First of all, thanks for the responses. All the tests except the VL were done last February when I started struggling with the health care provider to get treatment. That included a tumor marker test which was 8.3. My VL has been the same all along the way, prior to and 6 mos post Victrelis/Int/Riba. The liver enzymes bounce around a bit but stay just about the same also. The VL test I posted is from 2013. My current GI doctor was skeptical of the Fibrosure test but obviously felt I needed to get treatment ASAP. The first round of blood tests and another ultrasound since starting Harvoni is scheduled next Monday. I expect to be undetected mainly because of being undetected at 8 weeks on the previous triple treatment. The Fibroscan deal hasn't been mentioned so far and the availability here seems limited.
-- Edited by Lowrider on Tuesday 27th of January 2015 03:00:32 AM
-- Edited by Lowrider on Tuesday 27th of January 2015 03:03:32 AM
Tig said
Jan 26, 2015
Hi LR,
My first question is when we're these blood tests performed? There are some obvious elevated levels, that on the surface present the possibility of cirrhosis. The biopsy of 15 years ago is really a mute point right now, it only shows your condition then. I would be open to a biopsy or Fibroscan but don't know the recommendation while you're under treatment. The Fibroscan would be non invasive and easier at this stage of treatment however and could be done without much fanfare, a biopsy is more involved certainly.
Your viral load in this test remains quite elevated if this was just done. A result of over 4.2 million IU/ml would be something I would expect to see pre treatment, not after 6-7 weeks of Harvoni Tx. That's why I asked when it was performed. We've been seeing more undetected VL's at week 4 of Tx with Harvoni than most any previous protocol, so yours is unusual for the same time period.
It appears that you had a Fibrosure test, which is a blood test that measures various things in the blood and is said to show stages of fibrosis, yours is high. That test however isn't as accurate as either a biopsy or Fibroscan results. Fibrosure has been shown to be less accurate at the low and high end of the test parameters. The Fibrosis score and Necroinflammatory score are the two tests that determine the FibroSure result.
The Alpha 2 Macro is another test that is performed and provides additional information (markers) of fibrosis or cirrhosis. Here is a link to more data.
The last two tests are the liver enzymes, the GGT and ALT are both elevated, which are simply indications of liver inflammation and disease. You have some obvious indication that something is awry in your liver function. You can check our search function for that info or Google it for more data.
I think you've obviously got some issues that your doctor can explain to you better than I. I'm only providing an opinion, so please bring your questions and concerns up with your healthcare team. Hope this has helped. Good luck with treatment.
Tig
mallani said
Jan 26, 2015
Hi Mark,
You've had a FibroTest/ActiTest done for liver staging. This uses a variety of biochemical parameters.
The FibroTest component measures the liver fibrosis. Your value is 0.85. Anything > 0.75 is called F4 (cirrhosis).
The ActiTest measures the liver inflammation. Yours is 0.71. Anything > 0.6 is called A3 (severe inflammation).
So, you have cirrhosis but there is no date on the report. A normal ultrasound is not unusual in cirrhosis.
A biopsy is not necessary during treatment. You are doing 24 weeks of Harvoni which is standard for a cirrhotic who has relapsed on Victrelis.
I remember you had a bad time on the Victrelis triple, requiring Procrit and severe Riba dose reduction. It's a shame you couldn't do 48 weeks back then as you had an RVR.
Have you had a VL since starting Harvoni? I may have missed it. Cheers.
Lowrider said
Jan 26, 2015
Below are test results that seem to me out of whack, but who am I to judge? Trying to determine if there is cirrhosis along with the high score for fibrosis. I am 7 weeks into 24 weeks of Harvoni, prior relapse a couple years ago Victrelis/Int/Rib 28 weeks. HCV1A. No biopsy in over 15 years. That biopsy didn't show cirrhosis or fibrosis, only some fatty deposits. I am wondering if it is advisable to have a biopsy during treatment? I don't have liver pain, enlargement, stiffness, etc. Thanks for any insights.
Component
Standard Range
Your Value
Flag
HCV RNA, QUANT TMA
<43 IU/mL
4233212
H
HCV RNA,Quant,bDNA
<1.63 log 10
6.63
H
This test was performed using the COBAS AmpliPrep / COBAS TaqMan HCV Test Kit (Roche Molecular Systems, Inc).
Patient not fasting
Component Results
Component
Standard Range
Your Value
Flag
FIBROSIS SCORE
0.00 - 0.21
0.85
H
FIBROSIS STAGE
SEE NOTE
F4 - Cirrhosis
NECROINFLAMMAT ACTIVITY SCORE
0.00 - 0.17
0.71
H
NECROINFLAMMAT ACTIVITY GRADE
SEE NOTE
A3 - Severe activity
Alpha-2-Macro.
110 - 276 mg/dL
427
H
Haptoglobin
34 - 200 mg/dL
81
APOLIPOPROTEIN A-1
110 - 180 mg/dL
133
Bilirubin Total
0.0 - 1.2 mg/dL
0.5
Newborns, term and near term: mg/dL 24 hours old: 0.0 - 8.0 48 hours old: 0.0 - 13.2 72 hours old: 0.0 - 15.6 96 hours to 1 month old: 0.0 - 16.6 Children 1 month and older and Adults: 0.0 - 1.2
GGT
0 - 65 IU/L
119
H
ALT
0 - 55 IU/L
88
H
Interpretation
INDICATION: Hepatitis C
COMPARISON/CORRELATION: None.
