what does level 2 mean???

[jibber]

I have just received my biopsy report.  The report came back level 2.  What does that mean?  I am starting class for peg-int. on Saturday the 6th and will most likely start treatment sometime next week.  I am scared to death.  Anybody out there relate?  Jibber

[willing]

Sure - I've been thinking about this for a while. It's a pale comparison to Kim's songs or Indiana's jokes but it might be a useful addition to the forum. I couldn't decide whether it would be more useful to cover the new articles in one or more journals, say <a href="http://www.jhep-elsevier.com">Journal of Hepatology</a>, <a href="http://www3.interscience.wiley.com/cgi-bin/jhome/106570044">Hepatology</a>, <a href="http://www2.gastrojournal.org/scripts/om.dll/serve?action=searchDB&searchDBfor=home&id=gast">Gastroenterology</a> etc, or to select a new article, as in madbyron's post above, and put it in context of previous work.

[madbyron]

Thanks for the correction. I don't know why, but after completing 48 weeks, the distinction doesn't matter to me anymore. alpha beta gamma 2 3 4 5 6... it's all good.

[madbyron]

Oh yeah, we can all relate to your fear. But all is by no means lost. Your biopsy result is actually not bad at all. I am assuming that the level 2 applies to your liver scarring (fibrosis) stage, and not inflammation grade 2.

I know of two scales used to quantify liver disease progession, the <a HREF="http://tpis.upmc.edu/tpis/schema/mHAI.html">modified HAI</a>, and the <a HREF="http://tpis.upmc.edu/tpis/schema/HAI.html">Knodell HAI</a>. Note that the Knodell HAI jumps from 1 to 3 and lacks a stage 2, so it may be your biopsy was interpreted using the modified HAI. In either case, your liver is not in bad shape.

If you are committed to treatment, it's a good idea to learn as much as you can about what the experience may be like, and arranging your life accordingly before getting started. I wish you the best of luck.

[madbyron]

There was a fair bit of rancor recently surrounding the question of whether peginterferon/ribavirin therapy resulted in improved liver histology, so I wanted to drop in a link to <a HREF="http://www.natap.org/2004/feb/020304_02.htm">a recent study</a> pointing to a close relationship between viral response and improved liver health. Only peginterferon alpha 2a (peg-intron) was used, though it would not be much of a reach to infer that similar results would be derived from alpha 2b (pegasys) therapy.

[britgirl]

Yes, 2a is Pegasys.

[willing]

very interesting study, thanks! If we were more organized we'd get volunteers to cover the major journals every month and report on the interesting articles that the advocacy sites (hivandhepatitis.com etc.) let drop through the cracks. The Poynard 2000 study, which is the foundation of  "IFN reduces fibrosis regardless of SVR" recommendations had been controversial when published but I hadn't seen anything that really challenged it. Looks like unless the IFN is leading to per-protocol reduction in VL it's not worth the bother. In particular, pushing on for the sake of reducing fibrosis if you don't get a 2-log drop by 12 doesn't look like a good idea. BTW I believe it's 2a that Roche sells as pegasys and 2b that Schering sells as pegintron.

[LvdByGod]

PEGASYS/COPEG IS THE EASIER WAY TO GO,LESS SIDE EFFECTS THEY SAY.
IS THERE A REASON THEY DON'T PUT YOU ON THIS ONE? ASK YOUR DR. IT IS A NEWER DRUG AND SOME DR.S DON'T USE IT SIMPLY BECAUSE THEY NEVER HAVE. ALOT OF US ARE ON IT AND THOSE WHO HAVE DONE BOTH SAY PEGASYS IS EASIER THAN PEGINTRON.

try to get a copy of your biopsy report and write down here exactly what it says and we can tell you what we know about it.

it sounds like your in stage 2 inflamation and stage 2 damage. it is 1-4. four being worst. but, let us read your report. you should always get a copy after each test you have taken. blood counts, liver markers... keep your own records. so you can know what's going on. and make your dr.s explain them until you completely understand otherwise they will be the ONLY ones with your life in thier hands.

i like to know what's going on at all times and have all the info... "THERE IS WISDOM IN THE ABUNDANCE OF COUNCILORS"...

[audreywald]

Others know a lot more than I do, but I am between a 1 and a 1/2 and a 2, and that is not too bad yet. I have been at this point for the last 5 years.