Aa
SVR and decompensated cirrhosis
Hi !
Today is 4th week after end of therapy. And HCV still undetected. But bilirubin is highj enough ( 2 mg/dL ) and PLT count is low. And mild ascite is in place ( mild ascite without diuretics and no ascite on diuretics )
As i know, in US and EU modern therapy become available much before other countries. So i has a question -
Is here somebody, who got significant improvement in liver functions and portal hypertension after SVR ?
Today is 4th week after end of therapy. And HCV still undetected. But bilirubin is highj enough ( 2 mg/dL ) and PLT count is low. And mild ascite is in place ( mild ascite without diuretics and no ascite on diuretics )
As i know, in US and EU modern therapy become available much before other countries. So i has a question -
Is here somebody, who got significant improvement in liver functions and portal hypertension after SVR ?
Thank you, Hector.
Today i has feel very well - i ride to job almost every day on bike or inline skates - it's abount 50km/day. Only problem for me is need to eat something sweety 1-2 times/50km, else i lost energy very fast.
I never had neither fatigue, neither jaundice.
Today i has feel very well - i ride to job almost every day on bike or inline skates - it's abount 50km/day. Only problem for me is need to eat something sweety 1-2 times/50km, else i lost energy very fast.
I never had neither fatigue, neither jaundice.
COMMUNITY LEADER
Here are the thoughts of one of the leading hepatologist and hepatitis C experts in the US on the treatment of hepatitis C in patients with decompensated cirrhosis.
My Take on New Guidance for Treating Genotype 1 HCV–Infected Patients With Decompensated Cirrhosis - Norah Terrault, MD, MPH - 5/5/2015
The Most Challenging Patients
"...All patients with decompensated cirrhosis should be simultaneously considered for liver transplantation. For those who are not eligible for HCV therapy, transplantation may be the only means of achieving improved liver function and prevent progression of decompensation with HCV treatment in the posttransplant period. However, there are certain patients with decompensated liver disease who are not transplant candidates, and we are motivated to treat those patients with the goal of stabilizing their liver disease and reversing their complications of liver failure. We have no data showing a mortality benefit from treating this population; however, encouraging preliminary data are emerging that patients do have improvement in their MELD and CPT scores following treatment, suggesting that reversal of liver complications is possible.
Treatment Timing and Other Considerations
When managing patients with decompensated cirrhosis, it is important to be mindful of the fact that treatment does not immediately alter the natural history of their disease or its complications. Thus, ongoing management of current liver complications and surveillance for new complications is essential. For example, it is important to provide prophylaxis for variceal bleeding or spontaneous bacterial peritonitis as indicated and perform surveillance for liver cancer at 6-monthly intervals. These patients are preferably treated in a facility that is affiliated with a liver transplant program that has expertise in managing these complications. For patients on the waiting list for transplantation, the timing of HCV treatment needs to take into consideration of anticipated time of transplantation and treatment decisions should be done in concert with the transplant physicians.
The big question is whether we can reverse liver decompensation to the point where the patient no longer requires transplantation. Will all patients who achieve SVR derive improvements in the MELD score, and by how much will the score improve? We don’t have the answers to these important questions and the lack of data complicates decisions regarding treatment of patients on the waiting list. Since the MELD score determines the priority for liver transplantation, a patient with decompensated cirrhosis who achieves SVR and a reduction in MELD score (but not necessarily improvement in his or her symptoms of liver decompensation) may become ineligible for transplantation and more likely to experience progression of liver disease. Defining the group of waitlisted patients who benefit most from HCV treatment is an important future goal. However, certainly for patients who are not transplant candidates, HCV treatment is an important intervention and these patients should definitely be treated in hopes of achieving improvements in symptoms and lengthening survival.
We are in an exciting time where we now have effective options for treating HCV in our most ill patients, but we still have much more to learn about how best to manage these individuals in terms of treatment timing. Ideally, with highly effective and tolerable therapies, patients can be effectively treated earlier in the course of HCV, and our experiences with decompensated cirrhosis will become increasingly more rare."
