ALT level during Viread treatment

Stef2011 - I'm curious of your take on my situation.

I have been taking Tenofovir for about 10 months.  Prior to TDF my Alt level range was around 29-32.  Since starting with TDF, my Alt has been in the high 30s, low 40s.  Most journals I read claim that patients on TDF have Alt normalization/reduction.  Why do you think mine is in the 40s?  Possibly because of the Simvastatin, or because the TDF may be causing Alt level to raise?

[djxpress]

your thoughts?

[Jeff912000]

raised ALT could be due to many things including drugs, fatty liver and immune system fighting the virus.  I do not know your full history.  but Stopping simvastatin may help.  Getting good BMI to reduce fatty liver. may help.

[djxpress]

Also had an ultrasound which showed normal echogenecity.  Viral load in serum is UND.  10 months on Viread.  Wondering if it could be due to Viread?

[stef2011]

jeff912000 is correct

first thing, having higher alt is always better (except decompensated cirrhosis) because higher alt with hbvdna und lowers hbsag faster whatever the source

you have to exclude fatty liver, as to sim i d not consider it because it helps even if it increases alt (as long as it is less than 60-100)

it is probably your immune system which is not suppressed by tenofovir but activated a little

it is lke my situation probably, i have alt around 40-55, it was like this when i had fatty liver, when i was on etv mono and still around 40-50 without fattu liver and with etv+tdf

[imran4535]

I am curious why you started treatment. Your ALT and viral load didn't seem high and you didn't indicate any liver inflammation?

[djxpress]

HBeAg - and genotype C, viral load range of 2000IU-5000IU, according to AASLD and other groups, I met treatment guidelines

[imdrew]

Were your ALT twice the upper limit?

[imran4535]

According to AASLD you should consider treatment in the following circumstances.

1. Hbeag negative
2. Hbvdna 2000 to 20,000 iu/ ml
3. ALT persistently 1-2 x ULN

Check for inflammation or fibrosis and consider treatment if present, also take in age as factor.

So considering your around 30, did you have inflammation?

[djxpress]

not sure of inflammation, but AFP L3% was elevated, so I chose to initiate treatment.

[imran4535]

AFP L3 testing, I believe most HBV carriers and hepatologists don't know about that. I didn't either until I looked it up.

In most testing I believe they just do the standard AFP.

[djxpress]

my doctor is a world renowned hepatologist, thats how come he knows of this test

[studyforhope]

When the total AFP is low, then the L3% is often hard to measure.  Levels of the L3% over 10% were associated with a 10 times higher likelihood of HCC.

There is another marker of HCC that was reported to be even much more sensitive in HCC detection. While AFP levels were elevated in 80% of a cohort of 99 HCC patients ( from 1520 screened patients),
the Interleukin-2 Receptor levels were elevated in 98 out of 99 of these HCC patients.
This sounds like a extremely useful marker then, since being in the normal range would almost rule out HCC.

The paper is " Soluble Interleukin-2 Receptor levels in hepatocellular cancer; a more sensitive marker than alpha fetoprotein" .Senior author is Steven A. Curley, from the University of Texas. Find it in Pubmed. Annals of Surgical Oncology 1999.

[studyforhope]

The test is readily available by Labcorp BTW:

Interleukin-2 Soluble Receptor α
Synonyms:
IL-2 sRα
Interleukin-2 Soluble Receptor Alpha

Labcorp Test Number: 142455  

[djxpress]

Another test I get is the DCP Des-gamma carboxyprothrombin test (PIVKA-II), better tumor marker than AFP.  

AFP L3% is said to be elevated in people with hepatitis, so this test may be unreliable.  AFP L3 of 10% does show 7 fold increased risk of HCC (in normal population).  People with HBV are already at an increased risk, so this test seems to just confirm that fact.  Also a high AFP L3% in someone with an AFP of over 10 (as an example), is going probably be more significant than a person with an elevated AFP L3% that has a low AFP.

[Rome70]

What about A1AT - alpha 1 antitrypsin?
Is it any good for HCC screening?

[Rome70]

Any ideas?