Aa
can stage 3 fibrosis be reversed? to what degree?
i am 52 yrs. old and have been genome 3 hcv free for 1 1/2 yrs. after 24 wks. of peg-interferon/ribavirin combo. my doc.says it will not return.he also says stage 3 is not reversible w/increased chance of developing cancer. he also says i will not progress from stage 3 to 4.i am not overweight and have no complications yet. i do not drink or smoke or use sugar and have a very healthy diet. my question is; can i realistically expect any reversal of stage 3 and to what degree and any suggestions on what supplements can possibly help? thnx for your concern!
with all due respect to Dr. Dietrich it would be nice to know what evidence supports that rosy opinion. There definitely are a multiple studies that support the benefits of SVR in improving liver histology, reducing (but not eliminating) increased HCC risk, and reducing overall liver-related mortality. However the question of quickly fibrosis reverses and what if anything can be done to accelerate this seems far less settled. See for example two recent reviews (both should be free access)
"Antifibrotic Therapies: Will We Ever Get There? "
http://www.springerlink.com/content/25g827154j696057/
and
"Hepatic Fibrosis"
http://www.ncbi.nlm.nih.gov/pubmed/19396960
Two key problems in the field are that (1) formation of the extra-cellular matrix (ECM) (aka "scar tissue") is slow and (2) detecting changes in the amount/degree of ECM is difficult. Biopsy and FS are very approximate global measures and don't enable the sort of fine-grained monitoring needed to determine whether a given medication is having any effect.
The review by Patel includes a list of anti-fibrotic drugs in clinical trials. It's interesting that though there are lots of posts here about anti-oxidant supplements as antifibrotics, there doesn't seem to be much talk about the angiotensin receptor blockers (eg losartan ) currently in clinical trials (see also rial NCT00930995). Overall there seems to be much more certainty about the benefits of antioxidants in reversing fibrosis in posts here than in the published literature . On the other hand, science is slow and many of us are in dire need, so lack of certainty is definitely no reason to stop self-experiments. Two items about which there *does* seem to be widespread consensus: best way to reverse fibrosis is SVR and drink that coffee!
"Antifibrotic Therapies: Will We Ever Get There? "
http://www.springerlink.com/content/25g827154j696057/
and
"Hepatic Fibrosis"
http://www.ncbi.nlm.nih.gov/pubmed/19396960
Two key problems in the field are that (1) formation of the extra-cellular matrix (ECM) (aka "scar tissue") is slow and (2) detecting changes in the amount/degree of ECM is difficult. Biopsy and FS are very approximate global measures and don't enable the sort of fine-grained monitoring needed to determine whether a given medication is having any effect.
The review by Patel includes a list of anti-fibrotic drugs in clinical trials. It's interesting that though there are lots of posts here about anti-oxidant supplements as antifibrotics, there doesn't seem to be much talk about the angiotensin receptor blockers (eg losartan ) currently in clinical trials (see also rial NCT00930995). Overall there seems to be much more certainty about the benefits of antioxidants in reversing fibrosis in posts here than in the published literature . On the other hand, science is slow and many of us are in dire need, so lack of certainty is definitely no reason to stop self-experiments. Two items about which there *does* seem to be widespread consensus: best way to reverse fibrosis is SVR and drink that coffee!
how do you know what stage you're at?? i'm new to this and am a little lost...
Here is an old HR thread about current anti-fibrotics:
http://www.medhelp.org/posts/Hepatitis-C/Research-supported-antifibrotics---do-they-exist/show/346752
http://www.medhelp.org/posts/Hepatitis-C/Research-supported-antifibrotics---do-they-exist/show/346752
Expert? Hardly.
Nonetheless, I am flattered by the valuation you place on my contribution to the thread. Thanks.
Nonetheless, I am flattered by the valuation you place on my contribution to the thread. Thanks.
In 1998 I found out that I had Hep-C here in New Orleans. Must have gotten it in 1968 after an accident were I took alot of blood products. I have went through 3 harsh interferon/ribavirin treatments, cleared it once at 24 weeks, but come back soon after. The last treatment was in 2001 with a viral load of 4 million. In 2008 I developed stage 4 liver cancer and was given 7 to 30 days to live. I stated a new chemo and found a great supplement shake. The cancer tumors stayed dormat and the shakes helped with the side effects from the chemo and gave me energy. After a Two year battle I am cancer free with no tumors. The same doctor that told me I didn't have long to live, knows the chemo alone did no remove the tumor cells. He retested me for the HCV viral load and it came back at 725,000. Down 3.75% with no interferon/ribavirin treatments. So keep up with being checked every six months and fine the best supplement to promote healthy cells. Liquid supplements start working more quickly and is less likey to breakdown before passing through your system. Don't let things get out of hand like I did.