Hector
My Take on New Guidance for Treating Genotype 1 HCV–Infected Patients With Decompensated Cirrhosis - Norah Terrault, MD, MPH - 5/5/2015
The Most Challenging Patients
"...All patients with decompensated cirrhosis should be simultaneously considered for liver transplantation. For those who are not eligible for HCV therapy, transplantation may be the only means of achieving improved liver function and prevent progression of decompensation with HCV treatment in the posttransplant period. However, there are certain patients with decompensated liver disease who are not transplant candidates, and we are motivated to treat those patients with the goal of stabilizing their liver disease and reversing their complications of liver failure. We have no data showing a mortality benefit from treating this population; however, encouraging preliminary data are emerging that patients do have improvement in their MELD and CPT scores following treatment, suggesting that reversal of liver complications is possible.
Treatment Timing and Other Considerations
When managing patients with decompensated cirrhosis, it is important to be mindful of the fact that treatment does not immediately alter the natural history of their disease or its complications. Thus, ongoing management of current liver complications and surveillance for new complications is essential. For example, it is important to provide prophylaxis for variceal bleeding or spontaneous bacterial peritonitis as indicated and perform surveillance for liver cancer at 6-monthly intervals. These patients are preferably treated in a facility that is affiliated with a liver transplant program that has expertise in managing these complications. For patients on the waiting list for transplantation, the timing of HCV treatment needs to take into consideration of anticipated time of transplantation and treatment decisions should be done in concert with the transplant physicians.
The big question is whether we can reverse liver decompensation to the point where the patient no longer requires transplantation. Will all patients who achieve SVR derive improvements in the MELD score, and by how much will the score improve? We don’t have the answers to these important questions and the lack of data complicates decisions regarding treatment of patients on the waiting list. Since the MELD score determines the priority for liver transplantation, a patient with decompensated cirrhosis who achieves SVR and a reduction in MELD score (but not necessarily improvement in his or her symptoms of liver decompensation) may become ineligible for transplantation and more likely to experience progression of liver disease. Defining the group of waitlisted patients who benefit most from HCV treatment is an important future goal. However, certainly for patients who are not transplant candidates, HCV treatment is an important intervention and these patients should definitely be treated in hopes of achieving improvements in symptoms and lengthening survival.
We are in an exciting time where we now have effective options for treating HCV in our most ill patients, but we still have much more to learn about how best to manage these individuals in terms of treatment timing. Ideally, with highly effective and tolerable therapies, patients can be effectively treated earlier in the course of HCV, and our experiences with decompensated cirrhosis will become increasingly more rare."
Hector
COMMUNITY LEADER
Thank you for posting the additional lab results which helps to clarify the extent of your cirrhosis.
It appears that you have a MELD score of about 15 with these numbers. As well as a very low platelet count indicating extensive portal hypertension.
Studies have shown that people with advanced cirrhosis and portal hypertension do see an improvement in there synthetic liver function which is reflected in their MELD score after SVR. Have you noticed any improvement in your MELD score since starting treatment? We see many people at our transplant center being treated with similar MELD scores and have improvements in their symptoms/complications (ascites, hepatic encephalopathy and varices) after starting treatment . Over time their health continues to improve after being cured of the virus. We see many patients being able to reverse their liver disease and avoid the need for liver transplant after treating with the new effective treatments which allow those even with advance cirrhosis to be cured.
The only patients where there may be a question about proceeding with hep C treatment are those with refractory ascites (recurrent ascites that requires serial paracentesis to control) or moderate to severe encephalopathy (often requiring hospitalization) who will need to have transplants anyway due to the life-threatening complications of their decompensated cirrhosis. The first priority is a life-saving transplant and their hep C can be treated easily after transplant.
Hopefully over the next 8 weeks you will continue to remain undetectable and achieve SVR. Thankfully you got treated before your liver disease became irreversible.
Just keep in mind that while your hepatitis C may be cured you still have cirrhosis and portal hypertension which will require ongoing monitoring for probably a number of years. You should work with your doctor to continue to manage any ongoing complications of your cirrhosis, have your varices monitored periodically and continue any beta blocker to prevent a bleed, have periodic surveillance for HCC (ultrasound and AFP blood test), should you have any HE you should continue to manage it with lactulose. Of course with periodic blood tests you should see improvement in your liver function reflected in your lower MELD score.
