Aa
POSSIBLE CIRRHOSIS
I was infected with Hep C in 1974 at the age of 13 from a blood transfusion. My GI did a Fibrosure test and it came back F-4 bridging to Cirrhosis (possible early cirrhosis) and referred me to a Hepatologist. My platetes are at 130, Ast 64, Alt 92 and a viral load of one million two hundred thousand. When I got the news I was very angry and then afraid, I really did not think it would get to this since I feel so healthy.I am in very good shape and exercise all the time, never tired and lots of energy. My new Doc ordered new lab work, scheduled endoscopy and MRI. He also suggested new meds of Sovaldi and Olisio for 12 weeks to get rid of the Hep-c. I asked for a liver biopsy and he said I did not need one since it was not going to change what he was suggesting. I would like to know how accurate is the Fibrosure test for early Cirrhosis and if I am able to get rid of the virus would the progression of Cirrhosis stop. Also, when does itching and other complications begin?
I don't think you mentioned if you have previously treated or not.
Advocate1955
Advocate1955
I was concern about early Cirrhosis because I wanted to wait for a FDA approved med. without the Inteferon and ribavirin. I know Sovaldi and Olisio is off label and wonder how safe it is since it has not been approved. I also read about sovaldi and ledispivar might be available this summer and that also could be another option if I can wait. I thank you for your reply.
COMMUNITY LEADER
Hi and welcome.
Feeling healthy and approaching cirrhosis are not exclusive. Many people who have complete cirrhosis which is more advanced than your liver disease feel fine. It is only when cirrhosis becomes advanced that serious complications appear. Having fluid retention (ascites and edema), enlarged collateral veins (varices), etc.
Others may have more recent data on Fibrosure. This is what I found...
"Sebastiani and associates (2011) examined the effect of etiology and stages of hepatic fibrosis on the performance of fibrosis biomarkers. A total of 2,411 patients with compensated chronic liver disease (CLD) (hepatitis C virus [HCV] = 75.1 %, hepatitis B virus [HBV] = 10.5 %, non-alcoholic steato-hepatitis [NASH] = 7.9 %, HIV/HCV = 6.5 %) were consecutively enrolled in 9 centers. APRI, Forns'index, Lok index, AST-to-ALT ratio, Fib-4, platelets and Fibrotest-Fibrosure were tested against liver biopsy, considered the gold standard. The effect of the stages of hepatic fibrosis to diagnose significant fibrosis and cirrhosis (greater than or equal to F2 and F4, respectively) was investigated through difference between advanced and non-advanced fibrosis stages (DANA). Performance was expressed as observed area under the ROC curve (ObAUROC) and AUROC adjusted for DANA (AdjAUROC). Performance of APRI and Fibrotest-Fibrosure was higher than other biomarkers. In all etiologies, AdjAUROC was higher than ObAUROC. APRI showed its best performance in HCV mono-infected cases, with an AdjAUROC of 0.77 and 0.83 for greater than or equal to F2 and F4, respectively. In HBV and NASH patients, its performance was poor (AdjAUROC 0.73), except for greater than or equal to F2 in NASH (AdjAUROC = 0.64).
Performance of all biomarkers was reduced in HCV cases with normal ALT. The authors concluded that etiology is a major factor influencing the performance of liver fibrosis biomarkers. Even after correction for DANA, APRI and Fibrotest-Fibrosure exhibit the best performance.
However, liver biopsy is not replaceable, especially to diagnose greater than or equal to F2 and in HCV carriers with normal ALT."
I am not sure why you are concerned whether you have F3 or F4? Both indicate extensive liver damage but not irreversible damage. Cure your hep C soon and your liver will heal itself over time. Waiting until your are fully cirrhotic is a poor choice in my opinion. You risk liver cancer which is a very deadly cancer and will require a liver transplant to continue living. I had liver cancer and a transplant and can tell you it is nothing you want to go through if you can avoid it.
Sovaldi and Olisio for 12 weeks to treat Hep-C is an excellent opinion based on the small study data available if your insurance company will pay for it. The treatment is off-label.
In cohort 2 there were 87 treatment-naive individuals and prior null responders with advanced fibrosis or compensated cirrhosis (F3-F4). Two-thirds were men, 9% were black and the median age was 58 years. n 78% had subtype 1a, 40% with the Q80K mutation. Participants were about evenly divided between treatment-naives and null responders, and 21% had the favorable 'CC' variant. Just over half had advanced fibrosis, the rest cirrhosis.
In Cohort 2, all 14 participants who completed therapy had undetectable end-of-treatment viral load with no breakthroughs. One hundred per cent of both treatment-naive patients and null responders taking simeprevir/sofosbuvir who had adequate follow-up (seven of each) achieved SVR4, as did 100% of naive participants and 93% of null responders (all but one) treated with simeprevir/sofosbuvir/ribavirin.
We will have to wait to see the data when others finish treatment and the initial 14 have completed 12 weeks post treatment.
Why wait to treat your hepatitis if you can treat without peg-interferon and ribavirin? There are other treatments but you will need to take peg-interferon and ribavirin and possibly have some difficult side effects during treatment? You can stop the liver damage it has been causing for decades. In my opinion you should serious think about treating your hepatitis C now while your liver damage is still reversible.
