These are definitely legitimate concerns and this is why it becomes important to have these conversations with your health care provider, who can talk you through these decisions. It’s also good to keep up to date and informed so you can bring these topics up yourself.
Hi General Question,
What is normal ALT upper limit? As per AASLD guide line 35 for men, EASLD guide line states 40, some labs upper limit normal is 40 and some labs stating 50.
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
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.
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.
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?
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.
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
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
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 ?
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.
@ 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
In general, most (all?) guidelines recommend treatment if there is evidence of significant (>F2) fibrosis regardless of viral load, which would match your case.