cirrhosis reversible question

[simon4271]

Hi , most say cirrhosis is not reversible .
Why can cirrhosis be reversed in patients who have hepatitis B taking viread , doctors have told me this .
One of my doctors patients reversed cirrhosis while taking this .
I was under the impression that cirrhosis is cirrhosis no matter the cause .
If they can reverse it in Hepatitis B why not Hepatitis C ? never understood that .
One professor highly acclaimed told me that Cirrhosis in Hepatitis C can be reversed to stage 2 after successful treatment and another highly acclaimed doctor told me it can reversed to stage 3 .
Has anyone also heard this .

[almostsixty]

Thank you for sharing this encouraging experience. Although I have compensated cirrhosis my Doc insists I will be on the transplant list. I have successfully treated my HCV and my blood work is very good. There is hope!

[Livelife777]

Wanted to add some additional information relating to this topic.   Prior to being treated for my Hep C, I had a full evaluation at Mayo Clinic.  Was informed it would take 1-2 weeks of testing (no joke) and since I lived 3 hours away, booked a hotel in town for 10 days.  As it worked out they were able to accommodate me and squeeze me in so that my stay would be less of a hardship.  We tested from morning till midday for 6-7 days straight. That was 2 years ago.
As a cancer survivor I am very familiar with testing and what it entails.  
After completion it was determined that I needed to be placed on the liver transplant list.  And I was.
Approx 2 months after EOT12 in July, I received a formal letter from the Mayo Clinic stating that I was being removed from the transplant list as my newest scans and bloodwork indicated that I was no longer deemed a candidate for a transplant.
Must say that my interpretation tended to lean towards the fact that my liver has shown regeneration and reversal of my liver disease, since eliminating the Hepatitis C virus.
Don't believe this is wishful thinking.
....Kim
.

[hepc4Sandi]

This is such amazing news! Gives us all great hope for recovery for those on this forum with cirrhosis! An unexpected result!

[Pamelajean1]

I also think it is noteworthy to realize the only data available to date is with the old SOC.....and a lot of times with HepB not HCV. Especially in light of my recent results, I'm curious...even anxious....to see the data that will be forthcoming with the new era of tx.

[Pamelajean1]

Kim, thank you....it is awesome and I'm a very lucky lady! Lucky and Blessed however, I do think it is also a result of my efforts and the stage of damage I had. I will reiterate that I've had HCV for 35+ years in addition to the ascites....a symptom most commonly thought to be a sign of decompensation. As a matter of fact, I went from pre-screening for a transplant to having been told "see ya in six months" and being taken off "the list".

And to Nan's point....we don't know how these new DAA's are or will effect any healing other than removing the underlying cause so I felt sharing my results could be informative and most of all hopeful to others.

Can-do-man....please note Results and Conclusion of my attached article. I'm certainly not saying each and every one will experience my results but I think in this ever changing landscape, we should be open and aware....excited...of all the new results and studies now being brought forward.


"Early cirrhosis, compensated, class A, cirrhosis is reversible in many people. That is why people with compensated cirrhosis on transplant waiting lists are now being safely treated for their hepatitis C in hopes that they will not go on to need liver transplants. Many papers (AASLD papers, Hepatology Magazine articles, etc.) have been written on this subject disproving the older theory that cirrhosis was irreversible.

Pol S, Carnot F, Nalpas B, et al. Reversibility of hepatitis C virus related cirrhosis. Hum Pathol 2004; 35: 107–12.

George SL, Bacon BR, Brunt EM, Mihindukulasuriya KL, Hoffmann J, Di Bisceglie AM. Clinical, virologic, histologic, and biochemical outcomes after successful HCV therapy: a 5- year follow-up of 150 patients. Hepatology 2009; 49: 729–38.

Shiratori Y, Imazeki F, Moriyama M, et al. Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy. Ann Intern Med 2000; 132: 517–24.

Mallet V, Gilgenkrantz H, Serpaggi J, et al. Brief communication: the relationship of regression of cirrhosis to outcome in chronic hepatitis C. Ann Intern Med 2008; 149: 399–403.

Bruno S, Crosignani A, Facciotto C, et al. Sustained virologic response prevents the development of esophageal varices in compensated, Child-Pugh class A hepatitis C virus-induced cirrhosis. A 12-year prospective follow-up study. Hepatology 2010; 51: 2069–76.

Further studies are now being done by Gilead to see if decompensated, Class B and End-Stage Liver Disease patients, Class C patients, can be also be cured using Sovaldi treatments. Since these patients couldn't be treated before safely with previous treatment we will have to see how curing their hepatitis C (if possible) will affect their advanced liver disease and liver disease prognosis. While some cirrhosis is reversible the chance for reversibility declines as the liver goes through more advanced disease.

