Re: Liver Bx

Posted By Leisa Lane on June 11, 1999 at 09:06:47
Hi I have a question about my sisters liver Bx. She was told by her GI that it is normal. There are some abnormalities and I just wonder what they mean. I know there is no crystal ball and you can't tell when someone is going to progress but I wonder if these abnormalities indicate that she may progress at a later time. Is it safe to wait a year for better treatments or would she miss a window of opportunity if she did not seek Tx now when liver was not damaged to the point of fibrosis. The Bx says that there is mild intaacinar spotty necrosis no evidence of cirrhosis or portal fibrous bridging and negative for siderosis. Architecture is reg. and orderly, but there are scattered about intraacinar foci of spotty necrosis or " drop out" Sm # of lymphocytes in the area of lost hepatocytes. no steatosis. specimen had few portal tracts. they had an increased # of chronic inflamitory cells. viral load was 10,400 very low.
  still waiting on genotype. It also said on Bx that on one slde there is a small lymphoid aggergate in one portal tract.Any insight would be very helpful.

[Leisa__0]

Posted By Leisa on June 17, 1999 at 12:59:15
Also My sister would like to see a hepatologist, She has seen a Gastro Doc and an Infec. Disease Dr. She lives in Greenville SC and would be willing to travel to Atlanta or Charlotte To see a Doc with experience in treating hep c. Could you recommend a specialist in the area or facility with this expertise. Thank you so much.

[HFHSM.D.-D.M.]

Posted By HFHSM.D.-D.M. on June 27, 1999 at 17:17:41

Dear Leisha Lane:
I appreciate your questions.  You want to know what I make of your sisters liver biopsy and if I can recommend a good hepatologist in the Greenville, SC area.
When I look at a liver biopsy from some one with hepatitis C, the most important thing to me is the amount of fibrosis or scarring.  Fibrosis is scar tissue that forms as a result of persistent inflammation in the liver.  If you cut your skin, you form scar tissue which is good.  However, if you inflame the liver, you can develop scar tissue or fibrosis which can be bad.  If the fibrosis advances, it can start to destroy the liver. Typically fibrosis starts around the portal tract and the mildest form of fibrosis is periportal. Bridging fibrosis and cirrhosis are more advanced forms or fibrosis and your sisters report specifically says these were not present.  If there is little to no fibrosis on a biopsy in someone with hepatitis C, this is very encouraging.
The timing of therapy can be a little complicated but I can make a couple of comments to try to help.  First, I would want to know if your sisters liver enzymes (AST and ALT) are normal.  Individuals with hepatitis C, normal AST and ALT and a relatively benign liver biopsy, typically have very slow progression of their disease and we tend to approach them differently than other individuals with hepatitis C.
The argument for treating patients with hepatitis C and early fibrosis on liver biopsy is that patients tend to respond better to combination therapy with interferon and ribavirin when the disease is early.  On the other hand, we know that the progression of fibrosis in individuals with hepatitis C tends to be linear.  In other words an infected individual would tend to have twice as much fibrosis after twenty years as they did after 10 years.  In some one who has had hepatitis C for 20 years and has minimal fibrosis there should be little to no risk in delaying therapy for a year.  It would be helpful to know when your sister was exposed to hepatitis C. One advantage to waiting a year, is that we should have a better sense of the effectiveness of pegylated interferons that are only injected once a week instead of three times a week.  We should also have a sense of when these drugs will be available.  
I dont know exactly where Greensville, SC is but I can recommend a Dr. Adrian Reuben in Charleston, SC without hesitation.  I can also highly recommend a Dr. Ray Rubin in Atlanta and Dr. Robert Reindollar and Preston Purdom in Charlotte.  All of these physicians also do clinical trials and have access to some of the newest drugs for hepatitis C.
I hope this information is helpful to you. I wish you and your sister the best of luck.  The results of your biopsy certainly sound encouraging.   I would invite you to post any additional concerns or questions to us at MedHelp.  The direct number to our Liver Clinic at Henry Ford is [phone].  At Henry Ford, we have an active group of liver specialists with an interest in the research and treatment of hepatitis C.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.  

[Leisa__0]

Posted By Leisa on June 29, 1999 at 09:35:43
Thank you for your most helpful insight. I would like to add that her exposer to hep c has been at least 7 years, She gave blood in 1992 and got a letter stating she had hcv which she unfortunately acquaited to the hep A we had as children. We were told we would always carry the antibodies and she did not realize the seriousness of this. Her genotype came back a 1A. Not good news I guess. I have read that ones do not tend to respond as positivly as the other geno types. It makes me wonder if a pegylated trial would be better or more aggressive because of the longer half life of the inteferon. I will seek the opportunity for an appointment with one of the DR'S you have mentioned. Again Thank you for the help.

[Leisa__0]

Posted By Leisa on June 29, 1999 at 11:48:19
I also wanted to let You know that though levels of alt and ast have been elevated in the past (slightly).  Her transaminases have been increased in the past but have remained normal for the past two or three months. It should be noted that when levels were elevated she was on trovan for 8 weeks for a dog bite to the face that would not heal after a few weeks of augmenton. I understand that trovan has been pulled because Patients Have had liver problems and that when studied it was for a 6 week period. All levels have been normal now that she is off trovan as well as no etho.










Follow Ups:


Re: Liver Bx HFHSM.D.-D.M. 7/03/1999
(0)