you are a pwer of example!

way to go and thanks for info same happened for me after 6 months post treatment and will have another one done in September and post results thanks again for upport and knowledge base

Bill emma and raven and ????

Good news on so many fronts Malcolm - very pleased for you. 

Enjoy your golf with those new clubs!!!  Caroline

Malcolm,

That is an amazing fact - congratulations, an additional positive result to being HCV-free.  I have wondered about my case where I had more than half of my liver removed and according to the surgeon, it has grown back.  I have fantasized that it has grown back with no fibrosis, and maybe it has.  I will check this later when I see my HCV doc. 

Until then, such great news for you and all those with similar conditions.  Way to go!

Bill

Thanks for the info, Cheryl, and congrats!  It's very encouraging to hear news of post-treatment fibrosis improvement.  It's what we're all hoping for.  Best wishes..

wayne 

A similar story: My Fibroscan just before experimental treatment with asunaprevir/daclatasvir was 49.6 kPa; 12 mos. post-treatment, it is 18.0 kPa. That's still within the 17-75 kPa cirrhosis range, but coming down very fast! My gastroenterologist said he's seeing this kind of improvement fairly often. Amazing, eh? He also said I was still at risk for HCC until my kPa was down to about 6-8 kPa. So definitely taking ultrasound every 6 months. I was unable to digest meat or dairy (except yogurt or kefir) for many years. Now I've started eating meat occasionally, with no ill effects. I hope I'll be brave enough to try some nice cheese soon!

Goody!

You are amazing!

A big huge.  Enjoy !!!!!!

malcolm,

you're an inspiration to us all!! news like this give us all so much hope.

congratulations

sandy,ucbgal

Not longwinded. More like informative and concise, as always. Thanks, Malcolm!

Wayne

Fantastic news Malcolm! I knew that the liver could heal to a certain extent but had no idea that the fibrotic damage could actually reverse. My gastro doc & staff have "alluded" to my having some sort of nodes, or other "mild" cirrhosis(like being mildly pregnant I guess), but with attaining SVR any further questions are moot.   I believe that they said I would have a biennial  ultrasound to watch for HCC.

I'm quite sure that you'll get a lot of use on those new golf clubs- congratulations and enjoy! 

Tim

Congratulations Malcolm, this is astonishingly good news!!  You have every right to be over excited right now, anyone who`s been through what you have would be feeling the same!  And thanks for the detailed explanation, we are thankful to have you here to share your knowledge with us all.  This gives hope to many of our members, especially those with cirrhosis, and I`m so pleased for you!

Make good use of those new gold clubs, you deserve it! 

Thanks for the info, I am happy for you and it makes me hopeful. Now that your liver is getting better you won't need a handicap in youe golf game. lol

Thanks guys.

Olden: My doc told me about 50% of patients show regression of one fibrosis stage (or more) after SVR, but this can take years. I am certain that there are 2 reasons for the decrease in my Fibroscan score. The first is decrease in fatty infiltration. All my 3 previous biopsies showed 'moderate fatty change'. I was always borderline Diabetes 2, from my random and fasting blood glucose. This was partly dietary as I have a sweet tooth, but there was probably an element of Insulin Resistance due to autoimmune HepC induced changes. A direct pancreatic effect from HCV damage is also possible. Since starting treatment, my blood glucose has dropped to low-normal, and my fasting Insulin is also normal. This has a direct correlation with fatty liver so I am certain my liver is now 'less fatty'.  Inflammation is another cause of a high Fibroscan score. At the time of my previous scan, my enzymes were between 100 and 200 (VL 1.6m) so there would have been significant periportal and portal tract inflammation. This has now mostly gone.

I am pretty good at palpating my liver. It is now smaller, and softer. The edge is still firm, so I still have a fair amount of fibrosis. Remember than you can have normal liver function with only 10-15% of normal liver. The aim of treatment is to eliminate the virus and stop progression of liver damage to below those magic percentages.

Histologically, it goes like this. After SVR, there are no longer cytokines being released from damaged hepatocytes. The stellate cells stop producing collagen. Instead they become giant cells and macrophages and start dismantling the fibrosis. The first scars to go are those surrounding the blood vessels. The vessels dilate, the portal venous pressure drops, and portal hypertension ( varices etc) is no longer a problem. The decreased portal pressure allows better perfusion of the liver, with better oxygen supply. This promotes healing. The limiting plate is the membrane between the blood sinusoids and hepatocytes. In cirrhosis, this is quite thick, decreasing the flow of nutrients and drugs to the hepatocytes. This has been shown to decrease in thickness dramatically.  Next to go are the septae and fibrous scars. A lot depends on how thick they are. They may never be resorbed. Fibrous tissue is treated as a foreign body by the liver, so there will be continuing resorption.  Remodelling will then occur as the liver heals itself. There are several germ cell sources in the liver, so new hepatocytes are not a problem.