FINDINGS: Real-time ultrasound of the upper abdomen was performed. Color flow
and spectral Doppler evaluation of the portal vein was done as well. Permanent
images were recorded.
The liver has a normal sonographic appearance . Flow in the portal vein is
hepatopedal. Spectral and color Doppler characteristics are normal. The
gallbladder contains a single mobile stone, 12 mm in maximum dimension. The bile
ducts are normal in caliber throughout; the common bile duct has a maximum
diameter of approximately 3.1 mm. The pancreas appears normal. .
The right kidney is 10.0 x 5.2 x 5.9 cm and appears normal.. The left kidney is
10.9 x 5.1 x 5.4 cm and appears normal also.
The aorta appears normal. The IVC appears unremarkable.
The spleen is approximately 9.6 cm in length and appears normal.
First of all, thanks for the responses. All the tests except the VL were done last February when I started struggling with the health care provider to get treatment. That included a tumor marker test which was 8.3. My VL has been the same all along the way, prior to and 6 mos post Victrelis/Int/Riba. The liver enzymes bounce around a bit but stay just about the same also. The VL test I posted is from 2013. My current GI doctor was skeptical of the Fibrosure test but obviously felt I needed to get treatment ASAP. The first round of blood tests and another ultrasound since starting Harvoni is scheduled next Monday. I expect to be undetected mainly because of being undetected at 8 weeks on the previous triple treatment. The Fibroscan deal hasn't been mentioned so far and the availability here seems limited.
-- Edited by Lowrider on Tuesday 27th of January 2015 03:00:32 AM
-- Edited by Lowrider on Tuesday 27th of January 2015 03:03:32 AM
Hi LR,
My first question is when we're these blood tests performed? There are some obvious elevated levels, that on the surface present the possibility of cirrhosis. The biopsy of 15 years ago is really a mute point right now, it only shows your condition then. I would be open to a biopsy or Fibroscan but don't know the recommendation while you're under treatment. The Fibroscan would be non invasive and easier at this stage of treatment however and could be done without much fanfare, a biopsy is more involved certainly.
Your viral load in this test remains quite elevated if this was just done. A result of over 4.2 million IU/ml would be something I would expect to see pre treatment, not after 6-7 weeks of Harvoni Tx. That's why I asked when it was performed. We've been seeing more undetected VL's at week 4 of Tx with Harvoni than most any previous protocol, so yours is unusual for the same time period.
It appears that you had a Fibrosure test, which is a blood test that measures various things in the blood and is said to show stages of fibrosis, yours is high. That test however isn't as accurate as either a biopsy or Fibroscan results. Fibrosure has been shown to be less accurate at the low and high end of the test parameters. The Fibrosis score and Necroinflammatory score are the two tests that determine the FibroSure result.
http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/91402
The Alpha 2 Macro is another test that is performed and provides additional information (markers) of fibrosis or cirrhosis. Here is a link to more data.
http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9270
The last two tests are the liver enzymes, the GGT and ALT are both elevated, which are simply indications of liver inflammation and disease. You have some obvious indication that something is awry in your liver function. You can check our search function for that info or Google it for more data.
I think you've obviously got some issues that your doctor can explain to you better than I. I'm only providing an opinion, so please bring your questions and concerns up with your healthcare team. Hope this has helped. Good luck with treatment.
Tig
Hi Mark,
You've had a FibroTest/ActiTest done for liver staging. This uses a variety of biochemical parameters.
The FibroTest component measures the liver fibrosis. Your value is 0.85. Anything > 0.75 is called F4 (cirrhosis).
The ActiTest measures the liver inflammation. Yours is 0.71. Anything > 0.6 is called A3 (severe inflammation).
So, you have cirrhosis but there is no date on the report. A normal ultrasound is not unusual in cirrhosis.
A biopsy is not necessary during treatment. You are doing 24 weeks of Harvoni which is standard for a cirrhotic who has relapsed on Victrelis.
I remember you had a bad time on the Victrelis triple, requiring Procrit and severe Riba dose reduction. It's a shame you couldn't do 48 weeks back then as you had an RVR.
Have you had a VL since starting Harvoni? I may have missed it. Cheers.
Below are test results that seem to me out of whack, but who am I to judge? Trying to determine if there is cirrhosis along with the high score for fibrosis. I am 7 weeks into 24 weeks of Harvoni, prior relapse a couple years ago Victrelis/Int/Rib 28 weeks. HCV1A. No biopsy in over 15 years. That biopsy didn't show cirrhosis or fibrosis, only some fatty deposits. I am wondering if it is advisable to have a biopsy during treatment? I don't have liver pain, enlargement, stiffness, etc. Thanks for any insights.
(Roche Molecular Systems, Inc).
Patient not fasting
Component Results
F4 - Cirrhosis
A3 - Severe activity
24 hours old: 0.0 - 8.0
48 hours old: 0.0 - 13.2
72 hours old: 0.0 - 15.6
96 hours to 1 month old: 0.0 - 16.6
Children 1 month and older and
Adults: 0.0 - 1.2