Hepatitus C?

[puccinitenor]

Dear Dr,
I have had a strange mono-like illness for 3 and a half months.  During that time, my symptoms have improved alot but I still don't feel great.  My symptoms have included swollen glands, night sweats, and fatigue, all of which have improved alot but not gone away completely.  I have been to several doctors (4) and had multiple blood tests for many illnesses over these nearly 4 months.  Tests have included HIV (4 times over three months), Mono (also 4 times over three months), Hepatitus (hepatitis) A & B (once about 2 months after onset of symptoms), Syphillis (twice), Lyme's Disease, Cat Scratch Disease, TB, and 2 Metobolic panel tests.  All of these were negative and normal.  Just the other day however, my latest doctor noticed some elevated enzymes in my liver.  He did a blood test for Hepatitus (hepatitis) (all forms) and is specifically looking for C and D.  This has me very worried.  I also had an ultra sound done of my liver.  I am going to see him Tuesday for the results of the blood test and the ultra sound.  I am very nervous and wanted your opinion on the chance of being positive for Hepatitus (hepatitis) C.  I have never had a blood transfusion and have never used drugs.  I am, however, homosexual but only engaged in anal sex (with a condom) one time in my life.  Since seeing the doctor today, I have developed some discomfort in the liver area of my abdomen, but I must wonder if it is anxiety induced, since I have had no pain there before.  Is it true that hieghtened enzyme levels do not indicate Hepatits C?  If so, that could be comforting as I await my results...  Thank you for your time.

[Kevin Pho, MD]

There are many reasons for an elevation of liver enzymes.  This can include hepatitis, fatty liver, medication side effects, anatomical abnormalities, gallbladder disease or pancreatic disease to name a few.  

The initial workup seems reasonable.  If the tests for hepatitis C are negative, it is unlikely the disease is present.

If the enzymes continue to be elevated without a clear cause, a liver biopsy can give a more definitive diagnosis.  

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[puccinitenor]

I also had a catscan of my chest and neck which showed my lymphnodes to all be within the normal size.  (Thought I should mention this...so many tests!)

[puccinitenor]

One more piece of information that may apply: I have always been only an occassional drinker.  However, since the onset of my symptoms 3.5 months ago, I have not drank at all.

[Kalio1]

Sorry you aren't feeling well. Your symptoms could indeed be related to Hep C. Elevated liver enzymes can also be an indicator. They can be raised for other reasons too, your doc is probably starting there and will check for other things if it isn't that in order to diagnose you. Good for your doc for testing for it, sounds like he is doing the right things.
About 20-30% of people that have Hepatitis C have no known risk factors in their history yet they have the virus, so it is a good idea to test for it.  
Try not to worry yourself too much until you know for a fact. If you do have it, a good move would be to get an opinion from a liver specialist(Heptoogist) who deals with Hep C patients often before you decide how you wi manage your illlness. There are treatments available, many people are able to live with it and do nothing except monitor their liver condition, it is a very slow moving disease.
Stopping alcohol was a good idea if it turns out you do have it. Alcohol acts like an accelerant to the virus so it is a good idea to stay away from it.
Good luck to you.

[puccinitenor]

Also- how reassuring is a negative test for Hep A & B 57 days after my last sexual encounter, and 50 days after the ponset of flu-like symptoms?  The "window period" for Hep A & B is not clear to me.  Thanks...

[puccinitenor]

also- how reassuring is a negative Hep A & B test 57 days after my last sexual encounter and 50 days after the onset of flu-like symptoms?  The "window period" for Hep A & B is unclear to me.  Thanks...

[puccinitenor]

One more piece of information that I have uncovered: One month to the day after the onset of my flu-like symptoms, I had a normal Hepatic Panel Test.

[jaz1314]

Hepatitis C is a very strange disease. I am very fortunate not to be progressing but am curious as to why. Ive seen toher people with porro prognosis, in fact my ex's husband had a transplant two years ago and now the new liver has been deteriorating and he loooks 9 months prengant (Acites (ascites)) after having been drained just a couple days ago at Philly.  Anyway my history...

1970's I was a drug user for a few years, speed, cocaine, heroin..what a mess. 1979 I jaundiced and went to the hospital where I was diangosed with hep B. from 1980 on I was clean except for enjoying my wine at night (2-3 glasses) . My liver enzymes were always double what they should be. In 1989 I had a polyp observed in my gall bladder and ended up having my GB removed, durng that procedure I had my first liver biopsy.

The results of the biopsy were portal inflammation and some fatty infiltration but positive for Hep C. I wonder if the 1979 diagnoses was correct.

I did an intereferon treatment for 6 months where my viral load became undetectable. After stopping treatment the viral load came back to 300,000. A couple years later I repeated the treatment, same results.

I didnt pay much attention as I always felt good! Lots of energy, no symptoms other than the high liver enzymes. In 2001 the biopsy was repeated. No change. No cirrhosis, no cancer, jsut portal inflammation and some fat infiltration. Doc suggested Intereferon again with Ribavin. I tried it and stopped after two weeks, I felt HORRIBLE!

Had blood work done last year and viral load was now 1 million.
Genotype 2

So now I had a surgery to correct GERD ( Nissen Fundoplication ) and had them do antoher biopsy. Results are:


Chronic portal triaditis, suggestive of chornic hepatitis
Steatosis
Iron stain shows normal reticulin pattern
Trichrome stain shows mild lobular and portal fibrosis without bridging or evidence of cirrhosis.


So being 46 and having had chronic hepatitis for 27 years and fairly good biopsies, my questions are:

1) Should I really be concerned anymore? One doc told me I would die of old age first!

2) Why me? Not to sound ungrateful but what is it about me, my body, my life style that keeps this virus at after all these years? Ive always been told to stop alcohol intake completely but never did.  (I am NOT recommedning that anyone not stop!)

3) What causes some Hep C to be "active" as compared to "chronic persistent"?

Thanks

Jaz

[puccinitenor]

My Hepatitis Panel (A,B,C) was negative and my liver sonogram was normal!  I am very lucky.