An expert's point of view:
http://www.medhelp.org/posts/Hepatitis-C/Recovery-of-Fibrosis-and-Cirrhosis/show/534318
http://www.medhelp.org/posts/Hepatitis-C/Recovery-of-Fibrosis-and-Cirrhosis/show/534318
i am lucky to have a fibroscan machine in town and I decided to track the results
at baseline , 12wk, EOT , 24wk after EOT.
so far baseline was 5.9 kPa and 12wk 5.6 kPa so no change but they pretty much
are normal values anyway , still I prefer to monitor since FS is totally non invasive
and repeatable and it is like with all other tests that repeating them over time
really gives you much a better idea.
at baseline , 12wk, EOT , 24wk after EOT.
so far baseline was 5.9 kPa and 12wk 5.6 kPa so no change but they pretty much
are normal values anyway , still I prefer to monitor since FS is totally non invasive
and repeatable and it is like with all other tests that repeating them over time
really gives you much a better idea.
you always get the same answer to that question. In some cases it has been bx proven
that liver histology improved even during tx.
My personal believe is the answer lies more within how the liver repairs itself.
Once there is a scar it will be very difficult to dissolve that scar. However I believe
the liver builds new healthy tissue around that scar thus the healthy tissue to
scar tissue ratio improves and therefore overall histology and liver function.
The problem also lies within the fact that neither histology test method is 100%
and the liver does not scar uniformly so it is difficult to get accurate before and
after results.
that liver histology improved even during tx.
My personal believe is the answer lies more within how the liver repairs itself.
Once there is a scar it will be very difficult to dissolve that scar. However I believe
the liver builds new healthy tissue around that scar thus the healthy tissue to
scar tissue ratio improves and therefore overall histology and liver function.
The problem also lies within the fact that neither histology test method is 100%
and the liver does not scar uniformly so it is difficult to get accurate before and
after results.
http://www.hivandhepatitis.com/2009icr/ddw/docs/070709_a.html
"Mitchell Shiffman and colleagues from Virginia Commonwealth University Medical Center reported follow-up findings from a prospective cohort study (initiated in 1998) looking at long-term histological outcomes in chronic hepatitis C patients treated with conventional or pegylated interferon, with or without ribavirin.
A total of 755 patients underwent a baseline liver biopsy and received a single course of interferon-based therapy or no treatment. Of this initial group, 230 were followed without additional treatment for 5 years before undergoing a repeat biopsy. This group included 41 patients who declined therapy and 189 who received treatment but did not achieve SVR (continued undetectable HCV viral load 24 weeks after completion of therapy). Participants with no evidence of fibrosis at baseline who achieved SVR did not receive a repeat biopsy.
At baseline, untreated patients, treated patients without SVR, and treated patients who achieved SVR were not significantly different with respect to age (average 46 years), sex (55% male), and baseline HCV RNA (5.7 IU/ml).
However, inflammation, fibrosis, and serum ALT were lower in the untreated group (i.e., these patients were least likely to be deemed to require therapy). The SVR group had fewer African-Americans and people with HCV genotype 1 (i.e., these individuals were less likely to achieve sustained response). The analysis did not include patients with other causes of liver disease besides HCV, HIV-HCV coinfection, chronic kidney failure, or prior organ transplants.
Results
Patients who achieved SVR continued to have undetectable HCV RNA throughout the 5 year follow-up period.
After 5 years, inflammation and fibrosis scores increased significantly in the untreated group (by 2.1 and 1.1, respectively) and the treated group without SVR (by 1.6 and 0.5, respectively).
More patients with no fibrosis at baseline and no treatment experienced liver disease progression (28% vs 11%).
Liver histology improved significantly in treated patients who achieved SVR.
After 5 years, all treated SVR patients with portal fibrosis and 80% with bridging fibrosis at baseline had no fibrosis.
20% of sustained responders experienced resolution of cirrhosis.
"Interferon treatment reduces the rate of histologic progression over 5 years compared to [no treatment], even in HCV patients with [no fibrosis]," the investigators concluded.
"Patients with HCV who achieve SVR, including those with [cirrhosis], resolve fibrosis, and after 5 years liver histology returns to normal in most patients without pre-existing [cirrhosis]," they added."
