Biopsy Report

[slagle2]

I saw my doc yesterday got the results from the second reading of my recent biopsy.  The reason for the second reading was that because I am still grade 1 fibrosis just like I was ten years ago when I had the first biopsy.  But there  is a bit of confusion in that a biopsy taken five years ago said I was grade 2 fibrosis.  I have been grade 2 inflammation on all three biopsies.  Here is the text of the report:  

"Diagnosis:  Liver, biopsy:  Mildly active chronic hepatitis, consistent with chronic hepatitis C, with patchy periportal fibrosis.  

Comments:  This is a beautifully large biopsy.  At low power it is characterized by dense blue aggregates which are portal inflammatory infiltrates composed almost entirely of lymphocytes.  Every so often, a lymphocyte sneaks into  the peirportal parenchyma, but, actually there is virtually no interface component.  Similarly, hardly any inflammation is occurring in the lobules.  The only clinical information we were given was hepatitis C and this is a pretty typical example of hepatitis C.  There is a little periportal fibrosis but nothing more ominous than that.  

This case was sent here at the request of the patient and the clinician, Dr. XXXX.  I don't know what the specific concerns were but I hope my comments have dealt with them."  

Anyway, I posted this because I am still trying to decide if I treat or not and if I do which PI, Inc or Vic that I will use.  I have more testing and see my doctor at the end of December.  

[slideman]

Your tx sounds very similar to mine, accept there are some vl tests not done at all during tx that are standard now. I did go und at 8 months and virus came back. I also took ultra thisle, maybe there is something to that. I was not checked for vl at all untill 5months into tx in 2001 and 2002, so there is no way to tell what my vl did. Tx this time is not good, but I dont think its as bad as it was then. Hang tough!!!

[slagle2]

I had my first biopsy in 2001 and did the treatment in 2003-2004 with Pegasys and generic ribavirin.  I was undetectable at 12 weeks, had a viral breakthrough of 211,000 at 24 weeks and undetectable at 48 weeks.  Six months later my viral load was 15 million, much higher than the three to five million that I registered before TX.  

THen in 2006 I was considering a clinical trial for VX-950 and had another biopsy and that one showed grade 2 fibrosis.  THe one I had this July was back to grade 1 fibrosis.  

I'm guessing that there is a great deal of latitude in reading these biopsy slides and a fair amount of variability from one observer to the next.  So maybe my liver actually looks the same now as it did five years ago instead of improving as the biopsy report tends to indicate.  I have taken "Ultra Thistle" herbal medicine most of the last five years so maybe that helped.

My recent biopsy result really surprised my doctor. I called and made an appointment right after the two PI's were approved by the FDA back in May  and during my first visit (I hadn't seen this doctor since 2005) he looked at the two earlier biopsies which indicated progression and told me that it was likely that I already had cirrhosis and asked me about diarrhea,  ect.  He told me that if the biopsy report was bad that he would get me lined up for a transplant.  So when the biopsy was favorable we were both surprised.  And that is why he had it "re-read".  

I though that maybe they got mine mixed up with another patient but I remember when the biopsy was taken that they were instructed to take five  samples and I see that agrees with the report.  I think four is normal.

Good luck to you and I may be joining you soon in TX.  Thats great to be UND so early.

[slideman]

Did you do tx after your last biopsy? My first one was also 10 yrs ago it showed 2 and 2. Right after a long tx it was at 1 and 2. Now 10 yrs after the first one its 1.5 and 2. Ive had I think 5 total because they were all freaked out, and unsure of tx several yrs ago and I think there was some lab rat type things they did back then. I'm not real bitter about all that because I know that all that is what has brought us to the better tx we have now. I did not do well with tx back then, and am struggling with it now, but not as bad as then. I dont know what makes some people have such awfull desease and others dont progress as much. I fully expected a way worse biopsy result as it had been a long time sice my last one, and I am a painter by trade so I have dealt with very harsh chemicals for years. I am now in the office so I dont have all that exposure now. I am told I need to do 48 wks of tx now even though I'm und at 4 and 12wks. 5 more shots untill 24 wks. No promises in reguard to 48, but I will do 24, just to be hard headed. I cant think past that for now. Good luck to you!!!

[slagle2]

Hector, my doc will gladly go with Inc or Vic and his nurse gave me "Treatment Algorithm" sheet for each of them showing testing dates and the route you take for the various "guided therapies" which I guess are very standardized by now.  But the choice of which one is my choice and right now I'm leaning toward Vic but I haven't even made my final decision as to whether I treat now or not.  

There are a very large number of people being treated right now and it would be interesting to see how the SVR works out post TX but as the two drugs have only been on the market since May it will be this time next year before we start to get the results from the first people tested since the drugs got FDA approval.  

[HectorSF]

"Patchy (or "mild") periportal fibrosis" is consistent with Stage 1. It really doesn't matter if it is stage 1 or stage 2 neither stages impact treatment SVR rates. Assuming all other tests are constant with your biopsy, the choice of treatment will be what your doctor (a gastroenterologist I trust) recommends and is most familiar with. You will have no limitations on treatment choice due to your liver disease.

Good luck with your treatment!
Hector