Hep C Discussion Forum

wmlj1960 · Moderator

An old cirrhotic's tale-part2

mallani · Guru

Hi Mike,

Good question. There are many causes of liver fibrosis, and removing the cause should help stop the damage. For HCV and alcohol-induced fibrosis, the pattern is quite different. Fibrosis from HCV occurs in the periportal areas, whereas alcohol induced fibrosis occurs in the percentral and perisinusoidal areas. The mechanism is the same- liver cell damage/ death releases cytokines that activate the stellate cells (and others) to produce collagen. In alcoholics, there is chemical damage from acetaldehyde (produced by breakdown of alcohol in the liver), and also a change in gut bacteria. The cirrhosis pattern from HCV is a little different from alcoholic cirrhosis, but the end result is the same, with haphazard fibrous bands and regenerative nodules.

We know there are slow, intermediate and rapid fibrosers. This is almost certainly controlled by genes. The alcoholic gene alleles are well known. With HCV, it's not yet been fully researched.

After removal of the source of injury (virus or alcohol), these genes almost certainly play a part in fibrosis reversal. In theory, the stellate cells become phagocytic, resorbing collagen. Other cells (K.cells, WBC's) are involved. Various antifibrotic agents are being trialled.

In short, resolution of alcoholic liver fibrosis should be possible. Unfortunately there will be slow, intermediate and rapid regressers, and like HCV, some may not regress at all.

wmlj1960 · Moderator

Malcolm, is there any data to show a difference in rate or extent of the regression process for a cirrhotic liver after SVR + sustained alcohol abstinence in relation to whether the damage was due to HCV as opposed to long term alcoholism? Is there a difference in the damage to the scar tissue structure etc. dependent on the cause?

It makes no difference I supposed seeing as how the damage is done. The first step of the solution is obviously removing the cause of damage, but I was wandering about possibly a means of enhancing the healing process that may work for an HCV damaged liver or, if not, an alcohol damaged liver.

wmlj1960 · Moderator

dustbear wrote:
I have a friend who is SVR and still thinks he is cirrhotic. Who knew that it could change!

Hi Julie. You do know that your friend may, or may not still be cirrhotic even after he has achieved SVR. SVR can enable the liver to heal and returning to a non-cirrhotic condition is possible, although it is not a short-term process. A test (biopsy, FibroScan, Fibrosure etc.) is needed to determine cirrhosis or not and that test result is not affected by HCV viral load, or sustained lack of viral load (SVR).

I may have misunderstood your comment... Just checking your wording? smile

-- Edited by wmlj1960 on Sunday 31st of January 2016 04:19:50 AM

dustbear · Senior Member

This is super duper fantastic news! smile

Thank you for sharing this because I have a friend who is SVR and still thinks he is cirrhotic. Who knew that it could change!

robertsamx · Guru

Great news Malcolm! Thanks for all the detail-Giving all us hope for cirrhosis regression. Your leading the way. Thank you. RC

Zlikster · Guru

Congrats! I had hunch it would be F2-F3 ;)

A1/F3 is a great result. Next time hoping for A0-A1 / <F2 :)

Matt Chris · Guru

Hey Malcolm

Super congrats on your results, again you are leading the way for the rest of us to follow.

I attribute your great improvement to two things, staying physically active and changing your diet to a healthy less fatty choices. Whatever the reasons it's shows that the human body has the ability to repair itself given the right circumstances, good attitude and good habits by its host. BTW how is your golf game doing?

matt

wmlj1960 · Moderator

Excellent news Malcolm! This result certainly exceeds your hopes for "F3-4 with A0-1", and it is very encouraging for us cirrhotics. I know the having "NO nodules" is good news and will give you peace of mind for the future. It's a shame you couldn't get the MRE due to inexperienced personnel but that doesn't surprise me nor does specialist being "to busy to do these 'mundane' procedures." when it comes to biopsies. In my experience you couldn't expect any better here in the USA.

