Hep C viral load

[2oldman]

Does a viral load drop from 25M in 2002 to 3M in 2006 mean anything?  No treatment.. just healthy living.

[Kalio1]

Viral loads fluctuate. You can test one hour, test the next our and get different results. Viral load is not a measure of how well or how poorly your system is fighting off the viral attack.

Healthy living and no alcohol are great meausres to take if you have Hep C but you must monitor your liver carefully with blood work and scans and you have a biopsy periodically. The damage progression is nonlinear, you never know if or when it can escalate more rapidly. Have you had a biopsy? Remember, Hep C is a "silent killer" meaning you can feel just great and your liver can be being damaged by the virus. It is a very stealthy virus. You want to keep a close eye on your liver if you have decided not to treat it. What are your LFT's? How about your platelets?   Being Hep C positive puts you at much higher risk for other diseases, diabetes and lymphoma to name just a few. It does attack the liver but it ALSO stresses your whole immune system. Search "extra hepatic manifestations" for more info on related illnesses. Your viral load IS NOT an indicator of liver status. Even LFT's are not a very accurate measure of your liver condition. Symptoms are hardly ever present for decades. The only true measure of liver damage is a biopsy however there is a new scanner called a Fibroscan in trials now in the US and it is looking promising as a "noninvasive" biopsy and a way to get an excellent accessment of your true liver condition. The "normal" range for LFT's runs up to about 60 on the test results, but truly if your LFT's are over 25 they are "high" and your liver is under stress.
there is serious consideration of changing the "normal" range of reading these enzymes to a high of 30 being a more accurate measure. You can have cirrhosis yet still have within normal enzymes for instance.

[2oldman]

My last biopsy was 2002 -fibrosis 0, inflammation 1.

I don't even know what LFT is.  I hope the gastro is doing what he's supposed to.  But he's already screwed up my Colonoscopy.

I've been symptom-free 37 years.  Genotype 1a.. I think.  Not looking forward treatment side affects, so I'm taking the watchful waiting approach.  Scheduling another biopsy now.

[gobipuba]

kalio, another example here.  sure the liver enzymes can be normal with end stage liver cirrhosis, but other obvious examples of end stage liver disase would be present..jaundice,,,ascites etc.   If there is ongoing liver damage it would show up in lfts and ast/alt, as wll as imaging tests  stop scaring everyone.  You seem to diagnose everyone with hepatitis/cirrhosis, even if they have nornmal blood tests, and imaging tests.  I appreciate your concern and passion for getting things checked out, but at what point do you say trust the doctors and the tests, and look in another direction?

[Kalio1]

Many doctors don't know even the basics about hep c, they give out false info or incorrect info all the time.

Im not scaring anyone, Im stating the facts.  Were you unaware of the dramatic increased risk being hep c positive puts you at for other deadly diseases? Many people who were diagnosed long ago are not aware of that fact. If you choose to put your health care in the hands of a doctor and dont heed the fact that YOU are in charge of your own medical care and educate yourself about your disease and stay up on the current research and monitor your disease you do so at your own peril. Stay on top of monitoring and if something comes up, you can act quickly. Hep C is known as a "silent killer" because it does NOT cause symptoms to alert you something is up, this is the point of monitoring.

You are incorrect, not all people have symptoms if they have advanced liver damage or even cirrhosis and certainly not all cirrhosis patients are end stage as you imply. You seem to think cirrhosis is one static condition and it is NOT. It is gauged in stages. It is progressive. You can be in the early stages of cirrhosis and not even know it and have NO SYMPTOMS. The symptoms YOU describe are for cirrhosis that is already in the advanced stages in most cases. My advice to oldman comes from current, cutting edge information on Hep C. and the best doctors dealing with this disease in the US. Check out all the info. coming from the latest conference in Boston to confirm what I say about enzymes. The field of HEP C  is in a CONSTANT state of motion and change and the research and understanding of this disease is ongoing. You speak of hep c as if it is a fully understood, linear disease and it is not.

Every single person who has Hep C should be monitoring their condition with hepatic blood panels, scans and biopsies. Having it a long time with no progress doesnt mean a dang thing with a nonlinear disease like hep c, things can change and change fast.

[Kalio1]

Thats a good biopsy reading. Im glad to hear you had a biopsy done within the last 5 years.

