TOPIC: Hepascores only work PRE treatment

So over here I had a bit of a rant about the difficulty of getting a Fibroscan and resolved to use Hepascores.

Now there are only 2 problems:

1) Despite being able to do it some Sonic labs claim they can't. Please direct them to this:

www.clinipathpathology.com.au/media/85361/cm-h.pdf

Clinipath is one of the many Sonic Pathology groups and it can be done via them. Sonic pass stuff between states, for example Hobart Path sends the HCV RNA tests to QML in Queensland. So don't take no for an answer!

The test itself is just put the bilirubin, GGT, alpha macroglobulin and hyaluronic acid results into a formula. Given that bilirubin, GGT and globulin are part of the LFTs it does not seem all that hard.

2) Because the numbers used essentially come from the LFTs, and we know that LFT results rapidly improve on treatment......

ONCE YOU START TREATMENT YOUR HEPASCORE IS GOING TO BE LOWER THAT IT WAS aka INACCURATE

So if you have started treatment and don't know your fibrosis score to guide a 12 vs 24 week decision you need to get a Fibroscan or just bite the bullet and either treat for longer on spec, or stop at 12 weeks and hope for the best.

Assuming a decent initial response then wouldn't fibroscan be lower also ie reduced inflammation?

Hi Dallo,

The inflammation and progression will slow and stop but the bridging/scarring that makes the liver stiff and is what the fibroscan measures takes much longer to heal. Similar to scars on your skin, it fades with time but it's a slow process and probably never totally resolves.

G

GAJ wrote:
I don't think that's correct. The inflammation adds significantly to the "stiffness" as well. It's late here but I'll try to find something in the Lit tomorrow. Personal anecdote: I recently treated and SVRed with the AbbVie meds (EOT January). My baseline fibroscan was 60.4. It was checked again when I had week 24 follow-up bloods done.and was 29.2. Still quite bad obviously but much, much better than baseline. Possible there was a little improvement in the histology but the only real explanation for the difference was cessation of inflammation. Same person ran both scans. 10 passes each time.

In the light of day with a clearer head, I withdraw the question. There's no doubt in my mind that ALT (in HCV context) is a good surrogate marker for liver inflammation, which means that higher ALT equates probably with higher fibroscan score. However, if you remove the inflammation, or most of it, as would likely occur with a decent response to the DAAs then you might actually get a clearer picture of the true situation re fibrosis if you deploy a fibroscan, and so performing that test during Tx to decide whether liver damage warrants Tx extension is actually a reasonable idea.

Thanks and I agree. To clarify for anyone else reading, while the inflammation causes the damage and if extensive can impact the fibrosis reading, it is the bridging/scarring that we are trying to measure to determine the length of treatment as we know that the worse that is the longer the treatment required.

Btw good reduction in F score Dallo. Your LFTs must have been pretty high pretreatment?

GAJ wrote:
Yeah, they were, mate. AST wasn't too bad but ALT was in the 200s and GGT about 300. I was lucky enough to get into the first AbbVie compassionate access program but there were months of red tape. The TGA had to pass individual treatment plans, something which had never been done in Australia before for HCV+. Seemed clear there'd be no problems (HIV+ had done it), but geez, it was a stressful time. And then there were some problems getting the meds from where they'd been made. It was all a really nervous time and the stress was bad. Sent my LFTs through the roof sky-high at a time when my liver seemed to be transitioning Child-Pugh A ---> B. Technically that would've made my place in the Access dicey since they were only treating compensated cirrhosis. I lost weight. It was a bad time. I had some edema and ascite which got much worse until I restricted sodium, and numbers of key markers were mostly going south.

Got the drugs and felt unbelievably better within the first week. Mind fog cleared, I had more energy. depression I didn't even know I had lifted, appetite improved, lots of other stuff. Just turned me around. Not that it really matters but I was UND by week 5. Never panicked about bloods after that because I simply knew the filth had gone. I felt too good, and having relapsed before I know how that feels.

My liver dude is really optimistic, feels that I should experience considerable regression of my situation. Having read a bunch of recent studies I'm not so sure, numbers say it's about the toss of a coin for significant regression, but hey, I'll take it

Cheers!

My cirrhosis isn't as bad as yours so far though my ALT/AST higher so lots of activity. Resect in Jun and ablate last month. Was so grateful to find the club in Oct and get tx. Three weeks in now and you're right about the differences. Didn't realise how down I was, just going through the motions so as not to worry others too much. Still a way to go but I feel alive again and ready to greet each day. Amazing what a bit of hope does. Yeah, specialist reckons that getting rid of the activity will slow or hopefully stop problems and should reverse some of the scarring with time.

Best wishes

GAJ wrote:
Cluster of tumours? What sort of ablation? Did they get it? I had a HCC resected back in '06, which was switched on by IFN/riba. Lucky it was really since AFP was high and the cancer was lurking, and when it turned feral I was being closely monitored. AFP started going exponential and they picked it up via U/S when it was about the size of a small pea. Also only a single tumour and fairly peripheral. Lucky all 'round. It was an aggro sucker though, no doubt fed by the iron in my system from riba action on my red cells.

Awesome. All the best!

Single units, both 8-10mm. S5 Resect - clean. S? RFAblation - radiologist pleased & CT last week with results at monitoring visit next week and no urgent calls so sounds good. Pretty much the same comments as you. Failed Peg/riba 2013 so close monitoring. Bloods went silly this year so u/s upped to MRI and CT and confirmed #1. Came out clean so thought okay. First 3mth scan in Sept picked up the other one. Found Greg then the club the same week as doc called me and here I am.

G

Yes but the reduction in Hepascore happens within days, whereas the Fibroscan results take weeks/months to fall and will remain usefully indicative.

With normal LFTs happening rapidly the Hepascore rapidly becomes inaccurate on treatment.

In a perfect wold you get a Fibroscan before treatment but if it's not possible and you don't want to wait.....

GAJ wrote:
So both stage 1. That's good. Took segment 6 with me.

Sounds like you've been well-handled. Cool stuff. The AbbVie meds have put my AFP into low normal range, which means no suss cells.

All the best!

James-Freeman-facebook wrote:
Yes, bloods seem to react quickly, and whilst GGT can come down reasonably quickly (though probably the slowest to react) bilirubin can sometimes sharply elevate, confounding the test all over the place.

An interesting one with the AbbVie meds seems to be an almost immediate bounce in platelets, and I know they were claiming it as a sort of surrogate marker for improvement in hypertension. Seemed a ridiculous claim to me given the time frame. Mine have improved a lot from baseline though.

Why aren't they deployed more? I assume inexperienced users can be a problem but why have them sitting around when they are obviously so useful?