Like Brownie, I was also interested in your doctor's concern about your platelet count. I was at my orthopedic surgeons office today discussing options for my upcoming surgery to remove metal hardware used in my back surgery in Nov. 2014 and he said that my platelet count of 64 would be an issue.

Wow, you've traveled a tough road to beat HCV! Having the opportunity to fish with your grandson for years to come couldn't have happened for a better person. Thank you so much, once again, for sharing your results and knowledge with us all.

Shadowfax · Guru

Wow, just wow Malcolm,

This is fantastic news and something I never thought I would see. You must feel like a kid at Christmas! Congratulations and best of health to you. Your post has given so many of us a new look at all of this.

Just amazing!

dharmabum · Senior Member

Malcolm,

This is stunning news! I think that going forward you may not need additional needle biopsies? Perhaps you can rely on FibroScan going forward, as your liver will continue to improve. Thank you for sharing this; there is meaning here for every single one of us. Just brilliant!

JimmyK · Guru

Malcom the news is greatly welcomed by us all. It is simply stunning!

I am speechless !

JimmyK

Cinnamon Girl · Guru

Hi Malcolm, this is absolutely amazing news. I was hoping for a noticeable improvement, as we all were, but for your liver to have recovered to the extent where you are no longer cirrhotic is wonderful to hear. And in the space of just less than 3 years since your last EOT!

Thanks for reporting back in such detail, this is hugely interesting and gives hope and encouragement to many of us here.

I`m so pleased for you, you truly do deserve this after the long and difficult path you endured to finally achieve SVR, and now you can really relax and get on with the main business at hand... enjoying your retirement!

Thanks as always for such a detailed and informative post, and for sharing your knowledge and experience with us.

Congrats on such a wonderful result smile

Rufus1 · Member

That's great news Malcom for you and everyone with hep c after Svr A

Groupergetter · Guru

Great news Malcolm, catch one for me. smile I've been fishing and boating more, and enjoying my grandson. He took about 10 steps yesterday. A blast to watch them grow and learn. Hoping my cirrhosis improves as yours has. Like you, I still deal with the neuropathy which is noticeably worse when lying in bed. Contributes to the insomnia. Maybe I should try sleeping in the standing position? biggrin Be well, and thanks for all you do to help others here.

movebo · Member

Excellent news, congratulations. I was anticipating your biopsy etc all weekend. Happy for you, though not quite selfless ... Tom

mallani · Guru

Thanks guys.

I asked the Pathologist about the relative loss of popularity of biopsies. He is aware that many Hepatologists now rely on FibroScan in Queensland but hasn't noticed any drop in biopsy workload. He's obviously biased, but to him, biopsy is still the gold standard. He is often asked for an opinion on biopsies from other regional hospitals. He is appalled that so many biopsies are done by junior doctors, who often produce a pathetic, small and un-diagnostic core of tissue. Specialists are now too busy to do these 'mundane' procedures.

Brownie: My doc used a 17 gauge needle which is pretty big. I only used 18 or 19 gauges. Obviously, the bigger the biopsy needle, the better the core sample. However, it does increase the risk of bleeding. Also, he biopsied my left liver lobe which had never been touched before. It's a lot easier and safer just to do the R. lobe. I wouldn't worry about the platelets. They do drop with age and also become less 'sticky'. IMHO, anything over 100K is fine.

Greg D · Senior Member

What wonderful wonderful news Malcolm! I'll let you get around the shock you must be in but I have to say how proud we all are of you. Quite a journey my friend! Excellent news.

Jaded · Senior Member

Congratulations Malcolm...what a journey. It's very encouraging to know that regression of cirrhosis happens and can only hope for the same. Enjoy your life and thanks for keeping us posted.

-- Edited by Jaded on Wednesday 20th of January 2016 05:25:41 AM

Tig · Admin

Outstanding news Malcolm! I'm excited for you and what it means for your future. That's a remarkable reduction in fibrosis and the lack of nodules is great news. You paid dearly for this bit of excellent news and pay off it did!! Congrats mate, truly deserved...

