Fibrosis F4

[SonjaTheGF]

Hi guys!
I’d like to ask you some questions, here is a short background:
My boyfriend has been carrying hep C virus (genotype 1a) for over 20 yrs and has never been cured because of the very limited options. Few months ago we discovered Harvoni and he decided he wants to start a therapy with this ‘miracle’ He had done a biopsy in september 2015 and he was told that his liver looked alright and that he had “milder hepatitis”. He was happy to hear that and after that he focused just on getting the virus off of his body, thinking that once he gets rid of it the liver will be just fine. He started Harvoni therapy about a month ago (16th Feb), meanwhile he did a fibroscan and he was diagnosed with F4 stadium (with 23,4 kPa) and told that he was one step close to having cirhosis.
So, my question is: What happens with the stage of fibrosis once a man is HCV free? Does Harvoni just get rid of virus or does it also improve the fibrosis? We are very confused and don’t know what to think so we decided to just ask you people with experience.

Hopefully I’m making sense, thanks in advance!
Sonja

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HCV genotype 1a
Hbs and Hiv negative
1 485 632 IU/ml —-> <12 IU/ml
ALP 90 —> 82
AST 54 —> 27 —> 22
ALT 85 —> 45 —> 24
GGT 114 —> 101 —> 44
(above-mentioned improvement after 4 pills of Harvoni and then after 40 days)
Fibroscan 23.4 kPa (F4)
Harvoni 12 weeks – started on 16th of Feb 2017

[splitdog]

Once the virus is eradicated, the liver begins to heal. It is one of the organs that heal quickly, and will reverse it’s damage to a degree. There is a thread on it somewhere around here…..

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splitdog@roadrunner.com

Genotype 3
VL 4,100,000
ALT 101 AST 71
Treatment Naive
Started Sof/Dac Jan 12, 2016
VL= <15 4 weeks in. AST/ALT normal.
VL=UNDETECTED 8 weeks in.
SVR4= Virus back. 3,300,000

Started generic Epclusa Sep. 23, 2017

4 weeks in <15 *Detected.
12 weeks in <15 *Not Detected.
16 weeks in <15 *Not Detected.
Finished 24 weeks treatment 3-17-18
SVR5 <15 Not Detected.
SVR 20 <15 Not Detected.
SVR 44 <15 Not Detected.

Thank you Jesus.
Thank you Dr. James

[Dr James]

Hello Sonja,

23.4 kPa is > 12.5 kPa which is where we say a patient has cirrhosis.

Yes, this is likely to improve with treatment. I think Hazel here has the record having gone from 40 kPa before treatment to 9.5 kPa after.

These numerical improvements are nice to see but here is what’s really important:

As you can see, patients at SVR are much less likely to die than patients who still have Hep C

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YMMV

[SonjaTheGF]

Thanks for your answers guys!

James, yes it’s cirrhosis. The thing is they wouldn’t tell him directly, probably because they know he tends to panic. And he does, he’s been really depressed since he found out yesterday that the 23,5 kPa means cirrhosis. He’s afraid that even if he cures the virus his liver will stay in a bad shape, or even get worse (God forbid)
And I’m trying to convince him to stay positive and focus on getting rid of HCV.

How did Hazel succeed to improve his numbers so drastically? Great for him!

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HCV genotype 1a
Hbs and Hiv negative
1 485 632 IU/ml —-> <12 IU/ml
ALP 90 —> 82
AST 54 —> 27 —> 22
ALT 85 —> 45 —> 24
GGT 114 —> 101 —> 44
(above-mentioned improvement after 4 pills of Harvoni and then after 40 days)
Fibroscan 23.4 kPa (F4)
Harvoni 12 weeks – started on 16th of Feb 2017

[lukemeister1990]

Stiffness measured by Fibroscan doesn’t say too much about real liver condition. It is only scale of inflammation. So, maybe your BF doesn’t have cirhossis. Biopsy is much more representative, because there are checked liver tissues.

