Thanks Bouba. Followup after EOT will be viewed differently by Hepatologists and patients. Basicly it comes down to the risk of developing HCC. Non-cirrhotics may decide the risk is acceptable, and will decide not to have regular Ultrasounds. Cirrhotics will have 6 monthly Ultrasounds and annual Endoscopies (for varices)- they will also have 6 monthly blood tests to monitor ALT, bilirubin , albumin and AFP. This is IRRESPECTIVE of SVR. I will have a Fibroscan at EOT and probably get one done annually.
We know very little about the incidence of HCC after SVR. There are some figures from the early 2000's. HCV has been around for 22 years, and only now are we seeing large numbers of SVR's (from triple Rx). It will take years to assess HCC rates in different fibrosis Stages. It may be that an F2 with SVR has the same chance of developing HCC as the general population- obviously all this followup then becomes meaningless. For F4's, the risk will diminish with SVR. If it drops from 4% per year to 2% per year, I'll still be having my Ultrasounds. It's going to be an individual thing.
Bouba said
Dec 14, 2012
Malcolm,
Foggy brain, sorry, but wanted to say in the firstplace, great news that you dont have to worry about HCC for more now. Congrats and keep'em crossed!!!
Bouba said
Dec 14, 2012
Malcolm,
Thanks for bringing an interesting point. How would you assess your liver condition post tx? Besides the blood work... Has fibrosis been reversed or not? If yes, how would you know the stage? Fibroscan? Fibrotest? Another biopsy? Assuming, you are SVR 3 months post, what would be the prrotocol? Tks a word. Cheers!
mallani said
Dec 14, 2012
Had my 6 monthly Ultrasound today. No change so I don't have to worry about HCC for another 6 months.
I've had an annoying cough since week 30 (10 weeks). I explained it as a Ribavirin cough to my wife, but she insisted I get a Chest XR as well. It was normal so she's happy.
The question about followup imaging after EOT (+ or - SVR), is something we all have to face. This has been previously discussed, and some expressed concern about the recommended 6 monthly Ultrasounds. This is only to exclude HCC. As a cirrhotic, I have no problems with this. I would hate to achieve SVR only to develop an inoperable HCC. For the F2's to F3-4's, they will have to weigh up the risk, and see if they are prepared to subject themselves to an inconvenient schedule of Ultrasounds. Get as much advice as you can. Cheers.
Thanks Bouba. Followup after EOT will be viewed differently by Hepatologists and patients. Basicly it comes down to the risk of developing HCC. Non-cirrhotics may decide the risk is acceptable, and will decide not to have regular Ultrasounds. Cirrhotics will have 6 monthly Ultrasounds and annual Endoscopies (for varices)- they will also have 6 monthly blood tests to monitor ALT, bilirubin , albumin and AFP. This is IRRESPECTIVE of SVR. I will have a Fibroscan at EOT and probably get one done annually.
We know very little about the incidence of HCC after SVR. There are some figures from the early 2000's. HCV has been around for 22 years, and only now are we seeing large numbers of SVR's (from triple Rx). It will take years to assess HCC rates in different fibrosis Stages. It may be that an F2 with SVR has the same chance of developing HCC as the general population- obviously all this followup then becomes meaningless. For F4's, the risk will diminish with SVR. If it drops from 4% per year to 2% per year, I'll still be having my Ultrasounds. It's going to be an individual thing.
Malcolm,
Foggy brain, sorry, but wanted to say in the firstplace, great news that you dont have to worry about HCC for more now. Congrats and keep'em crossed!!!
Thanks for bringing an interesting point. How would you assess your liver condition post tx? Besides the blood work... Has fibrosis been reversed or not? If yes, how would you know the stage?
Fibroscan? Fibrotest? Another biopsy? Assuming, you are SVR 3 months post, what would be the prrotocol? Tks a word. Cheers!
Had my 6 monthly Ultrasound today. No change so I don't have to worry about HCC for another 6 months.
I've had an annoying cough since week 30 (10 weeks). I explained it as a Ribavirin cough to my wife, but she insisted I get a Chest XR as well. It was normal so she's happy.
The question about followup imaging after EOT (+ or - SVR), is something we all have to face. This has been previously discussed, and some expressed concern about the recommended 6 monthly Ultrasounds. This is only to exclude HCC. As a cirrhotic, I have no problems with this. I would hate to achieve SVR only to develop an inoperable HCC. For the F2's to F3-4's, they will have to weigh up the risk, and see if they are prepared to subject themselves to an inconvenient schedule of Ultrasounds. Get as much advice as you can. Cheers.