Starting tx w/o Liver Biopsy

[fuzzy1dar]

I was wondering if anyone has started tx without having a Liver biopsy and knowing what stage their  liver is in.

thanks, Darla

[dlr2007]

Usually it's best to know what stage your liver is at. Many people who are only a Stage 1 or 2 choose to wait for newer meds (like me!). On the other hand, if your liver is Stage 3 or 4, you know not only is it probably time to treat, but you need to stick with it through all your might! If you know you're a Stage 1 and the side effects are getting awful and you're about to lose your job, well... maybe you'd stop treatment. But if you're a late Stage 3- you'd be better off to suffer through it if at all possible because you know you need to stop the Hep C from progressing.
  Interesting you should ask this question, because I've been considering trying to get my husband to tx without a bx (biopsy) first. Reason being is that they couldn't start an IV before his bx, and therefore wouldn't do it. There is a test called the Fibroscan, which is noninvasive and measures the stiffness of your liver- but it's not easy to get. Most docs don't have the machine and I think insurance often doesn't cover it. I may try to get my hubby one.
  There is a test called the FibroSpect II, but I found it to be very unreliable. It's supposed to be quite accurate at Stage 0-1 or 4 but not so great for the middle stages. I found it be be very misleading- my FibroSpect II score was 69- indicating Stage 3. My bx was a Stage 1!!! Big difference, huh :) ? Now there are some blood tests that will give you an idication of how your liver is doing. For instance, your platelets and albumin dropping can often mean that your liver damage is pregressing. And rising bilirubin can mean that also. My husband has low platelets and his albumin is getting on the low side too- so I'm betting he's in need of tx.
  Bottom line is- getting tx without getting a bx first is certainly better than doing nothing! If you can't get a bx or are too afraid to (it's no biggie, btw- ask for Versed first, it's way relaxing)- then you probably should just take what info you have and try to make an educated decision with an experienced hepatologist. I would say you'd be better off assuming your liver is in need of some help and tx'ing than assuming your liver is fine and not doing tx.
  Good luck whatever you decide!

[FlGuy]

It is not uncommon for some doctors, with geno 2 and 3 patients, to forego biopsy.  The thinking is that if a person is committed to treatment, then what impact would biopsy results have, presuming that standard of care 24 weeks would be sufficient? I don't necessarily agree with that position since progress of treatment coupled with liver condition could have impact on treatment decisions later on, depending on early response to treatment.

[pKinCA]

Hi,  

I started tx 3 weeks ago and did NOT have a liver biopsy.  I am Genotype 2b which is the easiest genotype to clear.  

I did have three tests though in this order:

1)  Ultrasound of liver -- mainly to check for presence of tumors (none)

2)  Fibrospect II -- "16" Index and 90% accuracy for F0-F1

3)  PillCam ESO -- swallowed a pill camera so doctor could see esophagus lining -- he wanted to make sure there were no varices (varicose veins that could burst which would not be good... usually seen after cirrhosis has developed I believe...)  I had none at all, and tissue was perfectly healthy.

After doing a lot of reading on biopsies, I decided there was still a lot of "gray area" with the results, as you are only testing one tiny area of the liver.  The Fibroscan is probably the better tool for determining extent of damage as it seems doctors probe many different areas.  If I lived near a Fibroscan machine I probably would have a scan.  I used to live in LA and once I feel better after treatment, I might go visit relatives and have a Fibroscan too!

Hope this helps some...  Do you not want to do a biopsy, is that why you ask?  Just curious...

pK

[oyasin]

I tried to do that because the thought of 'taking out a piece of liver' scared me.

Anthem BCBS would not cover meds without a biopsy. (I'm 1b)

The biopsy was one of the easiest and pain free procedures I've ever had. I'd rather have 5 Bx's than another colonoscopy.

David

[fuzzy1dar]

Thanks everyone for the great info. I started tx about 5wks ago w/o a biopsy and was courious as to how many people if any did this. I'm genotype 2b and found out today that my VL is in normal range. WHOOYA! The only problem is my blood levels are very low. Hoping to get these up soon as I am very tired and weak. I was telling my son that the reason my VL is normal (which was 1,500,00 before tx) is because I don't have many blood cells left in me. lol
Good luck to you all!
Darla