LFT stands for Liver function tests.

It sounds like you are in good shape. Good luck with the biopsy.

[Kalio1]

By the way, I didn't "diagnose" anyone with cirrhosis or with anything for that matter. Monitoring is extremely important when dealing with any nonlinear disease like Hep C. If you think that is "scary" good, Hep C is a scary disease. It is also the number one reason for liver transplant in the US today.

You labor under the mistaken idea that it can't progress suddenly in some people, it can and does. You need to monitor your disease because you cant know IF or WHEN it will advance in your case.

Other factors can contribute, age, other illnesses, being overweight, poor nutrition, consuming alcohol and some medications are all factors. As we age it is even more important to monitor closely.

People with Hep C are at high risk for diabetes, your glucose should also be monitored.

[2oldman]

My ALT has been slightly elevated for many years.  It was higher in the late 1990s than it is now.  

I have regular physicals including blood, and the tests always come out fine.

[gobipuba]

Oldman,

This is my point about Kalio scaring people.  It may be normal for some people to have alt/ast over 25. Those without any knowledge see that post and think"Oh my God my alt is 26 I might have cirrhosis'  This cause health anxiety to the max.  If you have reason to believe that you have liver damage, check it out--blood tests, hep tests, imaging etc.  but if everything looks normal and nothing suggests liver probs stop worrying about the liver. That said, kalio is right that viral hep must be monitored Kalio is also right that cirrhosis can be silent and present with normal or slightly elevated ast/alst.  but I think that imaging and other signs would point to liver probs at that point of progression.  that is, if the liver was so damaged that it no longer leaked the enzymes, would not imaging show that at that point?  I know biopsy is the only way to absolutely diagnose this, but it would be suggested by other tests.

Kalio, whre do you get your info about liver enzymes being 25 being too high?  There are always debates over reference ranges, and this is different for men and women as well

[Kalio1]

2Oldman is smart, he is monitoring his disease and is scheduling an updated biopsy. With his biopsy in 02 showing an all clear, it looks good but unfortunately the ONLY way to know for sure is to continue to update his biopsies like he is doing. Particularly since he says he has had consistently elevated alt/ast. ( even if it falls in the high normal range)
You are wrong when you say that you would have "other clues" That just isn't true. You will EVENTUALLY have symptoms and "clues" but by then your liver damage is usually quite severe. You seem to be in some level of denial about Hep C and the dangers and lack of warning signs patients have. You are just plain wrong,there are not all these "clues" you claim exist. Clues like what, liver failure? In many patients it is slow moving and not causing inflammation BUT that can CHANGE. It is a nonlinear disease! What your past experience has been does NOT dictate the future. I have seen people go from 01 level fibrosis to cirrhosis in 2 years! It does happen, don't kid yourself. Th problem is you don't know if or when it can happen to you. Keep an eye on it and you are in good shape but ou can't judge by how you feel or ( this one kills me) low viral load or many of the other false ideas that are floating aorund out there. IF your enzymes are consistently over 25 you have inflammation going on in your liver. My hep doctor specifically said "not over 25 for either gender" to me. Anything over that number indicates inflammation going on. Inflammation and cell death which are what causes fibrosis which in turn causes cirrhosis. Even in A stage cirrhosis you can be virtually symptom free. You are really kidding yourself if you think you will have symptoms and warning signs in the early stages of liver damage. Show me one legitimate source for that piece of info you are claiming. I could bury you in facts to back up what I am saying, they don't call it a silent killer because it gives you symptoms and clues your situation is worsening, they call it that because it DOES NOT.

The only thing a scan can detect is a mass, tumor or fatty liver, it does NOT see fibrosis at all. Having a scan that shows no problems means no masses or tumors, it is blind to fibrosis completely. Your only measure of fibrosis (which leads to cirrhosis) is a needle biopsy OR this new Fibroscan machine which is in FDA. trials now and not available to the public outside of those trials.

some of the latest info regarding enzymes

From:http://www.medscape.com/viewarticle/547077?sssdmh=dm1.222834&src=nldne

Upper limits of normal range from 30 IU/L to 60 IU/L, depending on the laboratory. "We want to reset it southward of 30 IU/L," Dr. DiBisceglie said.
"ALT levels are a reflection of the general vascular condition," he said. "If the level is above 30, then that person probably has a problem — fatty liver or some vascular disease, including occlusive coronary artery disease."
AASLD 57th Annual Meeting: Abstract 95, presented October 30, 2006; abstract 1251, presented October 31, 2006.

