help interpreting biopsy results

[latecomer]

I think my biopsy results are better than expected but have questions about whether anything on here could indicate autoimmune hep as i tested positive for smooth muscle antibodies and the stated purpose of biopsy was to rule this out.

I am gen1, 19 mil viral load- doubled in 5 years, elevated alt &  doc says higher than normal blood iron levels.  But, biopsy results identical to 5 yrs ago. Please don't yell at me guys, but I just stopped occasional social wine drinking completely about two months before this biopsy, so I wonder if abstinance may be likely to improve my alt scores in a few months.  Female and diagnosed syndrome x.   Probably had hepc for 20 years. Treatment naive.  Was hoping to wait for better treatment options or clinical trial--or at least lose weight and address insulin resistance to help my odds.

Biopsy results: grade II Stage 0.  Microscopic (3 H&E) 13 in 1) Aprox 10 portal tracts identified all expanded by cronic inflamation consisting predominantly of small lymphocites admixed wit few histiocytes and rare eosinophils. Occasional piecemeal necrosis. Hepatic loblues w/patchy smalll collections of lymphoid cels and occasional hepatocellular dropout. 3in 1 stain shows preserved architecture w/ predominantly one cell thick chords. No significant portal fibrosis. No increased iron. No atypia or evidence of malignancy.  Findings consistent with mild inflammatory activity grade II and no significant fibrosis (stage 0)

Any enlightenment on these result beyond the obvious good news that I don't have cirrosis would be greatly appreciat

[latecomer]

Hey Chuck --

Thanks for the leads I will research these and report back.  Maybe I will post the topic under a more descriptive header for broader discussion since this post is getting kind of old.

[crsrph]

think that you mean antifibritic  drugs some that are approved by the fda that may have some promise are 2 antiinflamitories sulfasalzine mesalamine and also trental and angiotension conversion enzyme inhibitors ( ace inhibitores )have not seen much on them lately if you find anything new on these let me know thanks chuck

[latecomer]

Thanks for your help!

[latecomer]

HI all-- I have been checking into this forum every few months since my first liver biopsy five years ago--although I may have forgotten my user names between and logged in with a different one. Appreciate what you do.  Part of my coping mechanism since finding out about this  is doing exhaustive research on the internet.  

Per the question excellent question  of what are the new drugs here is a very good summary of many of the new drugs in the pipline with links to more info on each and I try to read as much as I can on a lot of them.

http://www.hcvadvocate.org/hepatitis/hepC/HCVDrugs.html

Bavituximab does sound really good and I would like to know more if you can enlighten me.

I also am interested in  drugs that might have minimal side effects but  reduce damage and inflamation while we wait for a less risky treatment than RIBA/PEGASYS I was just reading about  JBK-122 and also PF-03491390 (Formerly IDN-6556) on the link I gave you.

I gotta say I have a problems with authority figures (which doctors often are),  plus problems with paperwork and thus hate insurance cos.--so after my liver looked good the last time I actually had to weigh whether the stress and negativity from those aspects of treatment might actually affect my immune system and make things worse. Okay denial, maybe. But I tend to come up with deductive conclusions and need to have my questions answered to my satisfaction before I want to put myself in the " expert's hand".  And my past experiences with doctors has not given me confidence that are infallable.   I am I am not finding my current specialist has much patience with my wish to participate intellectually in exploring  treatment alternatives or any interest in the clinical trial stuff I bring him.  Since I have gen1,  high viral, load insulin resistance and several other factors that ( based on my reading)  lower my SVR chances  significantly  below the stated 40% or 50%  rates I often see quoted, I was at least interested in trying some new antiviral med for a month or two before starting conventional treatment to get the viral load and inflammation down, but got no feedback on that. Tried  to discuss promising trials on taking Pioglitazone and Metformin both of which have low tx and reduce insulin resistance thus supposely increase success for Geneotype 1 people in conventional therapy and he basically said "whatever-go ask your GP."

So now  I am interested in hearing from people who know of any viral inhibitors (or any antiinflamatory drugs that might spare the liver)  or drugs affecting insulin levels that are promising and especially thoose that have passed FDA for other uses and are now in trial for Hep c.  Because I would like the option of just following a trial protocol with physician supervision without actually signing up for the trial. That way if my doctor and I want to vary dosages or treatement times we aren't messing up any research. I am thinking something my doctor could legally prescribe with out a trial.

Thoughts? Anyone here on the Forum I should ask about this?  

Thanks for any perspective you can lend.

[ladybug52]

You pose a lot of interesting questions but I can't help with the complexity of your issues. For me it boiled down to whether or not I wanted to make a stab at getting better before I got older or sicker. I always figured if the sides were too bad at least I would have tried. I just couldn't deny that this is a real illness with real consequences in spite of my minimal damage and normal enzymes. Good Luck with your endeavors, maybe try a P.A or nurse practitioner if you want someone who isn't so big on their own authority.

[chcnme]

Hi latecomer.  Enjoyed reading your note.  Can't help you on any of the drugs you mentioned  (know nothing about them) and have no clue how you can peek your doc's interest to be more in line with your own.  On the insulin resistance issues (if you haven't already) you might enjoy

www.mkandrew.com

Best of luck. Keep us in the loop!

[ladybug52]

Great biopsy results as far as the stage and grade. Especially since you have had this for 20 years, had occasional wine and are geno 1. This disease is so random I think. I would never yell at you for drinking because I've had this for 30+ years and was still a social drinker after I found out. (Not now) I kept getting normal enzymes and no symptoms so I was really in denial. If I hadn't found this website I might still be in denial, drinking and not treating. Thanks to the awesome people here, I quit drinking, started tx and am on the road to recovery from this disease. Good luck

[Pdilly]

Nope no cirrocis.  In fact it looks like you can wait awhile for the new meds and not have to deal with the stuff some of us have to deal with now.

[gazebo1]

I read posts mentioning "new meds" as if they were coming along really soon.  Are you all refering to Bavituximab anti-PS? I thought this was in phase 1, so when is it estimated it may become approved (if ever) and available?