Brownie · Senior Member

I'm happy for you, Malcolm. Now you can put your mind at ease and start believing your good fortune. Congratulations!

One thing in your story that stood out for me was your platelet count. It was within the normal range yet it worried your doctor? My platelet count went up to 105 which is still way low. What can I do (if anything) to get my platelets up into the normal range? It worries me.

Linuxter · Guru

Stunningly Wonderful News Malcom! This sounds better than you had even hoped (if I'm reading correctly). No more cirrhosis and it appears from your post, very close to F2-F3 if not already there.

Sounds like you'll have LOTS more time to spend boating with your grandson, life is good.

Congrats on the great news Malcom!

Dave

mallani · Guru

Hi all,

This is a bit lengthy. I'll start with a brief summary for the newbies.

Prologue:

Almost certainly infected in Vietnam in 1969.

Abnormal LFT's during 1970's led to liver biopsy in 1982= A0,F0.

After diagnosis of HepC in 1990, biopsy in April 1990 showed A1,F1.

After 2 attempts with Interferon, then Interferon/Ribavirin, biopsy in 1998 showed A3,F3-4.

Relapsed after another trial of Interferon/Ribavirin in 2000, so went out to enjoy life, as there were no other options on the horizon.

FibroScan in August 2008 was 30.1 kPa (cirrhosis). Started to get worried and starting looking at the new anti-proteases.

Did 48 weeks of Victrelis/Peg/Riba in 2012. Undetected after week 8, stayed that way until EOT (12.2.13). SVR 6.5.13

FibroScan Feb 2014 was 8.8kPa. Not believed. So, almost 2 years later, I decided to find out what's really going on in my liver.

The interesting bit:

Had bloods done last Saturday. All normal, but platelets down a bit to 148K. INR normal.

Had the new ELF Test done. I discussed this in a previous post. My reading came out at 8.8. For this test, <7.7 means little or no fibrosis. >11.2 means certain cirrhosis. For these two groups of patients, no more needs to be done. For 7.7-11.2, this is called 'íntermediate fibrosis' and further testing with FibroScan and/or biopsy is required.

Had the FibroScan on Monday (Echosens). 18 good readings gave an average of 9.7 kPa. This equates to F2-3.

My Hepatologist did the biopsy yesterday morning, under Ultrasound guidance and copious LA. I had asked for 4 sample sites, but he did two passes at both the R. and L. liver lobes. He got 4 good cores of tissue, each 2-2.4 cm in length. As he was using a 17 gauge Tru-cut biopsy gun, he decided to call it quits in view of my platelets. There was minimal discomfort, but after lying on my side for 3 hours, he wanted an MRI to check the biopsy sites. This was done, and just showed the expected amount of bleeding. I had hoped to get MR Elastography performed as well, but the only Technician who had a clue about how to do it was on leave. The duty Radiologist was a young pup who didn't know what I was talking about. Sigh.

Back to Brisbane this morning and have reviewed the slides with the Chief Pathologist from the Princess Alexandra Hospital Liver Unit. He was very impressed as each core of tissue had >15 portal areas to view. We had my old slides (or rather photos) from my 1998 biopsy.

I don't have the formal report as yet, but essentially I am A1, F3. There is very minimal inflammation, no piecemeal necrosis and no fat in the hepatocytes. There is periportal fibrosis, a few porto-portal septae and only a few thin bands joining central veins. The contrast between the thick bands seen in 1998 is dramatic. There are NO nodules, so I am no longer cirrhotic. I am being discussed at the Saturday Liver Meeting.

I am lucky to be one of the ~50% who show resolution of cirrhosis after SVR. I encourage any cirrhotic who obtains SVR, to get a biopsy, as I don't think FibroScan is good enough.

So I'll just manage my peripheral neuropathy and mild diabetes and stop worrying about HCC. Cheers and thanks for reading.

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