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TOPIC: My doctor is insisting on another Ultasound. Treatment 8/16

My doctor is insisting on another Ultasound. Treatment 8/16 2 months 2 days ago #28005

  • beahavan
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I finished treatment for G4 with Harvoni in 11/16. I had Ultrasounds in 2013, 2015 and 2018. They were fine. Now my doctor wants to order another. He says there are no guidelines that say that I am in the clear. I was F0-1 before treatment. I just saw this article posted yesterday in Greg Jefferys ‎ Hepatitis C Treatment Cure and Community Facebook group. I don't want to spend the time or co-pay on another Ultrasound but perhaps I should go along with my doctor's request.
‎http://hepcbc.ca/2019/02/22/no-time-to-relax-about-liver-cancer-after-hcv-treatment-time-to-change-monitoring-protocols/?fbclid=IwAR0qmWfb8UEU-RPz2Af4mijHF5AxGYxPRiFDF09GZ2E-ZSukuAQltBgd6Wg
G4
F0-F1
diagnosed in 2006
Tx naive
Treatment started 8/12/16, Ledipasvir/ Sofosbuvir (Harvoni) supplied by Monkmed
8/1/16 ALT 36 AST 40
1/4/17 ALT 17 AST 21
7/13/17 ALT 17 AST 25
12/28/17 ALT 22 AST26
2/22/18 ALT 19 AST 25
7/10/18 ALT 26 AST 32
1/8/19 ALT 16 AST 28
7/2/19 ALT 16 AST 26
Hcv Rna, Quantitative Real Time Pcr <15 NOT DETECTED (IU/mL) NOT DETECTED
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My doctor is insisting on another Ultasound. Treatment 8/16 1 month 2 days ago #28079

  • sabrecat
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Hi beahaven,

I was F3 from memory in 2012 when my G.P. found high AFP levels and a subsequent ultrasound a HCC.

Post liver re-section I was getting CT and ultra sounds every 6 months - now just ultrasounds. I think I progressed to F4 in the years following until treated successfully with DAAs.

I don't have to pay, but would if I had to. Just like servicing a car and probably cheaper too.

I understand that paying and getting the ultrasound done is inconvenient, but so was the HCC for me.

Hope this helps

Jeff
GT3a 1990 Failed Inter 1998, comb in 2000. HCC 2012
Started 24/52 Sof/Dac 27th October 2015.
1. Bloods 2 October 2015: AST - 165 (20-40), ALT - 265 (5-40), GGT 189 (5-50)
2, Bloods 20 November 2015: ALT etc normal; VL 19
3. Bloods 8 January 2016: AST - 40, ALT - 59, GGT 48 VL RNA UND
4. EOT 12 April 2016 - blood tests: all is well, CT scan: okay
5. AFP 11 June 2016: 4 ref< 11
6. VL July 2016: DET
7. Oct16 start treat - June17 UND
8. Jun 18, lfts okay, platelets a bit low.
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My doctor is insisting on another Ultasound. Treatment 8/16 1 month 2 days ago #28080

  • beahavan
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This is good advice. Thank you. I have had so many dental issues (root canal and dental implants) since treatment. I lost a lot of bone. This has been a great expense. I'm just worried about costs. However, you made a good point about maintenance. The cost of HCC would be a great deal more. I wish you well.
G4
F0-F1
diagnosed in 2006
Tx naive
Treatment started 8/12/16, Ledipasvir/ Sofosbuvir (Harvoni) supplied by Monkmed
8/1/16 ALT 36 AST 40
1/4/17 ALT 17 AST 21
7/13/17 ALT 17 AST 25
12/28/17 ALT 22 AST26
2/22/18 ALT 19 AST 25
7/10/18 ALT 26 AST 32
1/8/19 ALT 16 AST 28
7/2/19 ALT 16 AST 26
Hcv Rna, Quantitative Real Time Pcr <15 NOT DETECTED (IU/mL) NOT DETECTED
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My doctor is insisting on another Ultasound. Treatment 8/16 1 month 1 day ago #28086

  • DrJames
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Hello beahaven - from your F0-F1 starting point your HCC risk is pretty much the same as the general population (ie very small).

Normal, F0 and F1 are all close together. F3 and F4 are close together. F2 is a middle ground. You are at the lowest possible end for fibrosis and the lowest possible risk for HCC. While there is a push to extend surveillance to F3 patients there is not a push to extend it to F2 or F1 or F0.

Your doctor would seem to be being over cautious. Monitoring your AFP is almost certainly sufficient (if you are of a paranoid disposition), particularly if funds are tight.

If you were my patient I would not be monitoring you for HCC (with either AFP or U/S) and would have declared you cured.

The occasional patient with F0, F1 and F2 will get an HCC. So to will the occasional patient who does not have Hep C (or Hep B) or any other liver issue.
YMMV
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My doctor is insisting on another Ultasound. Treatment 8/16 1 month 1 day ago #28090

  • beahavan
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My last 3 AFP test results were
12/1/15 1.9
1/4/17 2.2
2/22/18 2.6

I will suggest another AFP test rather than an Ultrasound. Cost is an issue. Thank you.
G4
F0-F1
diagnosed in 2006
Tx naive
Treatment started 8/12/16, Ledipasvir/ Sofosbuvir (Harvoni) supplied by Monkmed
8/1/16 ALT 36 AST 40
1/4/17 ALT 17 AST 21
7/13/17 ALT 17 AST 25
12/28/17 ALT 22 AST26
2/22/18 ALT 19 AST 25
7/10/18 ALT 26 AST 32
1/8/19 ALT 16 AST 28
7/2/19 ALT 16 AST 26
Hcv Rna, Quantitative Real Time Pcr <15 NOT DETECTED (IU/mL) NOT DETECTED
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The following user(s) said Thank You: DrJames, coral, Sven, hanknassi, Mar

My doctor is insisting on another Ultasound. Treatment 8/16 4 weeks 1 day ago #28094

  • DrJames
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Hello beahavan,

Although there is a form of HCC that does not produce AFP the pre test probability of you having an HCC are the less than the general population (without HCV) because of all the monitoring we have done excluding it.
YMMV
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