It is unknown why some patients do not show this response. Sorry to be longwinded as usual, but I am over-excited and have just been to order a new set of golf clubs!

Zlikster, buddy: F1 is just a number. You stay F1 until you get your next drugs. I'm kust happy to go with the flow. Cheers.

Great news! 

Wow! Malcolm

I did'nt know you could drop a Fibroscore that far that fast. Shows the power of the human body to heal itself given the correct conditions.

Malcolm you really are an inspiration for all us cirrhotics, to never give up and try treatment again when we fail.

Sounds like you Aussies have a great deal cooking with Abbvie, hope it works out for both parties. Abbvie is committed for the long run with developing newer versions of there current DAA's which is important for all Gene types.

Cheers matt

Malcolm

That's amazing buddy, I would have never dreamed it could drop like that. Congratulations and the best of luck and health to you!

I'd settle for being called an "F2-3 whatever".   I think it's fantastic achieving that kind of improvement, Malcolm!  

A couple of questions:  Is this a typical response post-treatment?  I am early in tx, but often wonder about my liver's (F4) odds of improvement should I achieve SVR.  And... what's going on histologically that allows for the improved fibrosis score, aside from absence of viral inflamation?

i want to see you @ F1 next fibroscan session :) u ain't taking any antifibrotics, rite?

best

HI MALCOLM, CONGRATS ON YOUR 52 WEEK RESULTS.  WAY TO GO!!   GLAD TO SEE YOUR FIBRO RESULTS CAME DOWN, MY FIBRO IN DEC 2013 WAS 38, AND BIOPSY IN JAN 2014 WAS STAGE4. MY DR. TOLD ME ONCE I CLEAR THE HCV THAT MY FIBRO/BIOPSY RESULTS WOULD GET BETTER, AND YOUR RESULTS SEEM TO BACK THIS UP. MY HEART SUNK WHEN I WAS TOLD I WAS A 38-F4    IM 17 DAYS INTO RIBA/SOFOSBUVIR AND FEEL GREAT, JUST A LITTLE TROUBLE SLEEPING AND AMBIEN FIXED THAT. THANK YOU SO VERY MUCH FOR YOUR WISDOM AND ENCOUREGMENT TO ALL THE MEMBERS AND GUEST ON THIS FORUM, YOUR KNOWLEDGE IS BOTTOMLESS, AND KINDNESS ENDLESS  !!  I GO IN TOMORROW FOR MY 2 WEEK FOLLOW UP AND WILL GET MY ONE WEEK RESULTS, I CANT WAIT TO POST THE RESULTS.  TAKE CARE, PLEASE STAY PLUGED INTO THIS FORUM RC  

Hi Malcolm

Hi all,

Saw my doc yesterday, and he sent me for a Fibroscan this morning.

In August 2008, my score was 30.1 kPa ( F4).  Now, at EOT + 12 months, it's 8.8 kPa!!!!!!!!!!!!! On most charts that is F2, but my doc's practice has their own chart, based on thousands of matched readings compared with biopsy findings. They call me an F2-3. Whatever.

It's reassuring, but I was told not to get too excited. My doc allows for another stage to be added, so I still need the 6 monthly imaging to exclude HCC. He suggested getting a repeat Fibroscan and biopsy in 2 years, and depending on the findings, maybe I can reduce or stop the followup imaging.

He said my liver function is now normal and to go out and enjoy life. He's not convinced that any of the new anti-fibrotics have anything to offer.

We discussed the new DAA's. He was in charge of the AbbVie Trials in Queensland. They have all finished, with SVR rates in the 90-95% range. There is a rumour that AbbVie have done a deal with our Federal Government re pricing, when the AbbVie drugs are approved (estimated in the middle of the year). AbbVie have had the most extensive Trials in Australia compared with other companies, and have the Hepatologists on side. We may never see Sovaldi in Australia.

Despite being Dean of the University of Queensland Medical School, he's still seeing patients one half-day a week, so I'll see him in 12 months. I'm happy not to change Hepatologists. Cheers.