liver repair while on tx

[ppmguy]

hey every1, i know that the liver can repair itself.  my ? is, can the liver heal while on tx once you become undetectable.    barry

[Anne1717]

+1 Willbb!!!!  How the heck are ya???  HIJACK!!!

[HectorSF]

Thanks for the articles!

Hector

[mikesimon]

Review Article: The Reversibility of Cirrhosis

A. A. Sohrabpour, M. Mohamadnejad, R. Malekzadeh
Aliment Pharmacol Ther. 2012;36(9):824-832.

Conclusion

Here, we reviewed the available evidence for the potential reversibility of cirrhosis in various types of liver disorders. In summary, we emphasize the following points:

    Currently, the most reliable strategy for reversal of cirrhosis is the treatment of the underlying aetiology. However, treatment of the underlying cause is not feasible in all the patients with cirrhosis.

    Reversal of human cirrhosis is probably a slow process and may take several years.

    Not all patients with cirrhosis have a reversible disease. Patients with cirrhosis can be categorised into different stages. Patients in the earlier stages of cirrhosis are more likely to witness the reversal of cirrhosis. Although the point at which cirrhosis is irreversible is not established, it appears that cirrhosis becomes irreversible once septal neovascularisation happens and portal pressure increases significantly.[4]

http://www.medscape.com/viewarticle/772507_7

[mikesimon]

A morphometric and immunohistochemical study to assess the benefit of a sustained virological response in hepatitis C virus patients with cirrhosis.
D'Ambrosio R, Aghemo A, Rumi MG, Ronchi G, Donato MF, Paradis V, Colombo M, Bedossa P.
Source

Abstract

Although annular fibrosis is the hallmark of cirrhosis, other microscopic changes that affect liver function such as sinusoid capillarization or loss of metabolic zonation are common. A sustained virological response (SVR) may halt fibrosis deposition in hepatitis C virus (HCV)-infected patients, but its impact on the other cirrhosis-associated lesions is unknown. The aim of this study was to assess the impact of an SVR on cirrhosis-related histopathological features. Paired pre- and posttreatment liver biopsies from 38 HCV patients with cirrhosis with an SVR were analyzed. Fibrosis was staged using the METAVIR scoring system, and the area of fibrosis was measured using morphometry. Ductular proliferation, metabolic zonation, sinusoid capillarization, and hepatic stellate cell activation were assessed by anti-cytokeratin-7, anti-glutamine synthetase (GS), anti-cytochrome P4502E1 (CYP2E1), anti-CD34, and anti α-smooth muscle actin (αSMA). After 61 months from an SVR, cirrhosis regression was observed in 61%, and the collagen content decreased in 89%. Although periportal and lobular necroinflammation vanished, portal inflammation persisted in 66%. Ductular proliferation decreased in 92%. Before treatment, metabolic zonation was lost, as shown by GS and CYP2E1, in 71% and 88%, respectively, with normalization in 79% and 73%, after an SVR. Conversely, no changes in sinusoidal capillarization were observed after treatment, as assessed by CD34 (P = 0.41) and αSMA (P = 0.95). Finally, no differences in all the immunohistochemical scores emerged whether or not cirrhosis persisted. CONCLUSION: Cirrhosis regression and decreased fibrosis are frequently observed among HCV patients with cirrhosis with an SVR. Despite ductular proliferation vanishing and lobular zonation restoration, portal inflammation and sinusoidal capillarization may not regress after viral eradication.

http://www.ncbi.nlm.nih.gov/pubmed/22271347

[dmgt86]

Sorry for just impeding in on your conversation here but can I ask a few questions please as I think ul have the knowledge on the subject to answer them.
Many years ago i was very stupid and put myself at risk several times and in the last 2 years every person I took the risks with,except 1 have all tested positive for HCV and it's all the same genotype.I only found out theyd all been diagnosed 3-4 weeks ago as i had moved on and didnt see as much of them anymore now iv been tested and Iv come back negative for everything and I have to say i wasnt nearly as careful as some of them were it's really baffled me.Could I have had it and fought it off and have no antibodies?Id suspect that would be unheard of because if ud been incontact with HCV and fought it off it would have been the antibodies that done it or are some people just immune because I KNOW i have been in contact with HCV atleast a few times yet im negative?Answer please thanx

Frank

[willbb]

Hector & cando:
At the other end of that synopsis it is possible for one to have realatively high AST &ALT for decades with very little Fibrosis.

best...

Will

[willbb]

Liver repair on tx. and once SVR:
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It might be a stretch to assume that once you have eradicated the virus that the liver will regenerate to 100% with absolutely '"nill scarring" ..There is evidence that the liver is one organ within the body that has the ability to regenerate ,especially once the process of constant  "injury and  healing"  has stopped due to that inflamation that takes place when we have HCV.

If you were not chirrotic(I apologize  not knowing your level of fibrotic injury  )
there is no reason to concern yourself about what is happening with your liver now that that process of injury has abated.

Keep in mind ..."everyone " HCV or not has some degree of liver damage as just  "living  "can have this effect.given the liver is the bodys main filter

Best.........

Will


http://www.natap.org/2005/ias/ias_49.htm

     In this small study analysis from the APRICOT Study: 80% (8/10) of cirrhotics who achieved SVR also had a histologic response (improved liver condition), compared to 69% (51/74) of patients with an SVR in the study who had biopsies & SVR.

