Each lab and organizations uses different standard range depending on where you are. Some labs use 35, others 40 or 56 or even 70. It all depends on where you are and the lab company used. Thanks, Bansah1
Hi @staystrong,
Great questions!
In addition to what @Bansah1 has mentioned, it is also dependent on the background/ethnicity of the person - the average normal level will vary depending on different populations.
Both are indicators/estimators of liver fibrosis - Fib-4 scores will have a cut-off that would indicate advanced fibrosis (F3-4); while fibroscan will have cut-offs that will indicate F0-1, F2, F3 or F4. Fibroscan is generally considered as the more accurate measure of liver fibrosis stage.
Hope this answers your questions.
Thomas
1 Like
Thank you Banshah1 for your response
General Question : For CHB patient , as per AASLD guidelines conduct abdominal ultrasound every six months to rule out HCC. My question is if one conduct Ultrasound with AFP and as well as AST / ALP every six months. With these tests, can we rule out rule out HCC in comparison to MRI with contrast exam? As conducting MRI with contrast every six months may come up with there own hazards. As the gadolinium may remain in the body including brain. This can cause skin condition called systemic fibrosis. Reference from hsc.unm.edu, stanfordhealthcare.org.
I would request experts to provide your input.
Hi Thomas, Reference to mdcalc.com,
Fib 4 score. Approx. Fibrosis Stage
< 1.45. 0 - 1
1.45 - 3.25. 2 - 3
Greater then 3.25. 4 - 6
this is based on Ishak scoring system. Can you pls provide your input on this? I think 5 is advanced fibrosis. Could you pls provide your input on this?
Thanks for the great questions, @staystrong.
There have been studies showing that MRI is more sensitive (i.e., can rule out HCC if a test is negative) compared to ultrasound, but the difference in detection rate isn’t enough to offset the much greater costs of MRI compared to ultrasound. Also MRI isn’t as widely accessible as ultrasound.
Regarding contrast agent hazards, this has been discussed in a previous thread:
Regarding Fib4 scoring, there is an additional caveat in that calculator:
Lastly, the cut offs for HCV are different than those with NASH or HBV.
Sometimes it is difficult to extend the results from one group to another. My understanding is that Fib-4 was a way to very quickly and easily find people with advanced liver disease from standard liver function tests (which are cheaper and more widely prescribed) rather than using a fibroscan (which are less accessible and more expensive). The fibroscan would still be the best non-invasive way to confirm the level of liver fibrosis.
Hope this helps,
Thomas
Thanks Thomas. Is there any separate discussion that is talking about using Velmidy side effects? While reading threads, one of the known side effects in some of the patients is high cholesterol level even though they are on plant based diet and maintaining healthy weight
Hi @staystrong,
This is the main thread discussing medication side-effects: (Possible side-effects from antiviral therapy - General Discussion - Hep B Community). Increased cholesterol is only associated with one (TAF/Vemlidy) of the 3 first-line therapies.
Thomas
Thanks. Question to all experts. Metavir score range
Pls refer web site mskcc.org that defines liver stiffness result and corresponding fibrosis score for different diseases. Like hep b and NAFLD. per this guide line;
Hep B
2 to 7 Kpa. F0 to F1
8 to 9 Kpa. F2
8 to 11 Kpa. F3
12 Kpa or higher F4
NAFLD
2 to 7 Kpa F0 to F1
7.5 to 10 Kpa F2
10 to 14 Kpa F3
14 Kpa. F4
However some Fibroscan services shows different Metavir score.
F0 = 2 - 4.5 Kpa
F0 - F1 = 4.5 to 5.7 Kpa
F2 - F3 = 5.7 to 12 Kpa
F3 - F4 = 12 to 21 Kpa
F4 or greater 21 Kpa
Other Fibroscan services shows
F0 to F1 less or equal to 5 kpa
F2 5 to 7 Kpa
F3 7 to 9 Kpa
F4 greater then 9
I would request all experts to provide input
Could you pls let me know your input on this? Really appreciated.
Hi @staystrong,
I’m not sure what the source is for those other cut offs, so it’s difficult to comment I think.
Thomas
1 Like
Thanks Thomas, so do you know what is standard guide line of liver stiffness that defines F2 or f3 fibrosis for hepatitis b people?. Do you know any article that you can reference ?
Hello All
For a chronic hep B plus NAFLD 51 years male, latest blood work comes out 392 IU/ml, HbeAntigen negative.
ALT 32, and AST 27, all other blood work including AFP, platelet comes normal.
latest abdominal US normal. Elastrography ultrasound shows 7.1 Kpa liver stiffness.
Would you advise to start medicine? If yes which one you would recommend. One of the liver specialists is not advising to start medication and the other liver specialist advising to start medication Velmidy 25mg.
I would appreciate if you can provide your input.
@ Thomas, @ Availiant@,John Travis@ Paul and all other experts, could you pls provide your input
HBeAg negative and current viral load is 392IU/ml with all other blood work normal including, ALT, AST, AFP, platelet count, Albumin, Abdominal Ultrasound Age 51 , male, Chronic CHB since 2008 and NAFLD since 2018. Majority of years viral load was under 200IU/ml but latest viral load is 392IU/ml
I would request all experts to provide your input, as I am confused if I should start the medication or not. Please advise.
Dear @staystrong,
In general, most (all?) guidelines recommend treatment if there is evidence of significant (>F2) fibrosis regardless of viral load, which would match your case.
Thomas
Hi all, I’m Danny from Malaysia, I’m chronic HBV carrier. Just came back from specialist medical hospital to do my quarterly blood test, ultrasound on my liver. Utlsound found no finding or scare on my liver. HOWEVER, my blood test result shown my HBV Viral Load is 10100 (Unit - IU/ml). The Gastroenterologist Doctor advised me to take the Entecavir Sandoz Film-Coated Tablet. 0.5mg for duration of one month to reduce the HBV Viral Load. Is there any side effect for me to take the above drug as these is my first time taking it?.
Thank you
Regards
Danny
1 Like
Isn’t entecavir/tenofovir generally lifetime (unless you loose HBsAg, which is a very rare event etc., or VERY closely monitored for viral rebound)? Could any expert comment?
Yes that was told by doctor to take one month first to reduce the viral load. What I know that entecavir should be taken for long term not one month. Anyway I will meet up with specialist doctor at end of the month. Thank you very much for response to my question.