Review Article: The Reversibility of Cirrhosis
A. A. Sohrabpour, M. Mohamadnejad, R. Malekzadeh
Disclosures

Aliment Pharmacol Ther. 2012;36(9):824-832.

http://www.medscape.com/viewarticle/772507_1

Methods:  A PubMed search was performed and the evidence for histopathological regression of advanced fibrosis/cirrhosis following drug therapy was reviewed as of the end of February 2012.

Results: There is abundant clinical evidence in support of the idea of the reversibility of cirrhosis in patients with different aetiologies of advanced hepatic disease including viral, autoimmune and metabolic/infiltrative liver disease.

Conclusions: The concept of cirrhosis has changed from being a form of static and irreversible entity to a dynamic and reversible diseases stage. Novel therapeutic strategies are under investigation to target specific steps in the process of fibrogenesis with the aim of reversing advanced fibrosis/cirrhosis."

[nan535]

I think Kim  hit it on the head.  It all depends on how advanced the scarring of the cirrhosis is.  It seems to me that Pamelajean's normal ultrasound test results (done after completing treatment and reaching SVR12)  provides evidence that yes, the livers of  some patients with early cirrhosis can be healed.
    Many of the cirrhosis symptoms in the description cited as provided by ALF are what one sees in patients with decompensated cirrhosis ( I know this because my husband had it. ) The  Mayo Clinic excerpt confirms this.
     As I stated in my prior post, we are in new territory with these new meds.
I don't think anyone can say with certainty that early cirrhotic livers won't heal themselves once the offending agent (hep c) is removed. The human body is amazing and I wouldn't rule any possibilities out. But that of course, is my personal opinion.

Nan

[can-do-man]

By Mayo Clinic Staff

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcohol abuse. The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.

Cirrhosis occurs in response to damage to your liver. The liver damage done by cirrhosis can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.

http://www.mayoclinic.org/diseases-conditions/cirrhosis/basics/definition/CON-20031617

[can-do-man]

I see comments but no links... From the American Liver foundation. Which I would consider a very good source. Keep in mind many people and some doctors say they have cirrhosis when really they do not.
-----------------------
Cirrhosis

But if left untreated, your liver may become so seriously scarred that it can no longer heal itself. This stage – when the damage cannot be reversed – is called cirrhosis.

Cirrhosis can lead to a number of complications, including liver cancer. In some people, the symptoms of cirrhosis may be the first signs of liver disease.

You may bleed or bruise easily.
Water may build up in your legs and/or abdomen.
Your skin and eyes may take on a yellow color, a condition called jaundice.
Your skin may itch intensely.
In blood vessels leading to your liver, the blood may back up because of blockage. These blood vessels may burst.
You may become more sensitive to medications and their side effects.
You may develop insulin resistance and type-2 diabetes.
Toxins may build up in your brain, causing problems with concentration, memory, sleeping, or other mental functions.
Once you’ve been diagnosed with cirrhosis, treatment will focus on keeping your condition from getting worse. It may be possible to stop or slow the liver damage. It is important to protect the healthy liver tissue you have left.
-----------------------------------------

This is from the American Liver foundation.

http://www.liverfoundationprogression/.org/abouttheliver/info/

[Livelife777]

Yes.  Cirrhosis is reversible.   This is from Mayo Clinic where I am treated for Hep C and my liver disease.  
The basic guideline is compensated or decompensated.   Once decompensated, there is no reversal.   If compensated according  to them, if you eliminate the source and your cirrhosis is in the early stages it will reverse.   If you cure your Hep C, dont drink alcohol, eat healthy, exercise, don't smoke, you can eliminate cirrhosis.  They said it will never be perfect, but pretty darn close.  They predict that my early stage cirrhosis will become a 1-2 stage when I go back in Nov for my 6 month scan since I cleared the virus.
When I started Tx my meld was 8.  After EOT12 it was a 6.   All the blood work #s were in the normal range, not so before Tx.  Will let you know in Nov what the new scan shows.
Pamelajean that's awesome!   I aspire to achieve those same results and I think it will happen as I truly feel great since becoming cured.
Lets all hope everyone can achieve a good outcome.  Either way, they are having ongoing clinical trials with reversal which should become the norm within the next 5 years.   Think its super important in the interim to try to stay as healthy as possible.  The best news actually is for people with decompensation as they will benefit with this future Tx the most.  Its amazing what technology has in store for all diseases.
.....Kim

[hepcandme]

what a great thread

very hopeful

this may reveal my lack of understanding about how the liver regenerates but I have always wondered why scarred liver tissue is not removed surgically so that the liver can regenerate healthy tissue?

[Pamelajean1]

Thanks Simon....you're exactly right, we are seeing improvements, cures and vaccines happen at a incredible rate. The landscape for Heppers alone changing so very fast just in the past few months. Amazing!

