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Hep C Discussion Forum -> General Discussion -> HCV Advocate Newsletter - November 2012
Post Info TOPIC: HCV Advocate Newsletter - November 2012
Bouba


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RE: HCV Advocate Newsletter - November 2012
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Interesting link

http://www.hepatitisaustralia.com/__data/assets/pdf_file/0013/1534/Fibroscan_Transient_Elastography.pdf



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58 yo male, HCV since 1981. Gen 1B (IL28B, CT). Diagnosed 1999,  VL before tx 100'000. Biopsy A2, F3 fibrosis. Naive, SOT (with Incivek) Oct 26, 2012. UND @ week 4, 12, 18, 24, UND 12 and 24 weeks post-RX
Bouba


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Thanks, Malcolm. No, no, not confusing at all. Find it very clear and educative. As all the stuff, that you post smile Keep well! 



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58 yo male, HCV since 1981. Gen 1B (IL28B, CT). Diagnosed 1999,  VL before tx 100'000. Biopsy A2, F3 fibrosis. Naive, SOT (with Incivek) Oct 26, 2012. UND @ week 4, 12, 18, 24, UND 12 and 24 weeks post-RX
mallani


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Hi Bouba, we are getting away from Steff's post. The problem with liver biopsy has always been the dependence on the skill of the Biopsier and the Pathologist. Added to that is the fact that only 1 or 2 segments of the R liver lobe are sampled. Cirrhosis may not be uniformly spread though the liver, so there is always the risk of over-reading or under-reading the Fibrosis Stage by + or - 1. You are correct in that Fibroscan is very accurate for F0-1, and for F4 ( ~95%) . Calibration seems to vary but 0-6 kPa is F0-1, and >19 kPa is F4. F3 seems to start at ~10 kPa. So anything from 6-10 is F1 or F2. Bit confusing, but better than the other non-invasive formulae. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 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 +5 years

Malcolm
Bouba


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Thanks, Malcolm, for your prompt reply. Noteworthy, and I am talking of my own experience, that it is uneasy to establish a good correlation between biopsy and fibroscan results. Unless you do both simultaneously and perhaps several times. Which, as you said, no one would line up for. I had a minor and mild inflammation on 2 biopsies done in 2000 and 2004. And already F3 fibrosis on the last one 2 months ago. While in between, 2007 and 2009 fibroscans showed 4.5-4.7 kPa, with fibrosis starting benchmark anywhere between 8 and 12. I was surfing on the web trying to find an answer but it seems  there is no consensus on this matter. The bottomline of what I have found was

qte FibroScan have excellent utility for the identification of HCV-related cirrhosis, but lesser accuracy for earlier stages. Refinements are necessary before these tests can replace liver biopsy.unq

In simple words this would mean that fibroscan works in case of a very mild (good elacticity) inflammation or a cirrhotic liver but could have quite an overlap in readings between a moderate and stage 3 phase?

While biopsy tissue is very segmental as well and may not represent the processes in the entire organ, though giving a good indication of what is going on.

Do I read it correctly? Is there a solution to a more accurate findings?

Cheers!

 



__________________

58 yo male, HCV since 1981. Gen 1B (IL28B, CT). Diagnosed 1999,  VL before tx 100'000. Biopsy A2, F3 fibrosis. Naive, SOT (with Incivek) Oct 26, 2012. UND @ week 4, 12, 18, 24, UND 12 and 24 weeks post-RX
mallani


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Hi Bouba, no antifibrotic drugs have been approved. Many are being studied, mostly collagenases that can resorb fibrosis. Most researchers now seem to agree that liver fibrosis can be reversed, particularly if SVR is attained. Even a course of failed Rx seems beneficial in many cases. One of the main problems is getting repeated, accurate histological diagnosis. Nobody is going to line up for repeated liver biopsies, so there is a lot of guesswork. Biopsies can give false results (+ or - two grades). It's a very complex issue but it gives me some joy. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 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 +5 years

Malcolm
Bouba


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Malcolm et all,

 

Has anyone heard of antifibrotic meds coming into the market? I recall I read something about it but could not trace it back. My doc told me that eradication of the virus will reverse the fibrosis, but yet I wonder if there is a supplementary treatment available.  Assuming the virus is UND, how long can it take from that point to have the fibrotic tissue fully regenerated from F3? Thanks in advance for an insight. Cheers!



__________________

58 yo male, HCV since 1981. Gen 1B (IL28B, CT). Diagnosed 1999,  VL before tx 100'000. Biopsy A2, F3 fibrosis. Naive, SOT (with Incivek) Oct 26, 2012. UND @ week 4, 12, 18, 24, UND 12 and 24 weeks post-RX
mallani


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The Abbott results are very impressive. The quadruple Rx should really take care of mutations. For the next trials, I hope they do a breakdown into liver fibrosis subgroups. We are seeing some improved figures for Geno 1b compared with 1a- this is not surprising considering the 1b structure is more stable.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 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 +5 years

Malcolm
greenqueen


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http://www.hcvadvocate.org/news/newsLetter/2012/advocate1112.html



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Geno 3a. 24 wks tx 20/10/05 - 06/04/06. Achieved SVR.
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