[Kalio1]

"if everything looks normal and nothing suggests liver probs stop worrying about the liver."


This a really dunb thing to tell anyone with Hep C. They already HAVE A LIVER PROBLEM.

[gobipuba]

Dr kalio,

I read the article about the liver enzymes.  There is another one that suggests dialing down the numbers to 36 as being  normal for healthy people, though this one suggests that weight, race, sex are factors for what is considered normal.  From whatI read in your post you disagree with that...anything over 25 is abnormal  I don't have a problem with examining liver enzymes over 30 and changing the normal ranges.  This well as well cause a lot of anxiety to people who are perfectly normal

I am also not talking about the orginal poster here who has hepatitis, certainly someone who has been diagnosed has to be monitored on a regular basis

Scans can detect fibrosis and cirrhosis in later stages.  check out the following images.
http://images.google.com/images?hl=en&q=cirrhosis%20scans&ie=UTF-8&oe=UTF-8&sa=N&tab=wi

None of these methods, short of biopsy, is foolproof for diagnosing liver probs.

Take the average person who complains of subjective problems that might suggest liver probs.  He goes in and gets blood tests that are normal or high normal, perhaps with alt between 30-40.  He gets imaging tests that are normal.  At this point the Dr starts looking in other areas, many of which can cause similar symptoms.  The person who writes here sees your post asserting that anyone who has enzymes over 25 has liver inflammation and that scans are useless when it comes to this area.  So what does the person do?  goes to another Dr who tells them the same thing, your liver is normal, it is something else.  Even if the Dr said it was too high the advice would be to lose weight, stop drinking, examine any drugs that might be causing too high and then get retested later.

I am not a Dr but I can tell you obviously have a great deal of knowledge and passsion in this area.  People should be viglant to live healthy and get checked up. What do you suugest then for the person who has vague and subjective symtpoms that might suugest liver probs but has normal enzymes-let's say 30, and normal scans?  The response that I have seen over and over fro you is that a person with normal lfts and scans should not rest easy because they could still have liver probs.  But most DRs will not order any biopsy with normal numers and scans.  Perhaps your dr is very conservative on this number?

[gobipuba]

Also Kalio,

[gobipuba]

Also Kalio,

Your Dr that said over 25 is a problem Was he referring to a hepatitis patient?  From what you wrote I assume you have a form of hepatitis, and your Dr is responding to your personal situation.  Thanks for your response

[gobipuba]

Final comment-Here is that other article about alt levels-it does suggest lowering what is considered normal levels-but as I understand the research the 95th percentile of what is considered normal would be 31.8 for women and 44.9 for men, with the average being 37.5.  This is lower than what I see on many of the ranges, but does suggest that if I have an alt over 25, but less than 45 I don't necessarly have inflammation going on, especially if I am male.  Surely the experts and research debate this issue all the time.  You dr insists over anything over 25 is too high period, my Dr says you are normal, at what point do you have to live as healthy as possible and stop worrying?

http://www.medscape.com/viewarticle/529695_3

[Kalio1]

Believe what you want, you can ignore what I say, maybe you will luck out. This info about enzymes is not what "my doctor says" this is from a discussion amongst the top heptologists in our country at the conference in Boston and what their consensus is, my doctor was there. The discussion was regarding Hep C patients specifically. You won't see the numbers change on tests or protocols for years to come, you are being forewarned of news that WILL someday become the norm. Hep C is still a "new" disease and much is still being discovered about it, it is not as innocuous as some people were led to believe.

