Hep C Discussion Forum

Hi Gary,

That's good about your AST/ALT ratio. At least you know what to look for now.

RVR is usually determined by the Phase 3 Trials. For SOC and Incivek triple, this is defined as Undetectable HCV RNA after 4 weeks of treatment. For the Victrelis triple, this is at 8 weeks. For the new DAA's, little has been said about RVR. Until advised otherwise, this should be assumed to be after 4 weeks Rx.

The SVR rates quoted to patients are usually established during Phase 3 Trials. Quite often, these are modified after practice in 'the real world'. For the Incivek and Victrelis triples, the VA published revised SVR rates, and each Hepatologist will develop his own figures, based on experience.

Cirrhosis is a histological diagnosis, based on disruption of liver architecture, fibrous bands and scars, and regenerative nodule formation. Liver biopsy will identify this. When Fibroscan was first used in 2008, patients had both a liver biopsy and a Fibroscan. This allowed the prediction of cirrhosis using the Fibroscan reading ( usually above 17 kPa). Cirrhosis also has a typical Lab. profile, mostly based on ALP, albumin, platelet count and Prothrombin time. Some Hepatologists diagnose cirrhosis, based on these findings. However, some well-compensated cirrhotics do not develop these Lab abnormalities. Depending on a number of factors, patients can live a normal life with compensated cirrhosis for many years. However, it is progressive, and unless the cause ( in our case HCV) is removed, decompensated cirrhosis or HCC will eventually develop.

Re your question about Rx-experienced patients. This mostly applied to previous Interferon treatments. If you had previous SOC and were a non-responder, your SVR chances were less. If a partial responder, SVR chances were better. If a responder but relapser, chances of SVR were better still, and close to the Rx-naive rates. These days, with the new DAA's and Interferon-free, I don't think it makes much difference. Cheers.

Gary, Are you close to Canada?  I found a place that does the Fibroscan, in Toronto.     I was thinking of taking a trip to Niagara Falls, and maybe heading over to Toronto to have one done.  My PA doesn't think it is indicated, and didn't recommend a biopsy either, so if I do this it will be purely for my own peace of mind.

I really don't know if the place I found is reputable or not, but they advertise $100 for the test.    http://www.liverscan.ca/  It almost seems to good to be true, and I am a natural skeptic.  

Doh. So sorry. Looking again at the last lab test, my AST was 86. Alt was 92.  I guess I said it backwards before.

Mallani I am really encouraged by your success given your circumstances. A few questions:

1) Your RVR (Rapid Virological Response?). Can you define when this event occurs? (I never heard of it till now).

2) How are the figures about subsequent SVR chance calculated and by who?

3) I accept that I have cirrhosis. As I understand it, this is scaring of the liver. I would assume that the more scaring, the worse for liver function.  And the inverse of course.  Can you help me understand why my thought here is incorrect, in light of your 'no degree of cirrhosis' comment?

(I'm not challenging you. just trying to learn. thank you).

Gary

Thanks, and I agree about your liver enzyme levels not being too much cause for concern.  One thing I noticed is that your AST level is a bit higher than your ALT and it`s usually the other way around.  That could be an indication of cirrhosis, although you`d need to have that confirmed by a fibroscan test as the liver enzyme levels can fluctuate quite a lot from time to time anyway.

Even if you do have cirrhosis you`ll still have to do the same duration of treatment so it doesn`t make a lot of difference, although I can understand your concern about reducing the dose of Ribavirin if it becomes necessary.   Let`s hope it doesn`t come to that anyway, best of luck!

Hi again, yes, I did miss your edit earlier!  And yes, I did read your previous posts and the thread you referred to.

An ultrasound scan won`t necessarily detect fibrosis or cirrhosis, but there is an alternative to a biopsy, called a `fibroscan` which was approved by the US FDA last year.  It`s not quite as reliable as a biopsy in some ways but has certain advantages, mainly that it`s a non-invasive procedure.  Here`s some information about it, from the Hep C Advocate website...

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/fibroscan.pdf#search=%22fibroscan%22

Apart from your viral load, do you have any recent lab results for your liver enzymes (ALT and AST)? 

Ok, well that`s unfortunate.  It`s just that you either have cirrhosis or you don`t as far as the staging goes.  I was just wondering if maybe you had some degree of `fibrosis` rather than `cirrhosis` as such. 

I don`t think I can really comment on that then if you don`t have access to your records, although maybe your NP does?  Certainly if you do have cirrhosis then that will lower your chances of success, going by the chart, and I agree that it does indicate the importance of trying to stay on the full dose of Ribavirin, if possible. 

Sorry I can`t help you more! 

Hi again, hepcsurvivor, I`ve had a look and I see what you mean about the lower percentage success rates for cirrhotic patients. 

When you say you have `some degree of Cirrhosis` are you basing that on a recent biopsy result?  And if so, do you know what the actual stage was?  That would be very helpful information, thanks.