FibroSure and biopsy

[MarkFly1]

Last summer or thereabouts, I had a Fibrosure test which indicated a score of F3 which was quite high compared to previous assessments of my liver.  My doc then decided we should do a liver biopsy which showed a fibrosis score of 0-1.  We decided to do another Fibrosure test 2 weeks ago which I discovered yesterday was F4 Cirrhosis.  Yikes.  Well, I did a little further digging and discovered that the Fibrosure test requires 10-12 hours of fasting ... no one had told me this and in both cases I had eaten regular meals.  Would digesting food skew the results so dramatically?
Because of this last test, my doc wants to start me on Telaprevir+PegIfn+Ribavirin.  Only prior treatments were with regular Interferon and Ribavirin.  I have the IL28B allele CC.  Should I go ahead and do the TPR treatment or wait for Sofosbuvir or do another Fibrosure test this time after fasting?

[MarkFly1]

PD, I finally read your post and very much appreciated it.  I'm going for a 3rd Fibrosure later this week after fasting.  BTW, I've discovered I'm not diabetic, but fasting before Fibrosure, based on what you say, should provide greater accuracy I would think.  My doc gets back from the liver conference in Holland and I see him on the 6th to decide on a course of action.  I know you looked at my numbers and suggest my liver is functioning ok.  Well, time will tell.  Just don't want to wait too long before starting something.  This is my 30th year with the disease, I've had two attempts with Roferon and Interferon/Ribavirin... Never tried the pegylated form yet, I have IL28B allele CC so that is good, but have gt 1a which is a negative.  Just trying to figure out what condition my liver really is in and whether I should start a Telaprevir based treatment now or wait a few more months for Sofosbuvir which is better tolerated and more effective with less risk.  Thanks so much for you thoughts and words!

[MarkFly1]

Willy, thanks for your posts.  I finally have read them.  Just to clarify, my doc is not wanting to base treatment on Fibrosure.  My fibrosis stage on biopsy is 0-1, which after 30 years seems a bit too good.  The Fibrosure tests straddling the biopsy were F3 and F4.  I'm going to have another in a few days after fasting, no sugar and after several days after playing baseball.  Then I'm meeting my doc on the 6th to decide on a course of action.  If my liver is ok, then I'll wait for the Sofosbuvir.  How you doing?

[BoceprevirGal]

I just wanted to add, that my FibroSure test had me at Stage 4; cirrhotic. So I then ran, terrified, and got a biopsy for the first time in my life, and it had me at Stage 2, grade 3.  My alpha-macro had also been high.
   I treated for 28 wks with Victrelis, and slayed the dragon~ good luck to you, with your Treatment, Mark. And congrats to you, Willy, on yr Stage 2.  You are in good shape to kick some Hep C buttocks

[rivll]

I am so happy for you Willy.
I appreciate your information about the Fibrosure. Definitely food for thought.

[Willy50]

I went in to pick up my biopsy results today and I have to apologize; I made an error in recording the data. I got the basics over the phone, it was noisy outside.

To some extent.....It doesn't really change the principle involved. I have thought/known my fibrotests couldn't be *that* bad.  
Or so I had hoped......

The two fibrotests came in cirrhotic.  Both were 85 scores and another shoot from the hip method also indicated cirrhosis.

What I found today was that I had transposed my stage and grade numbers.

I am actually a stage 2 grade 2/3 inflamation.

Stage 2, but the MY fibrotests indicated stage 4.  

And yes......I'm pretty happy about being a stage 2. I moved about 1 stage in 5 years (45 days short of 5 years)

willy

[Willy50]

I wanted to give you a better /less sarcastic reply. I actually had written one and decided at the last minute to opt for brevity and snark.

You deserve a better answer though and we all might learn a little from my experience.

First off......I have had a few fibrosure tests. My first was in 2005.  When it came out worse than I expected (a stage1/2) I immediately began to search why. I had also run a 5K race, along the lines of a competitive race where I was running full out for 25 minutes or so, close to maximum target heart rate for my age.  It turns out that extreme exercise raise ALT.  ALT is a key score used in fibrotests.  Years back it was also used to evaluate if someone ad had a heart attack; when you destroy muscle tissue (from what I read) these enzymes climb.  I have never been able to find out how long they are/remain elevated.

I got a biopsy in 2008; 3 years after my fibrosure stage 1/2 score.

Guess what?  My damage was 1/6 ishak.  Does anyone believe that in 3 years my liver had repaired itself or even stayed the same?

Fast forward nearly 5 years.  I just got another biopsy.  Want to know the score?
.....Well wait a minute.

First...this summer I got another fibrosure test  In July my ALT was 100 and my fibrosure test score was 85.  Hmmmmm what is an 85?

According to the scoring specs;

0.72 – 0.74 = Stage F3 – F4

>0.74 = Stage F4 – Cirrhosis  

So.......If I am an 85 it is nothing to be happy about.  It is cirrhosis.
I took another one a little more than a week ago.  Recall that my ALT was 100 in July 2013.  This time it was 150.  If you were to infer that I got another bad news fibro test....this time from another manufactuerer, you are correct.  Then I got biopsy.

By the way....before I get to that, I will also mention that when my blood was drawn for a metabolic panel this summer, THAT ALT score was 80, the the ALT drawn for the fibrosure was 100.  Both drawn at the same time, yeah....even from the same arm.  : )
I have to wonder about that much variation; don't you all?

Well, one week later I had a biopsy; 2-3, I'm assuming metavir. I will see tomorrow.
Please recall;  2 fibrotests taken in the past 6 months, both showing cirrhosis.

I'm just telling you, you cannot trust the accuracy of the fibrotests.  If your doctor puts faith in these tests....which clearly were not administered correctly, then I am suggesting that perhaps you should consider your faith in this doctor.

Nor am I aware of any 12 week treatment..... any currently approved treatment..... that is available to treat a 1) cirrhotic (based upon your fibrotests)  2) past treatment failure, 3) with (if I understood you) diabetes/ insulin resistance.  

What your doctor is offering....I am cynical that there is any good approved method with any hope of success.  

It's too late to be brief, and there are also other issues that members mentioned in good posts before me.  

I wish you well and I apologize.  My sarcasm was not directed towards you, but I admit to being a little unhappy at your doctor's recommendations. I wanted to explain that in this thread.

Willy