Is There a Cure for Liver Fibrosis? Treatment Options

Is there medication for liver fibrosis?

Dear Doctor,
After reading your work, I have gained a better understanding of liver diseases.
However, I still have some concerns after my recent consultations, and I would like to ask a few questions:
Family medical history: I am a carrier of hepatitis B from my mother, who passed away from liver cancer.
My grandmother had cirrhosis, and my uncle had fulminant hepatitis.
Medical records from April 10, 1997, show: GOT: 485, GPT: 1079, AFP: 570, HBsAg: positive, HBeAg: positive, Anti-HBs: negative, Anti-HCV: negative, Platelets: 109.
An ultrasound indicated suspected mild liver fibrosis.

The physician at Nankang Hospital recommended self-paying for Tenofovir, while the doctor at Taichung Veterans General Hospital also suggested self-paying for Baraclude.
The physician at National Taiwan University’s Douliu branch recommended self-paying for Baraclude, stating that since I have to pay out of pocket, I should opt for a "better" option.
According to the National Health Insurance guidelines, HBsAg and HBeAg must be monitored for more than six months.
I obtained the above data in April, and the earliest I could apply for coverage might be in October this year.
If my indices decrease by then, I may not be eligible for coverage at all.
Therefore, I must purchase the medication out of pocket.
Recently, I participated in a free liver function screening at National Taiwan University’s Huwei branch.
Due to abnormal AFP levels, I underwent an ultrasound for confirmation.
The physician assessed that there might be signs of fibrosis and advised me to seek medical attention promptly without waiting for the HCV-DNA report.
I immediately took the above report to the Douliu branch, where the doctor surprisingly stated that there are no active treatment methods for liver fibrosis?! He advised me to rest and did not recommend any further blood tests or biopsies, as the data was already quite clear.
He suggested monitoring AFP every two months and continuing Tenofovir, and if there is any drug resistance, to self-pay for Baraclude.
My questions are: Doctors always urge us to pursue active treatment, yet the conclusions from my visits often yield the same answer: no medication available? Just continue taking Tenofovir.
If that is the case, how often should I return for follow-up appointments to monitor GOT, GPT, AFP, and ultrasound while continuing Tenofovir? Is the team at the Yunlin branch the same as the one at the Taipei main hospital? Would my condition be better managed if I sought treatment at the Taipei main hospital? I have seen three doctors already; why have none prescribed me any "active treatment" medications? I have only been on Tenofovir for three months, and perhaps in another three months, I can apply for National Health Insurance coverage for it.

Now, do you recommend that I switch to Baraclude? Honestly, without considering the cost, would Baraclude be more effective than Tenofovir? If so, should I focus solely on Baraclude and discontinue Tenofovir? The last issue of "Good Liver" discussed the issue of "liver fibrosis," stating that as long as it is controlled, deterioration can be avoided.
How do we determine what constitutes "control"? In the early stages of liver fibrosis, it can be repaired naturally.
What nutritional supplements or medications can promote liver cell repair?
Thank you for your assistance with these questions.

homa, 30~39 year old female. Ask Date: 2008/05/21

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello Homa!
Based on the information in your letter, your medical history is less than six months, but given your current condition of acute exacerbation of chronic hepatitis B, it is indeed necessary to initiate medication to suppress inflammation.
However, since it has been less than six months, it does not meet the criteria for health insurance coverage, so you will need to pay for the treatment out of pocket.
Both Tenofovir (干安能) and Entecavir (貝樂克) have shown good initial efficacy.

Among the medications for treating hepatitis B, Tenofovir is relatively inexpensive, but its drawback is that long-term use can lead to the development of drug resistance.
Entecavir is more expensive, but it has the lowest probability of inducing drug resistance among currently used medications.

