TOPIC:

This concern relates to the fear of severe fibrosis and/or cirrhosis. My ultrasound showed no damage (Doc was convinced I had no liver damage.) When I pressed for more evidence of no liver damage (I knew something was going on, hair loss, insidious itching, fatigue) she ordered a Fibrosure blood test. Result was 0.68 which is almost an F4 (0.71 being F4) That's high!

My APRI score was 0.61 but that's based on blood levels 7 whole months ago & even though I know my AST rose from 55 to 83 as of 2 months ago, I don't have a recent platelet score in order to calculate a more current APRI score. Hopefully will get new blood tests today at my 4 week check.

I do wish we had a Fibroscan available here. Apparently, only 3 private practices in Colorado have the equipment so its not possible to get it unless they're your physicians.

Any advice would be appreciated at how to best determine the possibility of fibrosis/cirrhosis. Thank you.

Hi Cristine,
I can't answer about your results and what it means but I can say- you are on treatment, so whatever is, already is; and really, it is how you feel, and how your liver is a few months after treatment that matters more than knowing exactly now...
You have probably heard or been told that there is irreversible damage possible- or certain, and that this will give you issues forever even when cured. As we say in NZ, yeah nah. I was told in 2003 after a biopsy that I was F4- it was a shock, I wasn't that old then, young kids- but I trudged through. I reached liver decompensating in 2015- tipping over the edge when I found FixhepC and got cured. All good, but what about cirrhosis?
It has gone. Happened really fast for me, I was lucky, but I am now F0 except for one rough corner, bit of fibrosis in it. I am pretty much normal, probably better than a drinker my age. So don't let the dread of numbers and scores worry you too much. There is nothing more you can do about whatever fibrosis you have now except fix it. Take the meds, drink the water, and let it repair from whatever starting point. Good luck!

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

Thank you Hazel and Songbird! At my 4 week check today, my doc said pretty much the same thing, i.e.: I do not have cirrohis but do have some fibrosis but that it may be reversible with the HCV treatment. I told her I calculated my APRI and Fib4 and they were .61 and 2.15 respectively and she did not seem concerned enough to help me locate a Fibroscan.

Yes, it is what it is! ❤️ I feel like this diagnosis has changed me for the better in many ways. I've stopped drinking entirely, stopped chronic pain meds entirely, and totally revolutionized my diet so hopefully I will be able to live a long life Hep C free.

My compulsive personality, though, still wants a Fibroscan

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.

Dr James,
I might have calculated APRI wrong. It seems I was using the recent AST but a 7 month old platelet count. Its all so confusing! If I use the 7 month old AST:55 (increased to 83 from Oct-March) and 7 month old platelets:199 (the most recent I have) then the score is .69. I will have new numbers when my blood work comes back later this week.

It does all seem a bit arbitrary though because when the AST returns to normal during treatment (fingers crossed) the APRI and for that matter, Fib4, scores would automatically be significantly lower, even to the point of reflecting no fibrosis, whereas just a few months previous w/the elevated enzymes, they reflected fibrosis?

Curious.

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.

Greetings,
Did I ever thank you ALL for the help, information & support you've given me so far on my journey? What would we newly diagnosed folks do without you HCV veterans and these forums to guide us through the maze of diagnosis, testing, tx and recovery! I'll tell you; we would flounder, be totally lost!

My 4 week tx labs came back today. AST 27 (down from 83) ALT 38 (down from 124). I think it's good but not sure if both enzyme values are supposed to be in normal range or not. ALT is still elevated.

Platelets have fallen from 199 to 164 since last test in Oct but maybe they had fallen even further and now are on the way back up after 1 month of tx? I'll never know, I guess.

Dr James: Im over thinking everything again! It's my annoying nature; frequently, I even annoy myself!

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.

I have to share the fabulous news as I just received my 4 week on tx Quantitive RNA results: 15 iu 'undetected! Jumping for joy, seriously in tears! Thank you ALL so very much!!! ❤️

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

Thank you, Mar, for your support through this! I will definitely continue faithfully! ❤️

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

Hi Cristine,

I am catching up with everyone's good news. I remember how wonderful it was to get that first undetected so congratulations. Best of luck with the rest of your treatment.
Coral

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.