Aa
Fibroscan score
I am from India, HCV Geno 1, on 44th week of SOC as PIs are not yet available in India. I had a baseline VL of 6.34 million, and have been UND since Week 10 of tx.
I never had a biopsy and just had a fibroscan yesterday, and it showed a score of 25. It is well above the Cirrhosis cutoff score of 12 or so. I just want to understand how advanced my cirrhosis is and what the chances of SVR are, given that I understand success rate for Cirrhotics are not high with just SOC.
Also, I am a bit confused by the fibroscan score. Wondering if it is reliable, going by other parameters below.
Platelet count was 165,000 pre-tx and now varies between 110,000 to 120,000 during tx.
WBC count was 8500 pre-tx and now between 3200 and 4000
ANC count was 4000 pre-tx and now between 1800 and 2000
The Ultrasound said the liver had coarsened echo texture, but marked portal vein (1.1 cm) and spleen (10 cm)as normal in size. It also said no portal hypertension.
Pre-tx, my doctor performed an endoscopy and said there is 1x Grade 1 Esophageal varix. But I don't know why he did not put me on beta blocker. He said it is not necessary yet.
My hepatologist now says there is some degree of cirrhosis and has confirmed that I have to do 72 weeks of SOC.
I never had a biopsy and just had a fibroscan yesterday, and it showed a score of 25. It is well above the Cirrhosis cutoff score of 12 or so. I just want to understand how advanced my cirrhosis is and what the chances of SVR are, given that I understand success rate for Cirrhotics are not high with just SOC.
Also, I am a bit confused by the fibroscan score. Wondering if it is reliable, going by other parameters below.
Platelet count was 165,000 pre-tx and now varies between 110,000 to 120,000 during tx.
WBC count was 8500 pre-tx and now between 3200 and 4000
ANC count was 4000 pre-tx and now between 1800 and 2000
The Ultrasound said the liver had coarsened echo texture, but marked portal vein (1.1 cm) and spleen (10 cm)as normal in size. It also said no portal hypertension.
Pre-tx, my doctor performed an endoscopy and said there is 1x Grade 1 Esophageal varix. But I don't know why he did not put me on beta blocker. He said it is not necessary yet.
My hepatologist now says there is some degree of cirrhosis and has confirmed that I have to do 72 weeks of SOC.
I would follow your hepatologist advice on doing 72 weeks.Fibroscan results aren't always accurate.I wouldn't worry to much about your platelets going down during treatment,it is very normal,same with WBC and ANC.How long have you been UND(virus undected) ?...As far as SVR rates for G1 with cirrhosis on SOC I don't know.From reading old threads I saw a few G1 with cirrhosis whom did 72 weeks on SOC and achieved SVR....I'm someone here will better answer you.
Here is a link that might be of some help,it is calculators to determine liver damage.It only gives you an idea in corralation of other non invasive methods...not sure if it's reliable using it while your on treatment.Try the fibrosis 4 score.You could always try doing your APRI INDEX.
http://gihep.com/?page_id=782
Best wishes
Dannyboi7
Here is a link that might be of some help,it is calculators to determine liver damage.It only gives you an idea in corralation of other non invasive methods...not sure if it's reliable using it while your on treatment.Try the fibrosis 4 score.You could always try doing your APRI INDEX.
http://gihep.com/?page_id=782
Best wishes
Dannyboi7
Someone here will be much better at giving you advice,there are a lot knowledgeable folks in this forum.
Thanks for the response. I am in 44th week of Tx now and UND for the past 34 weeks.
I am not worried about Platelet count and WBC reduction during Tx. My question was more on the lines of whether the other parameters that I mentioned in my post correlate with the liver condition as given by Fibroscan score.
I am not worried about Platelet count and WBC reduction during Tx. My question was more on the lines of whether the other parameters that I mentioned in my post correlate with the liver condition as given by Fibroscan score.
The things you mention that would correlate is the ultrasound
showing coarsened echo texture and the endo showing varices.
It is very odd that your Dr. did a Fibroscan @ wk44 and decides to extend
tx to 72wks based on the result.
FibroScans should not be done on tx because the meds can cause the
liver to have a "stiffer" reading due to inflammation ect...
If you were suspected to have cirrhosis you should
have had a biopsy prior to tx.
Congrats to your EVR being UND @ wk10.
What was the sensitivity of the PCR ? <50 IU , <10 IU , <5 IU ?
If I were you I would try to get the most sensitive viral load test
available.
How do you tolerate tx so far ?
It is great that you are being offered 72wks and in case of a doubt I would
take advatange of that as long as you can tolerate it well.
Better over treating than under treating and be done with it once and for all
Just my opinions...
b
showing coarsened echo texture and the endo showing varices.