Ideally your enzyzmes should be in the teens. If a person with Hep C has elected not to treat their illness, it is IMPERATIVE that they have a biopsy (or Fibroscan)and follow that up periodically to ensure there isn't a progression in liver damage. In addition they should watch their hepatic panels closely and have ultrasounds to screen for liver cancer.They must maintain proper body weight and good nutrition and exercise and abstain from alcohol. You will not have any symptoms until damage has progressed substantially. Blood tests and how you feel are not enough, if your ALT/AST are consistently over 25 then you consistently have inflammation in your liver It is a nonlinear disease, you do not know if or when it will escalate. Many people unfortunately do not properly monitor their disease. Many patients have never had a biopsy and many doctors know VERY little about Hep C or what they do know is outdated or incorrect. they even ell patients they don't "need" a biopsy because they are behind on the learning curve of this disease not because patients don't need them. As a matter of fact, ALL people diagnosed with Hep C should have a biopsy when diagnosed so they can establish a baseline. Unfortunately if you have had it a long time, chances are you didnt have a biopsy and believe if you take care of yourself and feel fine your liver is fine. Sadly, this is not always the case. Even sadder is the fact that many doctors do not enlighten their patients as to the dangers being Hep C postive represents to their OVERALL health, or their much higher risk that exists for them for other diseases and illnesses. It is not only a liver disease,that is a myth. Particularly as you age, your damage can escalate. Please read and/or watch all the information at clinicaloptions.com. Another myth is that an ultrasound is enough, it absolutely is NOT enough, it can not even see fibrosis. A clear ultrasound does NOT mean no liver damage.

The only true, accurate way to determine your liver status is through a needle biopsy or a Fibroscan. This should be done every few years. If you don't have a baseline biopsy, you have no idea if your liver is damaged or not if you judge only by ALT/AST readings and how you feel.

The virus can be relatively benign for many years and then suddenly change. You would have no idea if you aren't properly monitoring your liver.

This is the 3rd most common way to die in the US. for people aged 40-65. None of them had any "warning signs" either until it was too late.

[Kalio1]

PS. obviously this discussion and all the information I have posted was regarding people with Hepatitis C, a disease the original poster stated he had.

My comments were clearly about people with Hep C. Obviously people without Hep C dont need to run out and get a biopsy.

However, liver enzymes being in the high range of normal ( over 25) in people who do NOT have Hep C most likely have some other liver issues going on, either they drink too much alcohol or take medications that are affecting them or have fatty liver NASH or any number of possible liver issues that should be addressed.

[Kalio1]

And one last thing, yeah, scans can detect damage once it is SO FAR GONE that you are very unlikely to be able to do anything about it! You want to know in the EARLY stages of fibrosis that you have it so you can try to stop it, if you wait until it can be seen on a scan you are in deep trouble.

[gobipuba]

Kalio,

I have read your posts and appreciate your thoughtful comments, especially about Hep C, a very serious disease  Obviously you have studied and thought much about these issues.  I don't know if I agree with you about enzymes being over 25, being a sure sign of inflammation.  Surely you must agree that many, many doctors would disagree with you and your dr on this issue.  I am not saying you are wrong, only that this is a matter of debate in the medical community, as many, many issues are.  Even if I choose not to "ignore" your warnings what I am to do?  you must admit that I could go to 5 -10 drs in a row and they will all say the same thing.  Your LFTS and enzymes are normal(18-32) in my case  Your cat scans are normal.  We will not order a biopsy.  I do not have Hep C.  Even if I have fatty liver, a realtively benign disease, the treaqtment is stop drinking, eat right. lose weight etc.  I was too agressive in my initial email, I appreciate your comments. Thanks

Jd

[Kalio1]

Fatty liver is NOT a "relatively benign disease" as you state, anyone diagnosed with it should take their condition SERIOUSLY and heed the doctor's advice, it is a progressive diease condition. As little as 10oz. a WEEK of alcohol can increase it dramatically. Eliminate ALL tras and saturated fats ASAP. It is not "benign" it can be in SOME patients,but again, it is a nonlinear disease, progression is not the same in all people, overweight patients or drinkers or those who eat poorly and don't exercise need to act quickly, fatty liver can be a progressive disorder that can result in cirrhosis. Please read up on it. It is epedemic in our country, hey ae finding it even in children.

If you dont have Hep C, which was what ALL the above posts were about because the original poster stated he had Hep C, obviously you dont need to run out and get a biopsy. BUT you definately do have chronic inflammation going on with enzymes in the 30's and you need to take your fatty liver very seriously and work to reduce those numbers through diet and exercise and abstaining from alcohol. It is progressive.

