cirrhosis diag -> help and advice needed for reading results

[halt651]

Dear All,

First of all I would like to thank to you all for your helpful comments and support.
I will try to keep it short but let me do some introduction please.
on 4th of november my mum was diagnosed as cirrhosis due to hepatitis B.
Basically my life since then was in chaos and deep depressive.
I was worried for myself as well because I am also hbsag+ (this is later to discuss)
I have been reading this 'Hepatitis B' forum for a while.
honestly speaking you are really a hope for a lot people.
(not only in US but also all around the world I believe) so thanks!

on the other hand I am lost in interpretation of my mums results below and need your help.
She started using entekavir (baraclude)(1x500 mg) on 4th of november.

Could you please help me to understand? here are the results.
(I tried to translate terms from turkish so sorry for unknown words)

4th of november 2013
blood analysis;
hbsag (+), hbsab (-), hbeag (+), hbeab (+)
hbv-dna=5936400(copy/ml)

hepatic doppler report - 4th of november 2013
size-dimension: long, right lobe ~116mm
portal ven calibre, diameter: ~9mm
portal ven current direction: ~34 cm/sn
no lezions.
no delta agent.

(I searched in papers for fibroscan result but I couldnt see any parameter ends with kpa :( )

here my questions;
which parameter says that she is cirrhosis?
do you think treatmant is enough,ok?
do you have any advises?

Thanks,
Halit

[halt651]

thank you steff,
actually it was you and your posts here which brought me back to normal life after depression shocking. I am studying now your posts, I am preparing a list.

all the best!
halit

[stef2011]

just saw your post now, it is very very important to have a fibroscan and an expert doctor to monitor that, by means of fibroscan readings you can see if cirrhosis is improving or worsening.
US is not helpful at all (except the new ones which combine US and fibroscan in the same machine).US is important to monitor for hcc which is very high risk in cirrhosis and to monitor liver veins in case there is abnormal blood flow/pressure in the liver

it is also very important that hbvdna gets to undetectable and alt less than 19 in the shortest time possible if you don t see this by 3 months it would be best to add tenofovir just to push hbvdna to und faster and after 3months und go back to mono entecavir

check all my posts to see how i regressed advanced cirrhosis in 1.5years, which is mainly by:

antivirals, i used entecavir monotherapy at first, hbvdna und took 7months and liver worsen at first.combo tenofovir plus entecavir would have been better from the start

vitamin d3 supplements to make serum levels 60-80ng/ml.on cirrhosis you have to find your dose to make it, mine was 10.000iu daily

gcmaf therapy and nagalase monitoring

hepatitis technology supplements

coffee, cocoa, berries fruti, black rice and correct diet for liver cirrhosis

oxidative stress monitoring and correction of results by liposomal glutathione and vitamin c

keep in mind i had access to a research center, one of the best world scientists/center on hbv and research level labs available to private patients in europe.nagalase and oxidative stress might not be available in some countries

[halt651]

also I would like to add that after 1 month with antiviral,
hbv-dna dropped from millions to thousands.

4th november 2013 ====> started entekavir
hbv-dna=1020000 IU/ml
alt 40 U/L (ref 33)
ast 51 U/L (ref 32)
hbeag +

27th november 2013
hbv-dna=16400 IU/ml
alt 22 U/L (ref 33)
ast 25 U/L (ref 32)

it seems to be a good sign however still I am wondering how doctors will monitor her health.

[halt651]

dear StephenCastlecrag,
thanks a lot for your answers (I forgot to thank earlier).
I showed her US results some other radiologists&drs and one of them said it didnt look like cirrhosis even if so it maybe in 1st stage.
monday she will see another doctor and ask questions that I prepared for her.
on the other side I am searching a lab in the city she lives that she can have fibroscan so at least we will be able to monitor how treatment goes.

healthy days & thanks,
halit

[StephenCastlecrag]

I understand your concerns. One of the pitfalls of interpreting what we read on the web, including here, is that we can overreact and think of the worst. As I said before, I am not a doctor nor expert. I hope Stef2011 will add his comments as he has cirrhosis that has now regressed in a very short time under his own treatment protocol.

There are many types of ultrasound imaging, some are very sophisticated and can detect and measure specific features in the hand of a skilled operator. It is true, ordinary ultrasound is not very accurate in diagnosing cirrhosis, since you don't know what type of ultrasound imaging is used for your mother, you should not make your conclusion that her "cirrhosis is at a high level".

A biopsy is really not necessary. Doctors order biopsy when they want to prescribe treatment and to establish a baseline picture. Interferon is not recommended for patients with severe fibrosis/cirrhosis. So now that your mum is prescribed Entecavir, there is no need to know. You may have a Fibroscan when and if it is available, just to establish a baseline and track progress.

0.5 mg Entecavir is the standard dosage, all the side effects of Entecavir are well known and there is no need to test. 1 mg is used for patients with resistance to previous drugs or non-respondent to Entecavir after a period of usage. Make sure she takes it on an empty stomach, everyday, and monitor her hbvdna. It should come down very quickly.

qHBsAg is not useful at the moment, hbvdna is more useful. In several years time, when her fibrosis/cirrhosis improves, it may be useful then.

You should consult your liver doctor whenever your mum is given new medications for other conditions to make sure they are liver friendly. No drinking or smoking. Take Vitamin D if she is is deficient. Drink coffee regularly if she likes it.

[halt651]

hello again,
I keep reading and I gat a bit nervous actually.
because if my mother's diagnosis was easily to be seen via ultrasound that means cirrhosis is really at higher levels :( unless her dr didnt make any mistake and or I did a interpreation mistake.

in any case, would you still advise biosy (one of the doctor checked my mother's trombosit and said that it is still possible to have transjugular liver biopsy) or fibroscan to see if she has a chance or not.

the other question Id like to ask that she started taking entavoir with 0.5 mg (baraclude) instead of 1 mg, do you think it is because he is just testing if there are side effects (considering my mum had heart operation before ...)

and the last one if you dont mind, is it useful to see what hbsag quantative (iu/ml) for a cirrhosis patient?

thanks,
Halit

[StephenCastlecrag]

Yes, Stage 4  fibrosis is called cirrhosis. Cirrhosis can be compensated or decompensated. With antiviral treatment, fibrosis/cirrhosis may regress.

[halt651]

dear stephen,
thank you for your answers, I will try to get more information such as fibrosis level of my mum and get back to you.
as far as I understand fibrosis level 4 is the sign of cirrhosis. am i correct?

[StephenCastlecrag]

Fibroscan is not available in every country. As I said before, I am not an expert in ultrasound imaging. The blood flow pattern in a cirrhotic  liver is different to a normal liver, hence the difference in size of main blood vessels and flow velocities. It takes years of training to understand all the data. We normally just read the conclusion in the report by the radiologist

[halt651]

thank you StephenCastlecrag.
is KPa unit for USA?
I digged a bit more and found out that as you said I believe it is;
hepatic arterial Doppler ultrasound
Portal venous velocity is 34 cm/sn
but I could not understand if it is main criteria to diagnose.

here the link
http://www.ncbi.nlm.nih.gov/pubmed/9177521

[halt651]

one more thing to add;
04 nov 2013
alt 50 U/L
ast 41 U/L

[halt651]

I feel I have to add followings;
- due to some parameters of her blood, it was high risky to have tissue examples from her liver.