It is very odd that your Dr. did a Fibroscan @ wk44 and decides to extend
tx to 72wks based on the result.
FibroScans should not be done on tx because the meds can cause the
liver to have a "stiffer" reading due to inflammation ect...
If you were suspected to have cirrhosis you should
have had a biopsy prior to tx.
Congrats to your EVR being UND @ wk10.
What was the sensitivity of the PCR ? <50 IU , <10 IU , <5 IU ?
If I were you I would try to get the most sensitive viral load test
available.
How do you tolerate tx so far ?
It is great that you are being offered 72wks and in case of a doubt I would
take advatange of that as long as you can tolerate it well.
Better over treating than under treating and be done with it once and for all
Just my opinions...
b
I am not worried about Platelet count and WBC reduction during Tx. My question was more on the lines of whether the other parameters that I mentioned in my post correlate with the liver condition as given by Fibroscan score.
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IMO they don't,but I'm no doctor,nothing seems to indicate you have cirrhosis.The fibroscan numbers are totally out of whack because you had it done while treating .Even when not treating fibroscan results can be inaccurate.When you do a fibroscan the percentage of accuracy is given,your doctor should have that in his files.If you were UND at 10 weeks until now I think 48 weeks should be sufficient,72 weeks won't make much of a difference.
-------------
IMO they don't,but I'm no doctor,nothing seems to indicate you have cirrhosis.The fibroscan numbers are totally out of whack because you had it done while treating .Even when not treating fibroscan results can be inaccurate.When you do a fibroscan the percentage of accuracy is given,your doctor should have that in his files.If you were UND at 10 weeks until now I think 48 weeks should be sufficient,72 weeks won't make much of a difference.
Thanks for giving me the insight about the possibility of increased liver stiffness during Tx altering the Fibroscan score. The score of 25.7 scared me quite a lot, though Cirrhosis was not being completely ruled out by doctor before.
The reason fibroscan is done this late into Tx is - my treating hospital purchased the machine recently and my doctor wanted to have a status check as biopsy was not performed pre-tx. However he did not mention to me about the possibility of fibroscan score not being reliable during tx. He was in general telling me that fibroscan report can not be considered in isolation.
Any way, my treatment now got extended to 72 weeks and my doctor has been psychologically preparing me for this since week 12 of my Tx.
The sensitivity of my PCR test is <15. At week 8, it could detect my viral load as 17 . In India, we don't have PCRs more sensitive than this :-)
Regarding tolerance to Tx, I think I have been able to manage it pretty Ok thus far. I am taking 1200 mg of Riba for my body weight of 65 Kg, which has resulted in my HGB dropping from 16 to 10 by week 24. And it has been hovering between 10 and 10.5 since then. Apart from the moderate anemic problems, I don't have other major Sx. I work full time, at times putting in 12 to 14 hour work days and have managed without taking a day off during Tx. Hopefully I can manage this way for another 28 weeks, to reach the 72 week mark :-
The reason fibroscan is done this late into Tx is - my treating hospital purchased the machine recently and my doctor wanted to have a status check as biopsy was not performed pre-tx. However he did not mention to me about the possibility of fibroscan score not being reliable during tx. He was in general telling me that fibroscan report can not be considered in isolation.
Any way, my treatment now got extended to 72 weeks and my doctor has been psychologically preparing me for this since week 12 of my Tx.
The sensitivity of my PCR test is <15. At week 8, it could detect my viral load as 17 . In India, we don't have PCRs more sensitive than this :-)
Regarding tolerance to Tx, I think I have been able to manage it pretty Ok thus far. I am taking 1200 mg of Riba for my body weight of 65 Kg, which has resulted in my HGB dropping from 16 to 10 by week 24. And it has been hovering between 10 and 10.5 since then. Apart from the moderate anemic problems, I don't have other major Sx. I work full time, at times putting in 12 to 14 hour work days and have managed without taking a day off during Tx. Hopefully I can manage this way for another 28 weeks, to reach the 72 week mark :-
My fibroscan score showed some 10 readings in a graphical format, with 100% accuracy mentioned there. Those 10 readings were widely varying between 20 and 30, with average showing as 25.7. Like you mentioned, this score is during week 44 of Tx. So, I think I have to take it with a pinch of salt..
You're a real trooper,wishing you the best in finishing this treatment and its outcomes.
Sounds good.
I was still detectable @wk 8 as well and UND wk10
Decided to do 60wks and am virus free ever since.
Was geno 4 with no indication of cirrhosis.
b
I was still detectable @wk 8 as well and UND wk10
Decided to do 60wks and am virus free ever since.
Was geno 4 with no indication of cirrhosis.
b
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