After treatement, when the virus is gone, liver is not eaten by inflammation, and stiffness goes down. In some cases it is quite fast process, in others take some time…

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GT 3a
Contracted: October 2008
Diagnosed: March 2009
First treatement:
VL 250.000 IU/ml
Fibrosis F0
Start: November 2010
Copegus+Pegasys (24 weeks)
EOT: VL UND
SVR24: VL DETECTED
June 2016
Fibrosis F2 (9.1 kPa)
VL 1.230.000 IU/ml
Second treatement:
SoviHep+DaciHep (24 weeks)
Start: 13.08.2016
VL UND: 30.08.2016
VL UND: 27.01.2017 (EOT)
EOT+4 weeks: AlAT 9.8 SVR4
EOT+8 weeks: AlAT 9.7
EOT+12 weeks: AlAT 7.0
EOT+28 weeks: AlAT 7.6 SVR28

[Hazel]

SonjaTheGF wrote:

Thanks for your answers guys!

How did Hazel succeed to improve his numbers so drastically? Great for him!

Yes, feels great to me.
Who knows how it went down so far so fast. I was not perfect in taking it any particular way. Maybe what I did different was I lost a lot of weight too- about 25 kg over that time- maybe that took my poxy liver cells with it. I did that by cutting out sugar, reducing portions- all of a sudden it was easy to do, maybe it somehow seemed worth it, I had a kind of ‘ trudging towards doom’ attitude until it got serious, and there suddenly was an answer. But, maybe something about the cirrhosis itself- scan revealed was all mostly in one spot, not evenly spread through liver, which may be unusual. Good luck to your partner, it really is worth it.

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Genotype 3 30 years, 2x treatment interferon/ribavirin non responder. Cirrhosis 17 years. Fibroscan, decompensating, 40 down to 22 by 29/3/16- now down to 6.5, normal, no cirrhosis. Started Buyers Club Sof/Dac 14 Nov 15. SVR 12 29/0716

[SonjaTheGF]

Lukemeister:
Thanks a lot for your message! It gives us hope that it’s not that bad after all… And the doctor who did the biopsy 1,5 yrs. ago was also surprised to hear the fibroscan results. He was performing the biopsy in the same time he was doing laparoscopic gallbladder surgery on my BF, so it seems like he had a good view on the whole liver. I’m mentioning this because I read that the biopsy can be misleading since only a small piece of liver is taken…?

Hazel:
Hi Hazel, thanks for showing up.
My BF is 48 yrs old (HCV infected in 1993), 176 cm and 74kg so he doesn’t really need to lose any weight (you probably were not in your ideal weight?). He’s been careful about what he eats for 1,5 yrs (since his gallbladder was removed) and he’s not been using any alcohol etc. So his lifestyle is quite alright, the only thing he can’t master is his nervousness…
Thank you once again and good luck to you too!

P.S: Some more info about my BF:

HCV genotype 1a
1 485 632 IU/ml
Hbs and Hiv negative
Glucose 5,1
Urea 3,4
Creatinin 74
Proteins 62
AST 27
ALT 45
ALP 90
GGT 101
Amylase 78
LDH 186
calcium 2.34
sodium 141
potassium 3.82
chloride 104.2
CRP 0.30
Fibroscan 23.4 kPa (F4)

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HCV genotype 1a
Hbs and Hiv negative
1 485 632 IU/ml —-> <12 IU/ml
ALP 90 —> 82
AST 54 —> 27 —> 22
ALT 85 —> 45 —> 24
GGT 114 —> 101 —> 44
(above-mentioned improvement after 4 pills of Harvoni and then after 40 days)
Fibroscan 23.4 kPa (F4)
Harvoni 12 weeks – started on 16th of Feb 2017

[Dr James]

What are his platelets from the full blood count? If > 100 that is good and > 150 that is normal

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YMMV

[SonjaTheGF]

His platelets were 173 (9th of Dec 2016), so it’s okay. How is this linked to liver/ cirhosis, if I may ask?
Thanks for explaining.