In time you should see improvement in your liver disease and its complications. Keep in mind that liver disease doesn't reverse itself overnight. Now that you have stopped further damage to your liver from the virus your liver and body should be able to recover.
I am very happy you were able to treat your hepatitis C.The odds are very high that you have been cured, thankfully.
Best wishes for good health and a lower MELD score as your liver heals.
Hector
It appears that you have a MELD score of about 15 with these numbers. As well as a very low platelet count indicating extensive portal hypertension.
Studies have shown that people with advanced cirrhosis and portal hypertension do see an improvement in there synthetic liver function which is reflected in their MELD score after SVR. Have you noticed any improvement in your MELD score since starting treatment? We see many people at our transplant center being treated with similar MELD scores and have improvements in their symptoms/complications (ascites, hepatic encephalopathy and varices) after starting treatment . Over time their health continues to improve after being cured of the virus. We see many patients being able to reverse their liver disease and avoid the need for liver transplant after treating with the new effective treatments which allow those even with advance cirrhosis to be cured.
The only patients where there may be a question about proceeding with hep C treatment are those with refractory ascites (recurrent ascites that requires serial paracentesis to control) or moderate to severe encephalopathy (often requiring hospitalization) who will need to have transplants anyway due to the life-threatening complications of their decompensated cirrhosis. The first priority is a life-saving transplant and their hep C can be treated easily after transplant.
Hopefully over the next 8 weeks you will continue to remain undetectable and achieve SVR. Thankfully you got treated before your liver disease became irreversible.
Just keep in mind that while your hepatitis C may be cured you still have cirrhosis and portal hypertension which will require ongoing monitoring for probably a number of years. You should work with your doctor to continue to manage any ongoing complications of your cirrhosis, have your varices monitored periodically and continue any beta blocker to prevent a bleed, have periodic surveillance for HCC (ultrasound and AFP blood test), should you have any HE you should continue to manage it with lactulose. Of course with periodic blood tests you should see improvement in your liver function reflected in your lower MELD score.
In time you should see improvement in your liver disease and its complications. Keep in mind that liver disease doesn't reverse itself overnight. Now that you have stopped further damage to your liver from the virus your liver and body should be able to recover.
I am very happy you were able to treat your hepatitis C.The odds are very high that you have been cured, thankfully.
Best wishes for good health and a lower MELD score as your liver heals.
Hector
Result from my last blood test
INR - 1.35
total bilirubin - 2.3 mg/dl
albumine - 33
ALT,AST,AlkP,GGT,AFP - norm
PLT - 41
INR - 1.35
total bilirubin - 2.3 mg/dl
albumine - 33
ALT,AST,AlkP,GGT,AFP - norm
PLT - 41
If you provided a little more info it may help others to answer better
Baseline MELD score Platelets, Total bilirubin and serum albumin levels and other blood tests that were not normal.
Current Platelets ( low is expected but how low is more important) Plus
other blood that isn't normal besides bilirubin if any. MELD score if known.
Baseline MELD score Platelets, Total bilirubin and serum albumin levels and other blood tests that were not normal.
Current Platelets ( low is expected but how low is more important) Plus
other blood that isn't normal besides bilirubin if any. MELD score if known.
HectorSF (and few other) can best reply to your questions it may take a few hours or a day or so for a reply.
In the meantime I found a couple of sources with some information as do not have experience with your situation and wish the best for you..
http://hepatitiscnewdrugs.blogspot.com/2011/02/decompensated-cirrhosis-due-to-hcvsvr.html
SVR Signals Good Prognosis in Decompensated Cirrhosis Due to HCV
By: MARY ANN MOON, Internal Medicine News Digital Network
02/24/11
"The main finding of our study was the improved survival of patients who attained a sustained virologic response." Mean survival was 73 months in patients who achieved an SVR, compared with 53 months in those who did not "
treatment was PegInf + Rbv no longer recommended.
http://www.hcvguidelines.org/full-report/unique-patient-populations-patients-decompensated-cirrhosis
Last changed August 7, 2015
Date I Accessed August 12, 2015
Excerpt
"The SOLAR-2 study was a multicenter randomized controlled trial of 108 patients with HCV genotypes 1 and 4 who had decompensated cirrhosis. Study participants who were treatment-naive or -experienced, with CTP class B cirrhosis (score 7 to 9) or CTP class C cirrhosis (score 10 to 12), were randomly assigned to receive daily fixed-dose combination ledipasvir (90 mg) and sofosbuvir (400 mg) (hereafter ledipasvir/sofosbuvir) and RBV (initial dose of 600 mg, increased as tolerated) for 12 weeks or 24 weeks. All participants had a hemoglobin level greater than 10 g/dL and a creatinine clearance (CrCl) rate greater than 40 mL/min.
