I have a question regarding my recent Fibroscan report. Hope the experts give me some suggestions.
I was diagnosed as having Cirrhosis (HBV affected) in early 2024 and my Fibroscan KPA score was 18.4 then. I started taking Tenofovir in April 2024 and changed my life style substantially to maintain a very healthy life routine (no alcohol, exercise daily, go to bed early, stress-free, eat healthy with low sugar low sodium and low fat). There were no symptoms and complications. My endoscopy showed no hypertension.
I just completed my second Fibroscan. The results came out showing my KPA was 6.9. Though I expected some improvement but this was a bit unbelievable. The KPA score at 6.9 indicated F0-F1 meaning almost no fibrosis.
Is this reversal possible, especially in such a short period of time (18 months). Is there a possibility they mixed up my results with another guy? This morning when I did the procedure, the nurse did not verify my name and date of birth.
I am waiting for a response from my doctor, but would love to listen to the opinion of the experts here.
Thank you for your reply, Caraline. I appreciate your kind words. Yes, it is not easy but I am glad that I tried my best to maintain a healthier lifestyle.
I was just surprised by the number. My doctor (actually a nurse practitioner who specializes in GI. I don’t even get a real GI doctor or hepatologist. Health care in the US sucks) told me even though the reversal from compensated cirrhosis would be possible but I should not expected a big change. I also thought it would not be possible to get to 6.9, because it was a complete reversal. So I assumed that the result might not be mine. My Ultrasound showed that my liver still had coarsened hepatic echotexture.
Hi @geomo,
My understanding is that some HBV patients on treatment can reverse their cirrhosis if it is not too far gone. So it is possible to see some change. By how much and how quickly this occurs, I am unable to say. Are you due for another Fibroscan anytime soon? This can confirm whether the KPA of 6.9 is accurate or false.
I do believe US healthcare can be challenging based on where you live. I live in an area where there is an abundance of hepatologists who specialize in HBV treatment. This is not the case for everyone. I hope you can use the "Find a doctor " on the Hepatitis B Foundation website to find a hepatologist in your area or nearby. I hope you get some concrete answers soon. Best, Bansah1
Thank you for your reply, @Bansah1 I got the confirmation from the technician who did the Fibroscan (Oct 20) that it was my data, not a mix-up. So if the scores were real, it would be so great that my cirrhosis regressed. my cirrhosis was at it early stage and compensated when I was diagnosed (KPA 18.4).
But I am still confused because my Ultrasound image (Oct 6) still showed coursened texture indicating cirrhosis and my platelet remained low (112). My nurse practitioner could not explain this. I will try to find a hepatologist in the nearby city. I may request another Fibroscan to verify if this is true. To me, it is too good to be true.
Also, my nurse practitioner interpreted KPA 6.9 as F2 fibrosis and CAP 208 as mild fatty liver, which I think was incorrect. When I questioned this, She said there were different scoring systems. But according to my knowledge, KPA lower than 7 is considered at F0-F1 stage and CAP under 238 is considered no fatty liver. Am I right?
I am not a doctor or expert. Research has indicated that fibrosis is reversible once the underlying cause is treated or stopped. The time frame for reversal is usually long. Fibroscan is a measure of liver stiffness, and fibrosis increases stiffness. But there are other markers of fibrosis due to HBV, including a liver biopsy. I believe your endoscopy showed no varices due to cirrhosis. Congratulations, you are doing well. You can also check your hbvdna and other liver functions.
Thank you, Stephen @Stephenw . When I was diagnosed, it was compensated cirrhosis. I had endoscopy early 2025 and there were no varices or portal hypertension. After a few months antiviral treatment (TFA) my HBV DNA was suppressed from millions to less 10, which was successful. I did not expect such a quick reversal on Fibroscan KPA score. I also believe it is just an indicator of the stiffness, not the structure of the liver. The scars may not go away anyway. But I am happy with the reversal and will continue what I did in treatment and lifestyle changes.
What a great outcome to your story, glad to see it regress so quickly. There may be some factors that can increase KPA scores that are not fibrosis - for example if there is liver inflammation, this can also stiffen the liver. Antivirals will also reduce inflammation, so this change may be driven in part by this.
Thank you, @ThomasTu . Your explanation makes much more sense. My first Fibroscan was done during the period of time that my HBV DNA was so high and the inflammation must stiffen my liver at the time.
I still have a question regarding the ultrasound result I did two weeks ago before this fibroscan. The ultrasound image still showed coarsened texture which indicated cirrhosis. Also my platelet count was still low (112). How was it possible that my KPA was low at 6.9 but the ultrasound and platelet count still indicated cirrhosis? Do the structure of my liver and the vascular system need more time to remodel? Thanks!
My understanding is that coarseness in ultrasound is not a highly sensitive or specific measure of fibrosis - Accuracy of Routine Clinical Ultrasound for Staging of Liver Fibrosis - PMC . However, this is part of the “art” of medicine, to be able to take in the whole person and understand what might really be happening - this requires you to continue seeing your health provider who can physically examine you, order more tests if needed, and interpret from these results and your medical history to understand what might be going on.
Thank you, @ThomasTu . This really helps. I read the paper you mentioned. It well explained my situation: Fibroscan detected lower stiffness, but US still indicated coarsened echotexture. The US has lower sensitivity to identify mild to moderate fibrosis.
I agree that it should be explained by a competent provider using all data available. My current NP seems not knowing much about cirrhosis and fibrosis. I have found good hepatologists in a bigger city nearby. I will schedule an appointment with them before my next testing time.