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Post Info TOPIC: Liver damage and repair
Gator Man


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RE: Liver damage and repair
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Along with fibrosis regression, a corresponding improvement in portal hypertension will substantially decrease life threatening complications from advanced liver disease, particularly variceal bleeding. At my EOT + 24 week doctor's appointment, he told me that I had returned to a normal life span and had no reason to believe that my cirrhosis would progress now that I am SVR. Other than regular HCC monitoring and abstaining from alcohol, the news is positive for those of us with advanced fibrosis. The more recent articles on fibrosis like Pam's post, offer increasing support for the idea that fibrosis/cirrhosis is a dynamic process capable of improvement if the underlying cause is eliminated. All the more reason to get Tx as soon as possible.

Good stuff! Thanks Pam.smile



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Geno 1b, compensated cirrhotic, 54 yo, prior null responder. Pre tx VL approx 595,000, tx with Sovaldi/Olysio (no Riba) started 1/8/14. VL 40 @ 2 weeks, UND @ 4 weeks. Still UND @ EOT + 1 year.

Gator Man SVR12, Dragon 0, Final Score.
Ro


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Mine too!!!  So hopeful

Ro



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pamelajean


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You're most welcome, Tig and Ro. Of all the research I share...this is my favorite! 



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Ro


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Great info!  Thanks for sharing.

Hopeful for the healing

Ro

 



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Tig


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Hey Pam,

Just wanted to echo Roger's post! That was an excellent article on fibrosis regression. Thank you for sharing it! Such promising information provided in it!

Tig



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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pamelajean


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My pleasure. :) 



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rblood


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Thanks pamelajean!

Very encouraging news! Thanks for posting!!



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pamelajean


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With my Dx of cirrhosis with ascites...tx S/O and SVR 12...Regeneration has been one of my big concerns. A couple of weeks before tx my ultrasound showed cirrhosis, ascites, enlarged spleen and portal hypertension. SVR 12 my ultrasound was normal! No portal hypertension, no ascites, no cirrhosis and no spleen enlargement. Of course we are all different...but thought I'd share my notes regarding regeneration. 

"I was told by more than one liver specialist.. cirrhosis does not reverse after tx" Unfortunately those liver specialists must not be up on the latest developments in hepatology.
 
Early cirrhosis, compensated, class A, cirrhosis is reversible in many people. That is why people with compensated cirrhosis on transplant waiting lists are now being safely treated for their hepatitis C in hopes that they will not go on to need liver transplants. Many papers (AASLD papers, Hepatology Magazine articles, etc.) have been written on this subject disproving the older theory that cirrhosis was irreversible.
 
Pol S, Carnot F, Nalpas B, et al. Reversibility of hepatitis C virus related cirrhosis. Hum Pathol 2004; 35: 10712.
 
George SL, Bacon BR, Brunt EM, Mihindukulasuriya KL, Hoffmann J, Di Bisceglie AM. Clinical, virologic, histologic, and biochemical outcomes after successful HCV therapy: a 5- year follow-up of 150 patients. Hepatology 2009; 49: 72938.
 
Shiratori Y, Imazeki F, Moriyama M, et al. Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy. Ann Intern Med 2000; 132: 51724.
 
Mallet V, Gilgenkrantz H, Serpaggi J, et al. Brief communication: the relationship of regression of cirrhosis to outcome in chronic hepatitis C. Ann Intern Med 2008; 149: 399403.
 
Bruno S, Crosignani A, Facciotto C, et al. Sustained virologic response prevents the development of esophageal varices in compensated, Child-Pugh class A hepatitis C virus-induced cirrhosis. A 12-year prospective follow-up study. Hepatology 2010; 51: 206976.
 
Further studies are now being done by Gilead to see if decompensated, Class B and End-Stage Liver Disease patients, Class C patients, can be also be cured using Sovaldi treatments. Since these patients couldn't be treated before safely with previous treatment we will have to see how curing their hepatitis C (if possible) will affect their advanced liver disease and liver disease prognosis. While some cirrhosis is reversible the chance for reversibility declines as the liver goes through more advanced disease.
 
Review Article: The Reversibility of Cirrhosis
A. A. Sohrabpour, M. Mohamadnejad, R. Malekzadeh
Disclosures
 
Aliment Pharmacol Ther. 2012;36(9):824-832. 
 
 
Methods:  A PubMed search was performed and the evidence for histopathological regression of advanced fibrosis/cirrhosis following drug therapy was reviewed as of the end of February 2012.
 