The formation of fibrosis is due to previous liver inflammation, so to slow down liver fibrosis, it is essential to avoid any hepatitis episodes.
Your hepatitis is caused by the hepatitis B virus, so initiating treatment with either Tenofovir or Entecavir is the correct and most proactive approach.
The use of antiviral medications (Tenofovir or Entecavir) represents aggressive treatment, which we refer to as control.
At National Taiwan University Hospital Yunlin, whether at the Douliu or Huwei branch, the hepatobiliary team is the same as that at the main hospital.
There is no need to specifically transfer to the main hospital for treatment.
Your letter did not specify your GOT and GPT levels after taking Tenofovir.
If they are gradually decreasing or have returned to the normal range, it indicates that Tenofovir is effective for you, and there may not be a need to switch to Entecavir.
The frequency of follow-up will be determined by your physician based on your condition.
The best way to assess whether liver fibrosis has been controlled is through a liver biopsy, which directly examines changes in liver cells.

A balanced diet is sufficient; there is no single food or product that has liver-protective effects.

Reply Date: 2008/05/21

More Info

Liver fibrosis is a progressive condition that results from chronic liver injury, leading to the accumulation of scar tissue in the liver. Understanding the treatment options for liver fibrosis, especially in the context of chronic hepatitis B infection, is crucial for managing the disease and preventing its progression to cirrhosis or liver cancer.

Treatment Options for Liver Fibrosis
1. Antiviral Therapy: The primary treatment for chronic hepatitis B infection, which is a common cause of liver fibrosis, is antiviral therapy. Medications such as entecavir and tenofovir are highly effective in suppressing the hepatitis B virus (HBV). These drugs can help reduce liver inflammation and fibrosis by controlling viral replication. If you are currently on a medication like "干安能" (likely referring to entecavir), it is essential to continue this treatment as prescribed. If you experience any side effects or have concerns about its efficacy, discussing these with your healthcare provider is vital.

2. Monitoring and Follow-Up: Regular monitoring of liver function tests (such as GOT, GPT), alpha-fetoprotein (AFP) levels, and imaging studies (like ultrasound) is crucial. Typically, follow-up every 3 to 6 months is recommended, depending on your liver function and the stability of your condition. If your liver function tests remain stable and your AFP levels are normal, your doctor may suggest extending the intervals between follow-ups.

3. Lifestyle Modifications: Making lifestyle changes can significantly impact liver health. This includes maintaining a healthy diet, avoiding alcohol, and engaging in regular physical activity. Weight management is particularly important, as obesity can exacerbate liver fibrosis.

4. Nutritional Support: While there is no specific supplement proven to reverse liver fibrosis, a balanced diet rich in antioxidants (found in fruits and vegetables) can support liver health. Some studies suggest that certain nutrients, such as omega-3 fatty acids, may have a protective effect on the liver.

5. Emerging Therapies: Research is ongoing into new therapies for liver fibrosis, including antifibrotic agents. These are still largely experimental and not widely available. However, staying informed about clinical trials or new treatments can be beneficial.

Addressing Your Concerns
You mentioned that multiple doctors have suggested there are no aggressive treatment options for liver fibrosis. This can be frustrating, especially when you are seeking a more proactive approach. It's important to understand that while fibrosis can be serious, the primary goal of treatment is to manage the underlying cause (in this case, hepatitis B) and prevent further liver damage.

Regarding the differences in treatment approaches between hospitals, it is possible that different medical teams may have varying philosophies on managing liver disease. If you feel uncertain about the treatment plan, seeking a second opinion from a hepatologist or a liver specialist at a tertiary care center may provide additional insights.

As for switching from "干安能" to "貝樂克" (likely referring to another antiviral), both medications are effective, but they may have different profiles in terms of side effects and resistance. If your current medication is well-tolerated and effective, it may not be necessary to switch. However, if you are considering a change, discussing this with your healthcare provider is essential to weigh the benefits and risks.

Conclusion
In summary, while there is currently no cure for liver fibrosis, effective management of chronic hepatitis B through antiviral therapy, regular monitoring, lifestyle changes, and nutritional support can help control the disease and prevent progression. It is crucial to maintain open communication with your healthcare team and advocate for your health needs. If you have further questions or concerns, do not hesitate to reach out to your doctor for clarification and support.

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