FibroSure and biopsy

[MarkFly1]

Last summer or thereabouts, I had a Fibrosure test which indicated a score of F3 which was quite high compared to previous assessments of my liver.  My doc then decided we should do a liver biopsy which showed a fibrosis score of 0-1.  We decided to do another Fibrosure test 2 weeks ago which I discovered yesterday was F4 Cirrhosis.  Yikes.  Well, I did a little further digging and discovered that the Fibrosure test requires 10-12 hours of fasting ... no one had told me this and in both cases I had eaten regular meals.  Would digesting food skew the results so dramatically?
Because of this last test, my doc wants to start me on Telaprevir+PegIfn+Ribavirin.  Only prior treatments were with regular Interferon and Ribavirin.  I have the IL28B allele CC.  Should I go ahead and do the TPR treatment or wait for Sofosbuvir or do another Fibrosure test this time after fasting?

[MarkFly1]

Oh yes, the Haptoglobin increased from 55 to 64... I think that's in a good direction.???

[MarkFly1]

Guys, thanks so much for your comments!  My wife says I often "pre-worry" .. I guess I've been looking at the totality of information and that ultrasound sounds concerning.  My doc says he doesn't want to base any treatment on a Fibrosure and thinks waiting for Sofosbuvir is probably best (I see him on Wed.)  BTW, I don't have diabetes, so the high a2m may be due to something else, perhaps hemochromatosis?   Afterall, a positive predictive value of Fibrosure is 61%, is not very high but something is causing the a2m to be high.  In any event, I hope the Sofosbuvir is approved soon.  Please send your good vibes to the FDA!  I really appreciate your comments and thoughts.  

Mark

[Bali05]

Hey Mark
what was your haptoglobin on your Fibrosures , just curious....
As I stated earlier it is not only my experience , that of many other forum members and that of high ranking hepatologists that the Fibrosure blood test can be highly inaccurate. Than what good is it other than making $$ for the labs.
I did one 1 year post SVR it came back F4. I wanted to hear an explanation
from a  hepatologist Dr. Douglas Dietrich at Mt Sinai (they do transplants there)
He examined me by doing a FibroSCAN looking at labs and all history.
He laughed  because they just had another patient a week prior with a totally
wrong FibroSure and this happens frequently....
He told me my liver was totally fine no fibrosis to worry about.
I insisted on those blood values alpha 2 macros high ect... he said
to go see a hematologist if it bothered me but it wasn`t my liver.

Hope this helps

b

[pugdaddy]

Mark, for anything that it may be worth to you - since you and I have p.m'd about this as well.  I entirely agree w/Willy.  He's 'nailed' the major points in your case - and is giving you good, sound advice.  I hope that you can soon 'calm down' that A2M level.  Here's a related article:
http://www.jbiomedsci.com/content/pdf/1423-0127-17-58.pdf

[Willy50]

FWIW my ferratin at least was normal. I have managed to bring it down a little. It had just been out of range.

If you want to try to figure out how to make it work, good luck with it, but so far using the test as a contrarian indicator would have been more accurate.  : )

If I was terse my concern was that a doctor was using a weak test to "sell" you a treatment today, when in all likelihood you had a large safety zone in waiting; even if it was 6 months to treat w/ sofosbuvir and SOC.

I believe this would offer a relatively short wait, a higher cure rate, a shorter and safer treatment. I cannot quite fathom the urgency to treat with current triple therapy when you have demonstrated poor results with past SOC based treatment.(all I know is that you failed; not by how much, but you have mentioned diabetes, making me wonder about insulin resistance and it's role in potential diminished interferon response)

Good luck in whatever you choose....

I am so far quite happy with my choice, and my treatment is just the most current "best in class", but I believe they will get better still and in relative short order.

willy

[MarkFly1]

Willy, no need to apologize for anything and I appreciate your comments.  I guess my thoughts were to explore how sensitive FibroSure was to changes in fasting, vitamins, etc.  It would seem to fairly reliably indicate active inflammation and my high Ferritin level supports that.  I hadn't mentioned that the pathologist who reviewed the biopsy tissue is 80 or 81 years old and that a year ago, an ultrasound revealed "several small scattered shadowing areas in the liver" which the tech thought could be surgical clips (which I highly doubt).  30 years ago I had Hodgkin's disease and my medical care was significantly mismanaged (I won't bore you with the details) ... fortunately I survived incorrect initial treatment, a poor follow-up involving a relapse which my radiation oncologist did not discover (my gastro did) and finally chemo which cured me.  I vowed I would never let that type of mismanagement happen again and yet, I'm beginning to think I may have.  While I have previously told my doc I'd prefer to get the next treatment when it has a much better chance of success, such as with multiple types of inhibitors, I didn't think thinks would possibly deteriorate as they very well might have.  I don't know what those shadowing areas could be and that was a year ago.  The only response to it was the biopsy which as you know revealed fairly benign fibrosis and inflammation scores.  But there is a consistency with the Fibrosure such as a high alpha 2 macroglobulin value which I figured is the main culprit that elevated the scores.

In any event, I can at least wait until Wed. and will have a zillion questions.  I don't know what I'll decide, but the ultrasound of a year ago is worrisome and I will probably want to get a better assessment of my liver's condition at a minimum.

Thanks for your help and thoughts.  Your decreasing enzyme levels are quite dramatic and encouraging and also make me realize how long mine have been elevated.  :)

I hope you slay that dragon soon!

Best,
Mark