Hi Cristine,

Possibly what your physician was referring when he/she said there was no liver damage on Ultrasound was they didn’t see anything untoward as far as what an U/S usually can detect(ie nodules,tumors,cysts,overall size of liver,fatty areas).

U/S is not considered a good method to detect scarring (fibrosis) and certainly not to what degree.

Biopsy is still considered the gold std.in determination of degree of damage ,however not used very often as there is a plethura of other methods (some of which you mentioned,APRI,Fibroscan,Fib-4 and fibrosure)that are non-invasive.

My hepatologist (who is quite knowlegable in HCV) uses a combination of the above to assess degree of fibrosis. His thoughts are if the tests above show all relatively the same result he relies on that as a relative marker for amount of damage.

As you mention your APRI .61 would be considered very little fibrosis and yes the Fibrosure .68 would be considered more advanced fibrosis.
Having them done at the same time again and adding in a Fib-4 and a fibroscan may give a clearer picture .

However as Hazel mentions now that your are treating and eradicating the virus you are stopping the assault that your own body is reacting to on your liver and damage stops and studies yes do show there is some regression in fibrosis afterwards(especially in the first while post treatment.)

Hope that helps

S

Hello Christine,

To have an APRI of 0.61 with an AST of 83 your platelets must be about 330. Nobody I know with cirrhosis has platelets anywhere near that high – they are all <140 and typically <100.

The ONLY clinical significance (given we are treating now, can't treat you last year, etc) is would we like to use either longer treatment or Ribavirin. With GT1b being in the easy to treat category, you being a female, an no real indication of cirrhosis 12 weeks Rx will be just fine.

Platelets of 199 are good, they are normal, not low, not worrying.

Yes the AST and ALT fall on treatment (and so does the APRI). This is why APRI is only applicable to people PRE treatment – when they were looking at the numbers and the correlation with liver biopsy it was all in untreated patients…

I think you are overthinking things a bit. Your liver is in the state it is in and we know, because you’re posting, it’s good enough to keep you ticking over. We also know, that in the context of ongoing Hep C infection, it’s likely to get worse rather than better as time passes.

The question of cirrhosis (or not) relates only to odds of success, treatment duration, +/- ribavirin and the need for long-term HCC follow up.

The realm of the possible is treat, cure, and allow recovery. The earlier we do this the better. The only 100% specific way to assess fibrosis is liver biopsy and that has a whole lot of issues best avoided and why we have all the other ways of making an informed guess.

If you look at all the various tests that exist we see the best we can get is 80-90% so it’s really a matter of coming to terms with that degree of uncertainty.

Hello Chrisine,

That’s a perfectly reasonable response for ALT and AST – they are now 1/3 of what they were. You AST is lower than your ALT which is always a good rule of thumb sign. In most countries and ALT < 40 or 50 would be normal. Your lab probably says <35 and for all intents and purposes that's where you are now. Platelets are sensitive to how blood is drawn. If the draw is slow they stick together and you get lower levels, but they are not worrying.

Congratulations Cristine, that’s awesome . Keep doing what you’re doing and looking forward to reading your SVR post soon .

Congratulations Cristine! That is fabulous news.
Best of luck the rest of the way!
S

Hi Cristine
I don’t know you but I can say with certainty you’ll be SVR by summers end and you liver damage is very likely to reverse itself in time. I am a person whose liver damage was a 3 but my doctor now says I’m a 0-1. The liver has a remarkable way, and I think the only organ, to reverse damage once HCV is cured. So my advice is to stay the course and now UND <15and that is the best you can get on almost any test in the world.
Keep up the great work, positive attitude and always know we are here to support you and be beside you until you’re 100% cured.
May God be with you.