprroved  by the FDA and
sophistication of the" fibrosure along with fibroscan"  (often used in conjuction) is greatly improving  giving clinicians very good indications of liver damage(fibrosis) making the invasive procedure of biopsy even less prevalent,according to many hepatologists.

Possibly an option to speak with your doctor about...

Good luck

Will

[can-do-man]

Should add having a Biopsy will not risk you decomping. The main concern here is if your platelet level is high enough to risk it?

Do I think you need a biopsy? No, you need to treat anyway and should be treated as being a cirrhotic so a Biopsy at this point seems mute. Just my own opinion...

[can-do-man]

You really need to be seen by a Hepatologist at a large teaching hospital but it sounds like that is not possible? As for the fibrosure it is pretty good at determining either very early or late stages. But the Biopsy is the gold standard. Curious about your CBC results, mainly your Platelet, Billirubin and Albumin levels as these should help confirm your fibro findings. Your Platelet level should be a good gauge.

As for waiting for all oral with Sofosbvir at your stage, I would really question that decision as were still into trials so at least more then a year away... Really a decision by a Hepatologist on whether you are still able to treat needs to be made, from what you have said it seems like you are and the sooner the better. Stopping this now would be a big plus as your future goes, waiting only leads to many more risks. I treated at your stage and now SVR with one of the PI's. I would be finding out what kind of commitment to care Sofo will likely offer as they all have them and see If starting that drug with Interferon and Riba is a option, that is if your treatment naïve... Wishing you the best going forward.