Enzyme levels and Hepatitus(hepatitis) C

[Greg-Hurwitz]

  My father is 80 years old.  He feels great and is very energetic. 35 years ago he had a subtotal gastrectomy.  He contracted Hepatitus (hepatitis) from the blood transfusions.  A little over two years ago, his physician noticed and increase in his AST and ALT levels.  It was then that the physician discovered that my father has Hepatitus (hepatitis) C.  In Dec. of '96 his AST was 60 and his ALT was 111.  Since then, his AST has fluctuated between 98 and 156.  His ALT has fluctuated between 200 and 340.  In Dec.'98 they registered 107 and 318 respectively.  In Dec., my father had a physical exam and the physician found that my father's hemaglobin count was 6.3 (up from his usual 5.5) and his blood sugar level was 105.  The physician told my father to cut sugar out of his diet as much as possible.  He wanted to see what effect it may have on his enzyme levels.  My father did as he was told.  He went back in for a blood test in Feb.'99 and found that his hemaglobin and blood sugar levels did not change.  However, his AST shot up to 226 and the ALT shot up to 392.
  Two bits of background: 1) his father became diabetic at 75 years of age.  2)  my father's physician prescribed Prilosec for him about four years ago, I think for mild reflux.  It was after taking Prilosec for about two years that we discovered the increase in his enzyme levels.  I read the info. enclosed with the Prilosec and said that anyone with Hepatitus (hepatitis) should not take it.  I was furious that the physician didn't know this.
  Do you think that the prilosec had anything to do with the enzyme levels?  He stopped taking it about two years ago (when I read the info.)
  What does all this mean?  How serious is this?  Are these enzyme levels dangerously high?  How high have you seen them in patients and still not give them any problems.  How does the hemaglobin levels and blood sugar play into this?  Since December, he has lost about eight pounds due to the almost sugarless diet.  He is 5' 10" and weighs about 188 lbs.  He is concerned, because he doesn't want to lose any more weight.
  Sorry for the lengthly message, but I wanted to give you all the details.  
  My family and I would greatly appreciate any info you can give us as well as to answer our questions.  Thank you so much for giving us a place to turn for answers..

[HFHSM.D.-rf]

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Dear Greg,
thank you for your letter.  These liver elevations are not high bit there is no correlation between the magnitude of the elevations and the severity of the liver pathology.
With regard to the Prilosec, I doubt that it is the cause for the increased liver tests.  Both diabetes and chronic hepatitis C infection can cause fluctuating elevations of the liver enzymes.
The only way to know with certainty what is causing the elevated liver tests is to do a liver biopsy.  However, I do not necessarily favor such an approach in older people.  The question is whether one can find a treatable illness in which therapy will have a beneficial effect.  I would not treat an 80 yr old man with chronic Hep C infection with Interferon for there is no benefit.  Hep C takes many years to cause symptomatic illness.  If your father is symptom free at this age, it is unlikely that he will develop liver problems.  Treatment for the diabetes is ongoing so there is no reason to do a liver biopsy to confirm that he has nonalcoholic steatohepatitis.  ( I assume that your father does not take alcohol which can cause these liver enzymes).
This information is presented for educational purposes.  Ask specific questions to your personal physician.
HFHSM.D.-rf
*keywords: hepatitis C, liver tests
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