Recovery of Fibrosis and Cirrhosis

[FlGuy]

Welcome.  I have read other forums in which you have participated and appreciate your views. For a person who has achieved svr what should be the expectation for the reversal/repair of firbrosis and/or cirrhosis?  Secondly, if it's medically necessary to evaluate such recovery/repair; how, when and should it be it be done?  Thanks.

[Douglas Dieterich, MD]

If you had mild (Childs A )cirrhosis or anything less in fibrosis score, after SVR it should all go away. Your liver should return to normal. However in people with established cirrhosis, there may be a continuing risk of liver cancer so screening once or twice per year may be in order. Follow up biopsy is not really indicated. Good luck!
And Congrats on your cure!
DTD

[mremeet]

First, thanks so much for providing your expert input on this forum. Sharing what you know with us hep C patients on this public forum is more helpful to all of us than you can ever know.

I am very pleased to read your response to FLguy's question, especially coming from such an authoritative and HCV experienced doctor such as yourself. I was biopsy rated with mild fibrosis prior to being successfully treated for HCV last year (Telaprevir prove 1 trial). We've had many discussions here on this forum concerning the prospects and timetable for reversal of fibrosis after achieving SVR. Although the general consenus is that fibrosis improves after SVR (barring existing advanced cirrhosis, any ongoing drug/alcohol abuse or autoimmune issues), we always seem unclear on just how much improvement is to be expected and how long will that improvement take. To my knowledge reputable, large scale studies on this subject are sparse, and since biopsies after SVR are usually not performed, I've always felt unclear what to really expect after achieving SVR. So I was wondering if you could clarify how it is known with any real certainty just how much improvement in fibrosis is to be expected (post SVR) and how long it might take? Your unambiguous and bold statement "If you had mild fibrosis screening score, after SVR it should all go away" is extremely encouraging, and I would love to believe it is 100% true. But I've never heard a doctor say something like that with such authority, certitude and conviction - how do you know this? Is this based on studies? A large patient population you have personally treated and assessed post SVR over many years? Some combination of these factors? Thanks in advance for any further clarification.

[GoofyDad]

Further to FLguy's question: Given mild cirrhosis (ISHAK 4-5 transitional) and SVR, what would be your guess at a timeline for recovery from the cirrhosis? Would you expect suppressed platelet counts of 115 at baseline  to eventually return to normal, and over what timeframe?

Thank you for your insights!

[mamakat43]

I was treated for HepC in 2004 and have had SVR since then.  When I have a couple glasses of wine, I get a side ache.  I never had a biopsy, but my Dr. Dr. Tong said no liver damage.  Could I have cirrhosis?

[Douglas Dieterich, MD]

It could always be possible that he is drinking  but reversal of the AST ALT ratio also happens in cirrhosis. Two things, you can ask the doctor to draw an alcohol level on him or get a GGTP blood test more sensitive to drinking or both.. Second get him tested for hemochromatosis because of the family history and often alchololism is linked to hemochromatosis.  Good luck! DTD

[Skitwin]

My husband had cirrhosis, was diagnosed in July 2005 and stopped drinking.  Hospitalized in September of that year and in ICU for a week.  Improvement over the past several years until the last month or so.  He is jaundiced, bilirubins ar 13.7, AST 177, ALT 32.  I don't know if he is secretly drinking.  I've read that this ratio would indicate that, but his father and brother both have had serious liver issues (Dad died at 53 of liver cancer).  Our doctor, who is seeing him in a couple of days, indicated that it may very well be that he just needs to clean his system out with medications again.  I'm wondering if I need to get him into rehab (I honesly don't know if he's drinking - but it doesn't appear that he does.)  Could this be a sign of liver cancer?  He is 42.