On the Fibrogen call, they said that biopsies in HBV infection (with concomitant treatment of HBV) proved too noisy for them to conclude anything much (this is a small Hong Kong based open label trial).
They said they they were going to bring the liver program back to the US and look at two biomarkers in patients with more advanced liver fibrosis - hepatic venous pressure gradients and something called HepQuant, "a dual stable isotope labeled collate product, that actually simultaneously measures liver function and liver blood flow." Also going to look at high-resolution MRI and MRS.
Liver Biopsy: since there is so much discussion, thought I would add a different perspective. Our center does a medium to high number of liver tranplants. Within the last few years we have ramped up the number of biopsies we perform. It is the number one cause iatrogenic pneumothorax for our emtire health system. This has been a great concern; particularly when you consider only attending interventionalists perform the biopsies under realtime image guidance vs. interns placing central lines without imaging. The impact is real and twofold. Patients frequently require chest tube placement and the event is reportable as a sentinel event. So although biopsy may be more reassuring, there would be a significant increase in harm in performing them.
Gee tx guys.Youse guys are worth your weight in gold to me :) My gastro is railroading me into taking either baraclude or viread to bring down my hepb viral load and is suggesting a biopsy as a way to convince me of the need to start the drugs. I am loth to start these drugs as currently it is an irreversible step. He is concerned about me progressing to liver fibrosis but so far in the last 20 yrs that I have kept my eyes on my liver blood panel results, both my Alt and Asp results are normal and low even.I too am interested in finding out if I have liver fibrosis but not thru biopsy. I learned a lot thru youse guys really and am genuinely thankful of the knowledge you impart to a layperson like myself.
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