Of note, patients in APRICOT who took Pegasys/RBV who did not achieve an SVR (non-responders), 58% (7/12) cirrhotics had a histologic response, compared to all patients in study who were non-responders of whom 43% (26/61) achieved a histologic response (HR).

[Bali05]

We followed my 60wk tx with FibroScans as part of a research.

baseline  5.9 kPa ALT 75
wk12       5.9 kPa ALT 46
wk48       7.0 kPa ALT 47
wk60 EOT ---------  ALT 72
SVR        7.5 kPa ALT 28
1 y  post  5.6 kPa ALT 20

The first time I ever saw a real normal ALT was about 1 mo. after tx.
In my case the meds themselves caused some inflammation
which is propably why the FS scores and ALT kept going up towards
the end of tx and my ALT never got to be normal during tx.

Was pretty nerve wracking because when ALT goes up at the end of tx
one immediately assumes returning virus.

b

[working dog]

i had only fibrosis....i had many symptoms of hep c for years before i knew i even had it...i did push my body very hard with work and exercise so maybe thats why i had symptoms....never had any blood work done until about 6 years before i treated when i found out i had hep c...now over a year post tx and svr i feel much better....i'm stronger then i've been in years...no need for power naps all the time either...lots of other good stuff too....i'm sure its not just phycological......billy

[HectorSF]

You are right can-do about AST and ALT. Time to take a swig of Lactulose. They can remain normal even with early cirrhosis. I should have said, for those with high AST and ALT levels before treatment, when one becomes undetectable they usually return to within norms indicating less viral replication and liver injury.

whoops!...
Hector

[can-do-man]

I had normal numbers throughout my life, when they spiked in 2003 my GP was concerned, I was tested and was positive, plus I was already cirrhotic.

Yearly labs for a number of years did not suspect anything and I more then likely had been infected for 30 years...... Go figure.

[can-do-man]

Not sure I totally agree with that, for many people their ALT and AST are normal for much of their life and much damage is being done. Even some of us cirrhotics have can have somewhat normal levels......

One might think then why test for Hep-C if your AST and ALT could tell you if there is a problem or if you have Hep-C

[HectorSF]

Barry,

When a patient becomes undetectable we see the ALT and AST level come down with normal levels. This indicates the the liver is no longer being damaged by the virus. But keep in mind, for many of us we have had the virus replicating and causing inflammation and fibrosis to our liver for decades. So what is 6 months or a year compared to 20 years of damage? Repair takes time. Beside it is really not an issue anyway.

There is a misunderstanding on this topic. For most people with hepatitis C (F0, F1, F2, F3) the liver healing (meaning replacement of of fibrosis with new hepatocytes is not really an issue.
First, fibrosis has no symptoms. That is why we need a biopsy over something to measure our level of fibrosis.
Second, even with fibrosis the liver is still performing of its functions normally so there is no impact of other body systems. It is only when a patient has cirrhosis and the liver so so damaged that it begins to fail that we develop symptoms and complication from our liver disease.

All organ are designed to handle some levels of injury. They are more robust than they need to be in everyday activities. That is why it isn't until 80% of the liver is scared and non functional due to cirrhosis before a patient will experience the symptoms and complication of decompensated cirrhosis. That is why when see the complications of cirrhosis such as ascites, HE and bleeding varices as some examples. It is with decompensation that the liver damage is usually irreversible and the only alternative to death is a liver transplant.

For those of us with cirrhosis and portal hypertension that are cured of our hep C we still will have portal hypertension and its results issues. Enlarged spleen, low platelet counts, varices, etc. There may be partially reversible of liver disease over time depending on the heath of the individual but the liver can never fully repair itself. This isn't gonna happen 6 months or a year. It can take many years.

Cheers!
Hector

[BoceprevirGal]

  My personal experience is this:  I went into Treatment with very
elevated liver enzymes (AST 300 ALT 400)  
   At my 2 week blood test, my enzymes were going down, and when I took my 4 week blood tests, my virus was Undetetable, and my liver enzymes were within the normal range...for the first time in 20 yrs!!!!
   My biopsy a few weeks prior to my Treament had me at a Stage 2 (fibrosis) and a grade 3 (inflammation)
    I imagine that my liver enzymes being normal indicated that I no longer had this inflammation, although I am not certain. I know the inflammationis what causes the scar-tissue, leading to fibrosis and then cirrhosis.
    My liver enzymes remained normal thru out the next 24 weeks of my
Treatment, and I was Und at my last blood tests, at 12 weeks post treatment, and I was still Undetected, and all my blood values were normal, but my platelets were still a bit low. Next week I will go and have my 24 week viral load test done, and I am hoping my platelets are back in the normal range, as they had slipped below normal range 6 monhs prior to me Treating.  If the platelets are normal, then I will feel like my liver is healing well.
   I suppose in a couple years, I will have another biopsy done, so I can see if itr has in fact healed

[can-do-man]

For one thing just because you are Undetectable does not mean the virus is still not there, thats why we have relapsers. How much healing can be done in such a short time? People and even doctors have different opinions on this........ Myself It's more of a "feel good answer" to say yes. But others would disagree. when you become SVR all will be good, your liver should heal and then I would say that during the time you were Und helped speed that up.......... Good luck