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Liver biospy Risk
Nov 16, 2008

Dr McGovern,

Thank you for providing me information regarding risk of liver biopsy and blood tests for estimating degree of fibrosis. I took a cursory look at various indices like AST to platelet ratio (APRI) and Forns score, and found them very interesting. These formula have strong predicting values in detecting advanced scarring, as well as the lack of any significant scarring. They are applicable for HCV patients and to a similar degree, HBV patients.

Despite what these formula say about the conditions of my liver, I think I should take you advice in getting a liver biopsy as a baseline test. Information about the severity of inflammation has better clinical value than knowledge of fibrosis. Fibrosis may eventually happen anyway if there is untreated, on-going inflammation.

Can you please give me advice on how to persuade my doctor to order a biopsy? The doctors that I have visited were reluctant to recommend biopsy given my normal liver function and serum HBV-DNA of under 10,000 copies. I do respect their professional judgements, but like you said, the benefits of liver biopsy outweighs its small risk.

Response from Dr. McGovern

There was a recent consensus conference on hepatitis B that just convened about two weeks ago. I expect the summary of this conference and final conclusions to be available in 2009. I think it would be great to await the consensus of this meeting to see what the latest consensus is on the role of biopsy and what the cut-offs for treatment may be (based on HBV DNA results).

Also - since I don't know your entire case history, your doctors may be influenced by multiple serial HBV DNA levels which are even lower than 10,000 copies (since viremia usually varies and fluctuates). Serial follow-up may be certainly reasonable in your case if your levels have been very low and your liver function tests are always normal over the years. These treatment decisions are also related to age, family history of liver disease, your physical examination, etc...none of which I am privy to...

Let's also see what the consensus guidelines state in 2009.



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