Results: There is abundant clinical evidence in support of the idea of the reversibility of cirrhosis in patients with different aetiologies of advanced hepatic disease including viral, autoimmune and metabolic/infiltrative liver disease.
 
Conclusions: The concept of cirrhosis has changed from being a form of static and irreversible entity to a dynamic and reversible diseases stage. Novel therapeutic strategies are under investigation to target specific steps in the process of fibrogenesis with the aim of reversing advanced fibrosis/cirrhosis.
 
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In patients with chronic HCV, a strong relationship exists between hepatic inflammation and fibrosis, the researchers wrote. In patients with ongoing chronic disease, increases in inflammation are associated with fibrosis progression. In contrast, achieving SVR and eradicating HCV, not just receiving interferon therapy, is associated with a marked reduction in inflammation and fibrosis regression.
 
Of the patients who achieved SVR, 40% were clear of any fibrosis and 50% were clear of cirrhosis. 
 
The future of HCV treatment is to suppress HCV with multiple oral antiviral agents without interferon and/or ribavirin, the researchers wrote. The observations of the present study strongly suggest that fibrosis regression, including resolution of cirrhosis, will occur in the vast majority of patients who will achieve SVR with these future therapies.
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Patients who are cured of their HCV infection experience numerous health benefits, including a decrease in liver inflammation as reflected by improved aminotransferase (ie, alanine aminotransferase [ALT], aspartate aminotransferase[AST]) levels and a reduction in the rate of progression of liver fibrosis. (Poynard, 2002b) Of 3010 treatment-naive HCV-infected patients with pretreatment and posttreatment biopsies from 4 randomized trials of 10 different IFN-based regimens (biopsies separated by a mean of 20 months), 39% to 73% of patients achieving an SVR had improvement in liver fibrosis and necrosis (Poynard, 2002b) and cirrhosis resolved in half of the cases. Portal hypertension, splenomegaly, and other clinical manifestations of advanced liver disease also improved. Among HCV-infected persons, SVR is associated with a more than 70% reduction in the risk of liver cancer (hepatocellular carcinoma) and a 90% reduction in the risk of liver-related mortality and liver transplantation. (Morgan, 2013); (van der Meer, 2012); (Veldt, 2007)


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rblood


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Thanks Tim,

That is good news knowing they will keep checking. And they keep track of it too.

I have had the endoscopy once. They found ulcers. I treated them with Braggs Vinegar. That was seven or eight years ago and I have not had a problem since. I didn't have health ins. at the time and it was about $2000.00 then. I had a colonoscopy done at the same time which was another $2000.00 They found polyps (non cancerous) but now have it checked every three years.  



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hrsetrdr


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Hi Roger,

I am over 2 years post-tx, Kaiser continues to monitor me for liver cancer, they recently did an annual ultrasound and I just got a letter from my gastro doc stating that I am cancer-free. I hope that they intend to continue monitoring in the future.

I need to request that they do a follow-up endoscopy to check on a benign tumor they found in my stomach last time they did the procedure.

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"hrsetrdr"=Tim

Treatment halted on Aug.8,2012 due to vision problem.  6 month post tx labs

Aug.2013 SVR

Be strong when you are weak, brave when you are scared, and humble when you are victorious.
- Unknown

 

 
rblood


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Thanks Tig and Dragonfly,

The reason that question came to mind is that I got a notice from Kaiser today telling me they would be calling to set appointment for my six month liver ultrasound. I am assuming at this point even after I clear from the virus they will still be doing the ultrasound every six months checking for cancer......Roger

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dragonfly


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From what I have read those with a lower level of decompensated cirrhosis can revert to compensated.  I hope so - watch this space!

 



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Tig


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Hi Roger,

I'm pleased to hear that you're doing well after your first week! These new drugs are truly a blessing. We have fortunately witnessed a huge improvement in the reduction of side effects, but also the rates of success and the duration of treatment. It's an excellent triple play if you ask me!

There is evidence of improving fibrosis levels following SVR and as we would expect they are keeping a close eye on these results. We have members that have achieved SVR using other protocols and a year afterwards have reported evidence of improvement. So we don't know how long these improvements may take or in whom on a consistent basis, but the early reports are extremely promising. I think we have every reason to believe that the future looks excellent not only for SVR in general but fibrosis reduction as well. At least that's my plan and I'm sticking to it!!

Tig



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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rblood


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Hello,

One week of Harvoni behind me and all is well! I'm very happy to say that.

I have heard that the liver does an excellent job of healing it's self. Does anybody know if the fibrosis will heal and go away after the body has cleared the virus?....Roger



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