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Understanding Liver Biopsy Results
Nov 24, 2001

Dear Doctor,

First, I want to say how much I appreciate this service that you provide. You are a lifesaver! I am a 41 year old coinfected female (HIV/HCV). My HIV is asymptomatic and I am in good health. I recently had my second liver biopsy (first one was three years ago). The diagnosis was "Chronic Hepatitis with Grade 1 Inflammation and Stage 1 Fibrosis". The footnote reads, "The trichrome and reticulum stains show mild portal fibrosis. PAS/DPAS and iron stains are unremarkable." The biopsy I had three years ago had a diagnosis of "Chronic Hepatitis with Grade 1 Inflammation and Stage 0 Fibrosis". The footnote read, "PAS, D-PAS, iron, trichrome and reticulum stains are unremarkable." Are these good biopsy results? Is my HCV progessing in the three years between biopsies? Would you suggest starting the Peg-Intron? (I am a type 3). Or can I hold off on the meds in the hopes something better will come out? Is there a chance I may never progress beyond where I am now; that my liver will stay stable; the same? Thanks in advance for any info you can share!!

Response from Dr. Fried

Liver biopsy results are reported using a variety of scoring systems. Assuming this is a scale of 0-4, Grading reflects the degree of inflammation or irritation, while Stage reflects the degree of fibrosis. Stage 4 would indicate cirrhosis. From your description, you have mild inflammation and minimal fibrosis which is very encouraging. There may have been a very slight increase in fibrosis compared to the report of your earlier biopsy. Nevertheless, it appears mild. However, it is difficult to predict with certainty the likelihood of progression in a disease like hepatitis C that may progress over many years.

You are fortunate that you are a genotype 3, since the sustained virological response is always significantly better for genotypes 2 and 3, approaching 75-80% with the newer pegylated interferons plus ribavirin. All this should be factored into your decision to begin therapy after a discussion with your physician or other healthcare provider.



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