[Pamelajean1]

Thanks Nan....I agree with the miracle. As I've said before...from the beginning of my dx I kept asking Him for just that and I wonder why...at times...I'm so surprised.

But I am curious as to what we see long term with the new DAA's....too bad tracking the staging isn't part of the studies.

[Pamelajean1]

Just to clarify....it was 6 months not weeks.

I had a CT scan 9/13/2013 that showed cirrhosis with ascites. Six months later, 3/2014, I had an ultrasound showing cirrhosis with ascites and this one was a week before starting tx.

So the normal ultrasound, 9/2014 was again 6 months later but also coincided with my tx plus the 12 weeks after tx. Perfect timing....

[can-do-man]

What are the treatments for cirrhosis?

Once scarring of the liver occurs, it is permanent. The treatment of cirrhosis is designed to limit any further damage to the liver as well as any complications. A good diet and supplemental vitamins may help. Any drugs, including alcohol, that can lead to additional liver damage should be avoided. If a virus is found to be responsible for the liver damage, possible anti-viral treatment may be indicated. Interferon can be helpful when the cause of the disease is hepatitis B or C and the condition is not severely advanced. Combination therapy for hepatitis C-Rebetron (ribavarin+interferon) is approved for HCV treatment and is more effective in general in treating HCV than interferon alone. In cirrhosis related to the overload of certain metals, the metal burden in the body can be diminished by bloodletting (as in hemochromatosis) or medications to cause increased urine excretion (as in Wilson's disease). Medications that suppress immunity such as
prednisone and azathioprine (IMMURAN) are used in autoimmune hepatitis.

Cirrhosis
•Cirrhosis is a disease which involves irreversible scarring of the liver.
----------------------------------------
Since they say scarring is irreversible I would love to know how they do it as I am cirrhotic, been SVR for over four years now and had a Fibroscan done which showed no improvement. My doctor still insists I am cirrhotic and always will be and have to scanned for HCC and upper GI's for the rest of my life.

[orphanedhawk]

My understanding is the liver can indeed heal itself of cirrhosis as long as the cirrhosis isn't advanced ( compensated versus decompensated) and yes, once the cause of the problem, hcv, is gone.

[rexx73]

I was told by several docs including Dr Schiano that cirrhosis
caused by alcohol or hepb are more likely to be reversed than
other forms of cirrhosis.
but I was told also that hepc caused cirrhosis can be reversed
to some degree,but not that much as the 2 mentioned above.

[celtictiger67]

well my results with fibroscan improved slightly before and after treatment   Fibroscan before  28,8 after 26.3 dont know if the 2.5 lots or zero

[Sarah1949]

My doctor told me once the cause, hcv, is gone the liver can begin to heal itself of the cirrhosis.

[simon4271]

I remember reading on of Hectors post as he was on solvadi ribavirin for a long time I think 48 weeks , many of his labs came back much better than they have in a long time .
I think you are the cost and I guess no one has stayed on it for a long long time so what are the long term effects.

[simon4271]

that's great gives us all hope but I think the first major step is getting rid of this which you have congratulations , your ultrasound sounds great and you are not the first I have heard this happen to so don't doubt it as hard as it is to believe .  
       Regardless in the next 5 years there will be cure to reverse cirrhosis I believe  , if it can be done with hepatitis b which it has in many cases then surely companies which are already looking into gilead , genfit , cnat , galt and the  many whom will join in the  next few years , likely a key will be found .
       Modern medicine is moving much quicker than anyone could believe if you look back 10 years compared to now  its amazing in so many  fields what they have and will achieve .

[nan535]

My husband was on his treatment for 24 weeks. Before he started treatment his BM's were light  yellow due to blocked bile ducts. Over the course of the treatment, we saw changes happening. His BM's are now normal brown in color. This is proof to us that something positive was happening. Unfortunately, it did not end his bouts of HE though.
I have mixed feelings about his being off treatment. The virus is back and i fear the progress he made physically will soon be gone. So I too have thought about your question. Why not leave him on a low dose treatment that will allow his liver to slowly heal itself?  I fear the answer is "the cost".

Nan

[celtictiger67]

can riba interferon treatment cause diabetes just overheard my nurse saying that im first they have treated to get diabetes as b4 treatment started i was checkied for it also i was on treatment for piles lacoluse n some bran stuff n told to drink plenty of water and it seemed to start from there first urinating lots etc or is it just coincidence thanks
               geo

[can-do-man]

If these "new treatments cure cirrhosis I wonder why they don't keep us on a low dose until were healed?

[nan535]

That is an outstanding report, Pamela. We are in new territory with these new treatments. With the virus being gone and not attacking the liver for 12 weeks, the liver was able to heal itself, the only organ able to do so. Will this happen to all, I doubt it. You have your own special miracle going on.

Happy for you.
Nan