"Mitchell Shiffman and colleagues from Virginia Commonwealth University Medical Center reported follow-up findings from a prospective cohort study (initiated in 1998) looking at long-term histological outcomes in chronic hepatitis C patients treated with conventional or pegylated interferon, with or without ribavirin.
A total of 755 patients underwent a baseline liver biopsy and received a single course of interferon-based therapy or no treatment. Of this initial group, 230 were followed without additional treatment for 5 years before undergoing a repeat biopsy. This group included 41 patients who declined therapy and 189 who received treatment but did not achieve SVR (continued undetectable HCV viral load 24 weeks after completion of therapy). Participants with no evidence of fibrosis at baseline who achieved SVR did not receive a repeat biopsy.
At baseline, untreated patients, treated patients without SVR, and treated patients who achieved SVR were not significantly different with respect to age (average 46 years), sex (55% male), and baseline HCV RNA (5.7 IU/ml).
However, inflammation, fibrosis, and serum ALT were lower in the untreated group (i.e., these patients were least likely to be deemed to require therapy). The SVR group had fewer African-Americans and people with HCV genotype 1 (i.e., these individuals were less likely to achieve sustained response). The analysis did not include patients with other causes of liver disease besides HCV, HIV-HCV coinfection, chronic kidney failure, or prior organ transplants.
Results
Patients who achieved SVR continued to have undetectable HCV RNA throughout the 5 year follow-up period.
After 5 years, inflammation and fibrosis scores increased significantly in the untreated group (by 2.1 and 1.1, respectively) and the treated group without SVR (by 1.6 and 0.5, respectively).
More patients with no fibrosis at baseline and no treatment experienced liver disease progression (28% vs 11%).
Liver histology improved significantly in treated patients who achieved SVR.
After 5 years, all treated SVR patients with portal fibrosis and 80% with bridging fibrosis at baseline had no fibrosis.
20% of sustained responders experienced resolution of cirrhosis.
"Interferon treatment reduces the rate of histologic progression over 5 years compared to [no treatment], even in HCV patients with [no fibrosis]," the investigators concluded.
"Patients with HCV who achieve SVR, including those with [cirrhosis], resolve fibrosis, and after 5 years liver histology returns to normal in most patients without pre-existing [cirrhosis]," they added."
It sounds like you are taking good care of your body. Eating correctly, healthy weight and not drinking alcohol will all give you the best chance of reversing the damage. Supposedly if you have not moved to stage four the damage can be reversible.
Someone that did have cirrhosis posted on the board a few months ago that they had a biopsy a few years after successful treatment at that their there liver had improved by several stages. I think the problem is that there is not enough data from post tx biopsies since they are not often done. personally I will do a biopsy 2-3 years after I am hcv free.
I think you considering your healthy lifestyle you have a very good chance of reversing a good amount of the damage.
Welcome to the forum - Dave
Someone that did have cirrhosis posted on the board a few months ago that they had a biopsy a few years after successful treatment at that their there liver had improved by several stages. I think the problem is that there is not enough data from post tx biopsies since they are not often done. personally I will do a biopsy 2-3 years after I am hcv free.
I think you considering your healthy lifestyle you have a very good chance of reversing a good amount of the damage.
Welcome to the forum - Dave
There have been patients who have reported that they have indeed gone down stages in liver damage after treatment (however I would have no way to prove if it were indeed the case) and others who have not.
Unfortunately I believe the only way to really know what is going on with you would be to simply do another biopsy. I think anyone diagnosed at stage 3 has to be extremely careful and should probably follow up every few years - cured or not (but so far have not taken my own advice and I've been cured over 3 years. I was (am?) a stage 3'er too).
I wish there was a solid answer for you but there just is not as far as I know.
Unfortunately I believe the only way to really know what is going on with you would be to simply do another biopsy. I think anyone diagnosed at stage 3 has to be extremely careful and should probably follow up every few years - cured or not (but so far have not taken my own advice and I've been cured over 3 years. I was (am?) a stage 3'er too).
I wish there was a solid answer for you but there just is not as far as I know.
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A fibroscan is non-invasive and may not be definitive in evaluating staging (fibrosis), but it certainly is good for comparative tests, using the same machine and operator, hopefully, to measure the progression or regression of fibrosis in your liver.
There is also a fibrosure blood test, but this test is an algorithm of different parameters that is probably not very definitive.
I hope that helps.