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Post Info TOPIC: Can I be cured of Hepatitis C?


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RE: Can I be cured of Hepatitis C?
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You could add neuropathy to this list - it affects your feet and legs and make you look like Ray Milland in 'Lost Weekend'  to reiterate what Malcolm said, yes you can say your are cured but there is to be brutally frank a termination of some symptoms specially for those of us who have had this silent assassin for decades  can be hard to tell as we have developed secondary sides. .  I can however tell you this; I have more energy and more of an awareness of others round me.  It's not all about me and my disease.  I have gone back to the person I used to be- who others liked despite my lifestyle!  I am thankful for this.  Hope this helps.

Nxxx



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Hi Mark,

I have some pretty definite views on Fibroscan. My Fibroscan was done in August 2008, and my Hepatologist had only had the Echosens machine for 3 months. It was one of the first in Australia.

Previously, I had had 3 liver biopsies, and the last two mentioned significant fatty infiltration. Looking at my Lab. results at the time of the Fibroscan, my ALT was 216 and AST 208. In March 2008, ALT/AST were 88/89 and in December 2008, the ALT/AST was 69/71. I only give these figures to suggest I had increased inflammation at the time of the Fibroscan, thus giving an artificially high reading. I have no doubt I was cirrhotic, as the biopsy in 2001 was F3-4. I question the reading- 30 kPa is very high.

My followup after SVR was on a newer machine. My weight had gone from 90 kg in 2008 to my present 78 kg. I think the reduction in score was due to decreased fatty infiltration and inflammation. My ALT didn't normalise until 3 months post SVR, and still remains high-normal.

I can palpate my liver, and know what a normal liver feels like. Mine has decreased in size, but is still firm but softer than before SVR.

I think my initial reading should have been about 20, and my followup reading feels about 12.

I think my Hepatologist agrees. He was initially very enthusiastic about Fibroscan. I had to beg him for a followup, and when the reading came out at 8.8, he seemed dubious.

I should do the right thing and have a liver biopsy, but I won't. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 74 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +4 years

Malcolm



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Interesting article lot of useful information
Regards fibroscan are you saying that you do not believe the reduction in your score from 30 to 8.8 is an accurate indicator of your fibrosis regressing from 4 to 2/3
I thought that fibroscan was as good as biopsy at indicating cirrhosis but not so good at higher scores ie predicting the severity of cirrhosis
Are you suggesting that whilst fibroscan is a good indicator of fibrosis level up to the onset of cirrhosis
Post SVR. A reduction in score is not so accurate and may be attributed to reduced inflammation rather than fibrosis regression ?
Even so surely a reduction from 30 to 8.8 must indicate a much healthier liver and one would imagine that some of that must be a result of reduced fibrosis


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60 yo male cirrhotic fibroscan 23 base VL 105000 alt250 ast 200 bil high started trial nov. 6 week results alt 32 ast 30 VL blinded other tests normal range



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Thanks Mallani, excellent article.  Life may never be the same, but it certainly can be better!

Here's to SVR for all



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This is a good article on the subject.

 http://onlinelibrary.wiley.com/doi/10.1111/liv.12734/pdf



-- Edited by mallani on Monday 26th of January 2015 03:43:28 AM

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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 74 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +4 years

Malcolm



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Hi all,

This is prompted by another thread, 'Liver damage and repair'.

We are all aware that SVR is as good as we can get. The tiny risk of relapse is enough for some to say 'We are not cured- just successfully treated'.

We tend to concentrate on the liver. We look at blood tests and are happy to see normal liver enzymes, and are told that our liver fibrosis will regress. This may be true. In patients with a Fibrosis score of < F3, this will happen in most cases. In cirrhotics (and possibly the F3-4's) it's not so certain. The only way to know this for sure is to have a liver biopsy before treatment, and another 5 , then 10 years after SVR. The only data available to date, is from the SVR's using Interferon and Ribavirin. The DAA's haven't been around for long enough. Reports generally state that 50-60 % of cirrhotics with an SVR will have an improvement of at least one fibrosis stage in 5 years post SVR. Some cirrhotics (variously stated at 5-10%) will have some worsening of liver fibrosis. This suggests that some patients have ongoing inflammation, despite SVR. In fact, in about 5% of patients, the ALT never normalises, and remains slightly elevated. Why? Some suggest the possibility of an auto-immune hepatitis developing, or that there is continuing necrosis/regeneration of cirrhotic nodules. In these patients, the risk of HCC is higher than for those with a low-normal ALT. We are only talking about compensated cirrhotics, as decompensated cirrhotics were rarely treated with Interferon/ Ribavirin. On a positive note, it was observed that all cirrhotics with an SVR have some resolution of their portal hypertension. It should be mentioned that the search goes on for 'markers' that may indicate a better fibrosis response. It is probably a particular gene mutation, and there are some promising drugs that may help.

So we can ask, 'Is our liver cured' and for those with <F3, the answer will be yes. For cirrhotics, the answer is no, but for many patients, it is 'better'. We may never get detailed data about this, as many patients no longer have a liver biopsy before treatment. Getting them back for a repeat biopsy 5 years post-SVR is then futile. FibroTest and Fibroscan are not the same- I've gone from F4 (30kPa) to F2-3 (8.8kPa) in 15 months after SVR but I don't believe it.

Now we address the extra-hepatic manifestations of HepC. Those who have had chronic HepC for at least 20 years, will almost certainly have some extrahepatic problems. Whether this is due to direct action of the virus entering tissues, or whether it is autoimmune or part of mixed cryoglobulinaemia is still uncertain. Tissues and organs like thyroid, pancreas, nerves, muscles, joints, skin and lymph tissue are most affected. The vasculitis of mixed cryoglobulinaemia is very subtle, and hard to diagnose. It seems that those who develop cirrhosis have the most severe extrahepatic manifestations. Neuropathy, diabetes, arthralgia, hypothyroid problems are just a few common ones. If we are 'cured', these problems should resolve. From reading Forums, this is often not the case. In the old Interferon days, it was easy to blame this for any problems after treatment- and some of this blame was probably deserved.  We also become highly tuned to our body after successful treatment of a serious illness. Minor ailments become magnified- particularly in those who are getting old (>60?), and we are unwilling to take basic drugs to ease symptoms (they might damage my liver).  What I'm trying to say is that any discussion of 'cure', shouldn't just focus on the liver.    

It's an emotive topic. To each his own. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 74 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +4 years

Malcolm

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