Increased stiffness and steatosis in two years, worried

Hi, hope everyone have a nice weekend.
I had a fibroscan recently, and got stiffness score 5.2 (kPa), and CAP as 226, which has increased quite much compared with two years ago (stiffness core = 4.1 and CAP = 138).
I’m a bit worried about the increase. Does the stiffness increase have anything to do with the increased fat? Or just the hepb virus is making more damage? I’m quite skinny already and I don’t gain weight in these two years. The only reason I can think of which may contribute to the fat is that I did less exercise and maybe more snacks at night.
If I return to my regular exercise and control my diet, is it possible to reverse the stiffness and CAP score?

Another question is about taking Entecavir (I just started a few days ago). I understand that it should be taken with an empty stomach (2 hours before and 2 hours after a meal).
My questions are: 1. Can I drink water in the 4 hours gap?
2. How strict is it about “taking at almost the same time each day”? I’m thinking about daylight saving in NSW, and it will bring an hour difference in terms tablet taking time. Also, what shall I do when travelling to a place with a different time zone (for example, US or China)? How should I adjust the time to take the tablet?
Thanks!

Maggie

Hi @abcde,

Great questions. These scores indicate you’re still in the normal range for your fibroscan (<7kPa for your stiffness score and <248 CAP). The ranges are there because there may be some differences depending on when you ate, the person carrying out the fibroscan, etc. that can alter the scores even without your liver being worse.

It could indicate an issue if they continue to be on the high end, but you shouldn’t be worried about this single result at the moment.

Regarding fatty liver, it is becoming more evident that you can have fatty liver even though you appear lean. It turns out the fat that we can see (e.g. belly, thighs, etc.) is a different type to the more dangerous fat that we can’t externally see (e.g. surrounding the organs or within the liver). While they are sometimes correlated, they aren’t necessarily the same.

With taking Entecavir, I believe you can drink water (@patricia, @hope4us??) and “taking the same time each day” is not super-strict. The antivirals we take are pretty forgiving, definitely an hour shouldn’t make a difference. The best practice when shifting more time zones is probably off-setting by a few hours a day to match the time zone. But in all, it’s probably most important that you just keep taking it regularly, rather than worry too much about the time. Most people with Hep B on treatment have missed doses before, and as long as that is not extended or occurring too regularly, it doesn’t seem to make a big difference.

Hope this helps,
Thomas

Thanks @ThomasTu!

It turns out the fat that we can see (e.g. belly, thighs, etc.) is a different type to the more dangerous fat that we can’t externally see (e.g. surrounding the organs or within the liver). While they are sometimes correlated, they aren’t necessarily the same.

Thanks for the comments. Now I understand the two types of fat are different, but will healthy diet and regular exercise reduce the dangerous fat as well (i.e. the fat surrounding the organs or inside the liver)? I guess I don’t need extra treatment for it at the moment ? So what I can do now is to keep on Entecavir and adjust my lifestyle?

How often should I do the fibroscan for monitoring? I was told every 3 years before, but not sure whether I should do more frequently given the current score and the start of the treatment.

Sorry for so many questions. Many thanks for your time and patience!

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Dear @abcde,

Yes, physical activity and weight loss usually decreases CAP score, suggesting that you do decrease the amount of liver fat (see these papers as examples: ttps://onlinelibrary.wiley.com/doi/10.1111/jgh.14963; https://onlinelibrary.wiley.com/doi/full/10.1002/osp4.476). Entecavir and lifestyle changes sounds like a reasonable approach, but this is something you’d discuss with your health professional for your particular context.

Regarding monitoring, you should visit the doctor every 6 months for blood tests. I think the fibroscan is usually done every 1-3 years depending on how high the risk of liver disease progression is. Again, this is something you’ll have to discuss with you doctor.

Hope this helps,
Thomas

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Thanks @ThomasTu ! I really appreciated the discussion and comments. Will discuss with my doctor in a month time.

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@abcde,
Hi Maggie,

As a pharmacist, I can tell you when a drug is recommended to take on an empty stomach, it is referring to just food. So yes, you can drink any time irregardless of when you took the med. I did research entecavir dosing instructions. Just to clarify, it is recommended to be taken AT LEAST 2 hours AFTER a meal and AT LEAST 2 hours BEFORE next meal so you can take even more than 2 hrs before a meal or wait more than 2 hours after a meal if you want. If there is a day where it is taken close to a meal, it just means less of the drug is absorbed but this is still better than missing a dose. Hope this helps.

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Thanks @hope4us. It is really helpful!

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