![]() I tried to respond individually then kept getting confused with the Best answer & report a person buttons. Thanks everyone for taking the time to read & respond. If your husband has tolerated treatment without debilitating side effects, it may be a good safety measure if treatment continuation would be a burden, perhaps insisting on a biopsy before pursuing his doctor's recommendation any further would be a helpful decision-maker. In the end, I think whether or not your husband should extend treatment will be as much a 'evidence' based decision as it is an 'experience' based decision. I say this with certainty because my husband's biopsy revealed early cirrhosis although he had no other indicators of such. is not a negative test in other words not having those symptoms does not rule out cirrhosis. I should emphasize that I am not of the opinion that your husband has cirrhosis, but it's important to remember that decompensating symptoms are a positive test for cirrhosis, but the absence of varices, abnormal liver contour, normal spleen size, etc. Because decompensatory mechanisms differ greatly from person to person, absence of enlarged spleen does not exclude cirrhosis either. It would be important to track what kind of decline in platelets your husband has had over the years, and it is perhaps longer history review that is leading your husband's doctor to have concerns. God that your husband's platelets are in the normal range, but again that alone does not exclude cirrhosis. Though encouraging, normal imaging does not rule out cirrhosis. Because the liver's condition is not homogenous, surface contour can belie existing fibrosis within the interior liver parynchema. Cirrhosis CAN be present even if the liver is 'normal sized and has a smooth surface contour' - unfortunately, imaging, be it MRI, ultrasound, or CT Scan, does not have a high specificity or sensitivity in detecting early cirrhosis. I agree with my friend Hector that the results you posted make it unlikely your husband has frank cirrhosis, but there are some points on which we have differing opinions. Though there is no clear absolute signal showing that your husband has cirrhosis, I don't think the doctor's "gut" should be ignored either. Since your husband's physician is a Transplant doctor, the expectation would be that he is sufficiently experienced to make good estimations based on his knowledge and your husband's history. The elastography results do not indicate cirrhosis, nor for the most part do his other results, but the 'gold standard' for measuring liver fibrosis is still via liver biopsy, though even biopsies are not without error. " - Exactly what I did and how I felt when I happened on the forum. "I have been a stealth reader here for many months & finally got my nerve up to ask this question. I do appreciate all the expertise based on everyone's own experiences and would like to get your input on if you think he could have cirrhosis and therefore should continued the extra months of treatment of pegasys & ribavirin following the completion of the incivek. I realize that not even my husband's doctor can definitely say whether he has cirrhosis. 2011 Labs (Before triple tx) Protime 14.6 INR 1.16 Platelets 195 Alk Phos131 ALT 76 AST 49 AFP 1.9 Many thanks if you have made it this far in my ramblings. Calculated mean hepatic shear stiffness is elevated at 5.50 kPascals. Liver normal sized and with smooth surface contour. ![]() 2011 MRI Abd & Elastography - Borderline spleen. Mildly enlarged peripancratic & periportal lymphnodes. Esophageal varices identified (EGD done in response to this found no varicies). No reason identified 2007 Biopsy grade 1 stCT - Spleen normal size. So the doctor is considering him a relasper. Genotype 1 subgroup not identified Il28B CC Previous tx: 1996 Intron-A 3xweek x 5 months non responder 1998 Interferon & ribavirin daily for 28 days non responder 2008 Pegasys & Copegus x 11 months und 12 wks & till end of tx but virus came back 6mth after tx completed. Last August 2011, he started triple tx (Incivek) und at 4, 8, & 12 week and he is trying to decide if there is any evidence to support the 48 week treatment? Exposed to Hep C in 1981. The doc did not want to do a biopsy prior to triple treatment with Incivek as he feels the biopsies can be very inaccurate & feels the elastography is more reliable. The doc keeps referring to a "borderline spleen" and platelets being low (though still in the normal range) and stiffness from the elastography. MD is hepatologist at major transplant hospital. My husband's doctor's "gut" thinks that he may be borderline cirrhosis. ![]() This stuff is so hard to understand and I have been trying to make sense of it for months. ![]() I have been a stealth reader here for many months & finally got my nerve up to ask this question.
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