Excluding 6 patients who had received a transplant, sustained virologic response (SVR) was achieved in 87% of those given the 12-week treatment course and 89% of those given the 24-week treatment course. Posttherapy virologic relapse occurred in 8% and 4% of the 12- and 24-week groups, respectively. Total bilirubin and serum albumin levels improved substantially at week 4 posttherapy compared with baseline in both treatment groups. Baseline CTP and Model for End-Stage Liver Disease (MELD) scores improved in more than 50% of the treated patients, but some patients did have worsening hepatic function.Excluding 6 patients who had received a transplant, sustained virologic response (SVR) was achieved in 87% of those given the 12-week treatment course and 89% of those given the 24-week treatment course. Posttherapy virologic relapse occurred in 8% and 4% of the 12- and 24-week groups, respectively. Total bilirubin and serum albumin levels improved substantially at week 4 posttherapy compared with baseline in both treatment groups. Baseline CTP and Model for End-Stage Liver Disease (MELD) scores improved in more than 50% of the treated patients, but some patients did have worsening hepatic function."
In the meantime I found a couple of sources with some information as do not have experience with your situation and wish the best for you..
http://hepatitiscnewdrugs.blogspot.com/2011/02/decompensated-cirrhosis-due-to-hcvsvr.html
SVR Signals Good Prognosis in Decompensated Cirrhosis Due to HCV
By: MARY ANN MOON, Internal Medicine News Digital Network
02/24/11
"The main finding of our study was the improved survival of patients who attained a sustained virologic response." Mean survival was 73 months in patients who achieved an SVR, compared with 53 months in those who did not "
treatment was PegInf + Rbv no longer recommended.
http://www.hcvguidelines.org/full-report/unique-patient-populations-patients-decompensated-cirrhosis
Last changed August 7, 2015
Date I Accessed August 12, 2015
Excerpt
"The SOLAR-2 study was a multicenter randomized controlled trial of 108 patients with HCV genotypes 1 and 4 who had decompensated cirrhosis. Study participants who were treatment-naive or -experienced, with CTP class B cirrhosis (score 7 to 9) or CTP class C cirrhosis (score 10 to 12), were randomly assigned to receive daily fixed-dose combination ledipasvir (90 mg) and sofosbuvir (400 mg) (hereafter ledipasvir/sofosbuvir) and RBV (initial dose of 600 mg, increased as tolerated) for 12 weeks or 24 weeks. All participants had a hemoglobin level greater than 10 g/dL and a creatinine clearance (CrCl) rate greater than 40 mL/min.
Excluding 6 patients who had received a transplant, sustained virologic response (SVR) was achieved in 87% of those given the 12-week treatment course and 89% of those given the 24-week treatment course. Posttherapy virologic relapse occurred in 8% and 4% of the 12- and 24-week groups, respectively. Total bilirubin and serum albumin levels improved substantially at week 4 posttherapy compared with baseline in both treatment groups. Baseline CTP and Model for End-Stage Liver Disease (MELD) scores improved in more than 50% of the treated patients, but some patients did have worsening hepatic function.Excluding 6 patients who had received a transplant, sustained virologic response (SVR) was achieved in 87% of those given the 12-week treatment course and 89% of those given the 24-week treatment course. Posttherapy virologic relapse occurred in 8% and 4% of the 12- and 24-week groups, respectively. Total bilirubin and serum albumin levels improved substantially at week 4 posttherapy compared with baseline in both treatment groups. Baseline CTP and Model for End-Stage Liver Disease (MELD) scores improved in more than 50% of the treated patients, but some patients did have worsening hepatic function."
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