Here is an article anyone with fatty liver should read. Keep in mind your diagnosis is serious, it is not something that is benign, fat accumulation in the liver clogs up your bodies ability to function much like clogged arteries in your heart can cause a heart attack, fatty liver can cause liver malfunction to the point of increase liver disease and even cirrhosis. Did you know NASH is the LEADING liver problem in the US? If a doctor told you it was "benign" you ned a new doctor who knows what they are doing. A Heptologist would be best. Ignore the steps you were told to take, good nutrition, losing weight,regular exercise and you do so at your own peril.

http://www.emedicine.com/med/topic775.htm

[gobipuba]

Kalio,

"Simple fatty liver is believed to be benign, but NASH can progress to cirrhosis and can be associated with hepatocellular carcinoma."  Steatosis is a benign condition, and progression is very rare." from emedicine web md  kalio-did you even read the article you just referenced?


You jump all over my case for saying it is benign, and then you have the gall to reference an article that supports what I just wrote?
Why don't you stop trying to diagnose everyone's problem as if you know exactly what they have and don't have?  Simple fatty liver can progress and be more serious if the person refuses to change lifestyle habits that are causing it-obesity-drinking, but can be reversed if lifestyle changes are made. this is true with any condition that one has..if it is not take seriously it can progress and cause you probs...thyroid, high blood pressure, obesity  The fact that I said it was benign does not mean not to take it seriously.

[Kalio1]

Are you seeing a Heptologist? You might want to see a liver specialist for a second opinion. You didnt read the entire article I posted or you wouldn't keep focusing on the word benign. Fatty liver might begin as a relatively benign condition in the early stages but it is progressive if proper steps aren't taken to diligently work at removing that liver fat. How do you know how bad yours is? Keep in  mind symptoms from liver disorders (fatty liver is a liver disorder) are virtually nonexistant UNTIL they reach a more advanced stage. An ultrasound can sometimes (not always) see the fat but it CAN NOT see liver damage until it has reached a critical stage! The damage level caused by the fat accumulating is therefore unknown,all you know is it isn't at a critical stage yet so you don't know how advanced it is or is not without a biopsy. You want to get those enzymes down into the 20's or ideally down into the teens, if they are consistently reading out in the 30's, that says your liver is constantly stressing according to many top Heptologists including mine. Yes, fatty liver is "benign" INITIALLY but it causes more dramatic conditions as it progresses. Fatty liver is not a static situation at all. It should be addressed as a serious condition because if left unaddressed it can become a serious condition.

Your liver is being stressed by the accumulation of fat in it. If fat was collecting in your heart would you view that as benign? I doubt it. Anyone with a diagnosis of fatty liver should not cling to the word "benign" because it is progressive, what is benign today is dangerous down the road. It CAN be reversed but if left unattended it will go from benign to a more critical situation.

http://www.sciencedaily.com/releases/2005/11/051103080111.htm

http://www.liverfoundation.org/db/pressrelease/77

[motherfletcher]

I am confused and don"t know what to do...I have hep c and have known for 2 years..I started treatment and got very sick and stopped...I then started herbal medicines...I do feel better but my doc says I need to be treated...My viral load is high ; my alt"s and ast"s are normal...My biopsy put me at stage one and my genotype is 1....Can anybody help me with the confusion I am having?

[Effiedanna]

I am a perfect example of how Hep C can change fast. Last October during a routine phyical my ALT and AST were slightly elevated so my doctor asked me if i had been doing anything that would raise my ALT and AST because we didn't know i had Hep C yet so she said she will watch and we will redo liver test in 6 months. My second liver test showed my ALT and AST 10x higher i was immediately sent to a Hepotologist who did a panel of test that showed i Had Hep C, geno 1a, and high tumor markers. I had a bioopsy showed stage 1-2 and also had a cat scan which showed no cancer. So from October to March my life was turned upside down. I an currently in treatment with Pegasus 180mcg shot every week, 1200 mg of Ribaq daily. I stated with a VL of 1,450,00 after 4 wks 220,000 after 8 wks 65,000 getting ready for my 12th wk blood test hoping to be undetected or at least a 2 log drop. It hasn't been easy i am in the fight for my life just like everyone trying to gt rid of this Virus, but this Virus changes fast and it s better to start treatment when your still feeling good because you will be able to tolerate treatment better. I had no symtons found out all this my having my yearly physical thgank god i had such a good doctor she saved my life.  Good luck just keep on top of this it truly is the silent killer. Effie