Question Title: ALT & GGT levels

Posted by Richard on July 25, 1999 at 19:37:24

I was diagnosed with hepatitis C June 1998. July ‘98 quantitative HCV RNA level was positive 570,000 copies. Liver biopsy revealed no fibrosis or cirrhosis and revealed only very mild inflammation.

I began combo treatment (interferon/ribavirin) on Sept. ‘98 Treatment was discontinued after 24 weeks (Feb. ‘99) and RNA level was 542960 and ALT was 164.

My ALT was: ‘89/81, ‘90/75, ‘92/59, ’94/48, ‘95/59, ‘96/50,‘97/74, 6-’98/80. After 2weeks of combo treatment my ALT went up to 130. Two weeks later new RNA was 273,000 and ALT was 94.Then on 12/4/’98 Alt went up to 110, 1/12/’98 ALT was 121,and now 6 mos. later my ALT is 82.

Question #1: Is combo treatment the reason I saw such a rise in my ALT, since it went back down after treatment?

My GGT levels were: ‘89/146, ‘90/195, ’92/126, ‘94/108, ‘95/146, ‘96/222, ‘97/245, ‘98/173, ‘99/228.

Question #2: Why has it not fluctuated like my ALT? Should I be concerned about something else?

Thank you for your help and time.....Richard

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Posted by HFHSM.D.-D.M. on July 31, 1999 at 16:31:39

Dear Richard:

I appreciate your questions and I’ll try to make some comments.

I understand that your ALT went from about 80 prior to therapy to up to 120 on therapy and than down to 80 after therapy. First and foremost, we really would not consider a change from 80 to 120 on the ALT to be that significant. The ALT can bounce around quite a bit in individuals with hepatitis C. We generally would like to see the ALT come down with combination therapy and actually return to normal. In some individuals, the ALT can go up on combination therapy and it is possible that you were such an individual. There are a couple of potential reasons. The interferon, on rare occasions can have some liver toxicity though this is not usually marked. In addition, some patients with hepatitis C also have a component of autoimmune liver disease and this can actually be worsened with interferon. Again, in your case, the change in ALT would not be considered that significant. By the way, I have seen some patients whose ALT worsened on interferon actually have a good response. The way we could tell that is we monitored the HCV RNA. Even though the ALT went up the HCV RNA became undetectable. That is why this test is so important to determine response.

The GGT test is a difficult test to interpret and that is why I do not use it that much. It is not a test that we typically monitor in hepatitis C patients. I am pleased that your liver biopsy was so benign. That is the test that probably matters most in someone with chronic hepatitis C.

I hope this information is helpful to you. Good luck to you. If you have additional information or questions, I would invite you to post the material to MEDHELP. The direct number to our Liver Clinic at Henry Ford is (313) 916-8865. We have an active group of liver specialists and we have an interest in and experience with hepatitis C.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

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