Post hepatitus(hepatitis) treatment alt/ast question

[davem1]

Hi, I was diagnosed with hep c in 1998, genotype 1a or 1b, not sure but definatly sure Im genotype 1. My alt/ast was 150/200 +/- 10 or 20 either way. Viral load at start of treatment was 300k +/- 50k. I did six months combo treatment in 2000. (rebetron 1200 pen and six caps per day, 3 morn 3 night). Alt/Ast went normal within 2 months. Viral load was undetectable at two months. Quit treatment after six months because gallbladder went bad and had to have surgery and I thought it was the treatment. I know better now. Quit treatment on 9/29/2000. I was admitted to hospital on 10/4/2000 for gallbladder surgery and alt/ast were normal. When I left hospital on 10/7/2000 my alt/ast were back up to 300/300 +/- ten or twenty. Did pcr on 10/6/2000 and was detectable again. I redid one year of treatment using peg-intron. largest dose of interferon and six pills again 3 morn/3 night. Viral load at start of treatment was 850k +/- 50k. Ast/Alt were in 400 range at start of treatment. I was alt/ast normal at 30 days and undetectable at 30 days by RNA/PCR Quant, with range of detectability 0 ppm to <600ppm.(I think thats right,it was the old pcr) I stayed undetectable through treatment and was undetectable at one, three and six months post treatment using the new pcr which detects down to <5ppm. I think it was the quantasure. Six month test was one month ago. Monday I went for a routine blood test to test lipids because my cholesterol has never been higher than 95 and I am considerably overweight and I asumed my low cholesterol was due to damaged liver and I wanted to know if my liver was now producing cholesteral since I had been sucsecful in beating hep c or so I thought. ( I now know that was pretty stupid logic, but Im not a doctor so it sounded right). Test results showed ALT/AST at 42/45 test range being 0-40 for both ast/alt, lipids showed total cholesteral as 165. I dont remember what the ldl and hdl were, but the triclicerides were high. 181 with a normal range of 0-120. I freaked at that point and went to different lab on Wednesday and had redone LFT's. Results were 45/58 with normal range being 0-45 for both. Im a lot concerned, (thats the understatement of the century!! Im dying inside!)that my hep c may be back. Can you please tell me if there is anything else that could be causing the slight elevation. If my hep c was back, wouldnt my LFT's be back in the hundreds? dont know if it matters but I recently, (14 days ago), started the adkins diet which is extremely high fat/protein and low carbs. I aslo have been taking 2 percocets 7.5/325 for a pulled muscle in back as well as about twelve ibuprofen a day for the pain. I have had a pcr done but wont get the results for a week. Thank you for your time

desperate

[Kevin Pho, MD]

Erin, PA has mentioned there are more likely causes for minimal elevation and I would agree with what she said.  The Hep C PCR would be the best test to see if the hepatitis is back.  

The Percocet you are taking has tylenol in it - that may be a possibility why the enzymes can be elevated.  

Another test to consider would be a liver ultrasound.  

I would wait until the PCR returns.  If normal, you may want to consider a pain medication without tylenol (i.e. oxycodone by itself) and repeat the LFTs after a few months.

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.

Thanks,
Kevin, M.D.

[nurse12hr]

First, don't freak.  The elevation you described is extremely slight, and those numbers can vary.

LFT's don't necessarily correspond with reccurance of HepC.  They can be slightly elevated for many reasons.  Your diet could be a factor, possibly.  Fat accumulation in the liver can also lead to an elevation in liver enzymes.  

Best thing to do is see your gastro (which I presume you are doing anyway) and hang tight and wait for the PCR.  Your doc will be the best person to advise you in this situation.

Found this for you:

A host of medications can cause abnormal liver enzymes levels. Examples include:


Pain relief medications such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), neproxen (Narosyn), diclofenac (Voltaren), and phenybutazone (Butazolidine)
Anti-seizure medications such as phenytoin (Dilantin), valproic acid, carbamazepine (Tegretol), and phenobarbital
Antibiotics such as the tetracyclines, sulfonamides, isoniazid (INH), sulfamethoxazole, trimethoprim, nitrofurantoin, etc.
Cholesterol lowering drugs such as the “statins” (Mevacor, Pravachol, Lipitor, etc.) and niacin
Cardiovascular drugs such as amiodarone (Cordarone), hydralazine, quinidine, etc.
Anti-depressant drugs of the tricyclic type
With drug-induced liver enzyme abnormalities, the enzymes usually normalize weeks to months after stopping the medications.

[GI.PA]

First things first, with such a good response to treatment (early viral reduction, negative PCR at post treatment...with only the 6 month PCR pending) you are showing all signs of a sustained response.

The NSAIDS (ibuprofen), painmeds, atkins diet etc can all cause this minimal elevation.  Relapse of the Hep C is possible, but the other factors are more likely right now.

You are just going to have to wait this one out...

Feel free to join us over on the Hepatitis boards!

GI.PA