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HCV genotype 1a
Hbs and Hiv negative
1 485 632 IU/ml —-> <12 IU/ml
ALP 90 —> 82
AST 54 —> 27 —> 22
ALT 85 —> 45 —> 24
GGT 114 —> 101 —> 44
(above-mentioned improvement after 4 pills of Harvoni and then after 40 days)
Fibroscan 23.4 kPa (F4)
Harvoni 12 weeks – started on 16th of Feb 2017

[Dr James]

If you go here:

http://www.hepatitisc.uw.edu/page/clinical-calculators/apri

You can put in the AST or 27, the upper limit of normal (40) and the platelets of 173 to get an APRI of 0.39.

This is low and the clinical trials often use 2 for cirrhosis.

The high fibroscan probably represents relatively low fibrosis with high inflammation. The inflammation causes swelling and is a bit like blowing up a balloon that is caught in a net. It gets stiff not because there is a lot of net (the fibrosis seen in cirrhosis) but because of the swelling.

I would predict that with treatment AST will end up at 10-15, platelets around 200 and fibroscan drop to 7-9.

What your BF has is at the very mild end of things and a good response is expected.

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YMMV

[SonjaTheGF]

Thank you very much James! We feel so much better now.

I’m really happy that I shared the story on this forum. Thanks again to all of you.

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HCV genotype 1a
Hbs and Hiv negative
1 485 632 IU/ml —-> <12 IU/ml
ALP 90 —> 82
AST 54 —> 27 —> 22
ALT 85 —> 45 —> 24
GGT 114 —> 101 —> 44
(above-mentioned improvement after 4 pills of Harvoni and then after 40 days)
Fibroscan 23.4 kPa (F4)
Harvoni 12 weeks – started on 16th of Feb 2017

[SonjaTheGF]

Hi guys, I’m here to give you some update.
My BF did blood tests last Monday (40 days after 1st pill of Harvoni) and his results (in comparison with the previous results) were:
Glucose 5,1 4.9
Urea 3,4 3.9
Creatinin 74 80
Proteins 62 78
AST 27 22
ALT 45 24
ALP 90 82
GGT 101 44
Amylase 78 86
LDH 186 159
calcium 2.34 2,36
sodium 141 (same)
potassium 3.82 3,6
chloride 104.2 101
CRP 0.30 (same)

And from 1 485 632 IU/ml to <12 !

We are so glad, we had to share it Have a nice day all of you!

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HCV genotype 1a
Hbs and Hiv negative
1 485 632 IU/ml —-> <12 IU/ml
ALP 90 —> 82
AST 54 —> 27 —> 22
ALT 85 —> 45 —> 24
GGT 114 —> 101 —> 44
(above-mentioned improvement after 4 pills of Harvoni and then after 40 days)
Fibroscan 23.4 kPa (F4)
Harvoni 12 weeks – started on 16th of Feb 2017

[coral]

Hi Sonja,

I was just catching up on your posts. It’s so good to see those lovely numbers heading in the right direction for your BF. We can all relate to the anxiety and it’s good to see the happy quota increasing in your posts!

[SonjaTheGF]

Hi guys!
My BF finished his 12 weeks therapy and did PCR test that says he’s NEGATIVE!
We were really happy to see that although he’s still worried about his F4 and doesn’t know what to expect. He’s planning to do Fibroscan once again by the end of the year. Hopefully we’re gonna have another good news to share.
Have a nice day all of you and good luck to everyone who’s fighting this virus!

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HCV genotype 1a
Hbs and Hiv negative
1 485 632 IU/ml —-> <12 IU/ml
ALP 90 —> 82
AST 54 —> 27 —> 22
ALT 85 —> 45 —> 24
GGT 114 —> 101 —> 44
(above-mentioned improvement after 4 pills of Harvoni and then after 40 days)
Fibroscan 23.4 kPa (F4)
Harvoni 12 weeks – started on 16th of Feb 2017

[coral]

Great news for your BF and you Sonja. I should think with that result his Fibroscan results will improve.

[Author]

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