Treatment was generally safe and well tolerated. Amongst people treated for 12 weeks in both cohorts combined, there were no serious adverse events, grade 3-4 laboratory abnormalities or discontinuations due to adverse events with either regimen. Amongst people treated for 24 weeks, serious adverse events were rare (3 to 4%) and there were two discontinuations due to adverse events in both regimen arms.
The most common side-effects were fatigue, headache, nausea and insomnia, which occurred with similar frequency in both the ribavirin-sparing and ribavirin-containing arms. Anemia and elevated bilirubin, however, were more common amongst ribavirin recipients.
Best of luck!
Hector
Feeling healthy and approaching cirrhosis are not exclusive. Many people who have complete cirrhosis which is more advanced than your liver disease feel fine. It is only when cirrhosis becomes advanced that serious complications appear. Having fluid retention (ascites and edema), enlarged collateral veins (varices), etc.
Others may have more recent data on Fibrosure. This is what I found...
"Sebastiani and associates (2011) examined the effect of etiology and stages of hepatic fibrosis on the performance of fibrosis biomarkers. A total of 2,411 patients with compensated chronic liver disease (CLD) (hepatitis C virus [HCV] = 75.1 %, hepatitis B virus [HBV] = 10.5 %, non-alcoholic steato-hepatitis [NASH] = 7.9 %, HIV/HCV = 6.5 %) were consecutively enrolled in 9 centers. APRI, Forns'index, Lok index, AST-to-ALT ratio, Fib-4, platelets and Fibrotest-Fibrosure were tested against liver biopsy, considered the gold standard. The effect of the stages of hepatic fibrosis to diagnose significant fibrosis and cirrhosis (greater than or equal to F2 and F4, respectively) was investigated through difference between advanced and non-advanced fibrosis stages (DANA). Performance was expressed as observed area under the ROC curve (ObAUROC) and AUROC adjusted for DANA (AdjAUROC). Performance of APRI and Fibrotest-Fibrosure was higher than other biomarkers. In all etiologies, AdjAUROC was higher than ObAUROC. APRI showed its best performance in HCV mono-infected cases, with an AdjAUROC of 0.77 and 0.83 for greater than or equal to F2 and F4, respectively. In HBV and NASH patients, its performance was poor (AdjAUROC 0.73), except for greater than or equal to F2 in NASH (AdjAUROC = 0.64).
Performance of all biomarkers was reduced in HCV cases with normal ALT. The authors concluded that etiology is a major factor influencing the performance of liver fibrosis biomarkers. Even after correction for DANA, APRI and Fibrotest-Fibrosure exhibit the best performance.
However, liver biopsy is not replaceable, especially to diagnose greater than or equal to F2 and in HCV carriers with normal ALT."
I am not sure why you are concerned whether you have F3 or F4? Both indicate extensive liver damage but not irreversible damage. Cure your hep C soon and your liver will heal itself over time. Waiting until your are fully cirrhotic is a poor choice in my opinion. You risk liver cancer which is a very deadly cancer and will require a liver transplant to continue living. I had liver cancer and a transplant and can tell you it is nothing you want to go through if you can avoid it.
Sovaldi and Olisio for 12 weeks to treat Hep-C is an excellent opinion based on the small study data available if your insurance company will pay for it. The treatment is off-label.
In cohort 2 there were 87 treatment-naive individuals and prior null responders with advanced fibrosis or compensated cirrhosis (F3-F4). Two-thirds were men, 9% were black and the median age was 58 years. n 78% had subtype 1a, 40% with the Q80K mutation. Participants were about evenly divided between treatment-naives and null responders, and 21% had the favorable 'CC' variant. Just over half had advanced fibrosis, the rest cirrhosis.
In Cohort 2, all 14 participants who completed therapy had undetectable end-of-treatment viral load with no breakthroughs. One hundred per cent of both treatment-naive patients and null responders taking simeprevir/sofosbuvir who had adequate follow-up (seven of each) achieved SVR4, as did 100% of naive participants and 93% of null responders (all but one) treated with simeprevir/sofosbuvir/ribavirin.
We will have to wait to see the data when others finish treatment and the initial 14 have completed 12 weeks post treatment.
Why wait to treat your hepatitis if you can treat without peg-interferon and ribavirin? There are other treatments but you will need to take peg-interferon and ribavirin and possibly have some difficult side effects during treatment? You can stop the liver damage it has been causing for decades. In my opinion you should serious think about treating your hepatitis C now while your liver damage is still reversible.
Treatment was generally safe and well tolerated. Amongst people treated for 12 weeks in both cohorts combined, there were no serious adverse events, grade 3-4 laboratory abnormalities or discontinuations due to adverse events with either regimen. Amongst people treated for 24 weeks, serious adverse events were rare (3 to 4%) and there were two discontinuations due to adverse events in both regimen arms.
The most common side-effects were fatigue, headache, nausea and insomnia, which occurred with similar frequency in both the ribavirin-sparing and ribavirin-containing arms. Anemia and elevated bilirubin, however, were more common amongst ribavirin recipients.
Best of luck!
Hector
Have an Answer?
You are reading content posted in the Cirrhosis of the Liver Community
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
