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High Level of AST & ALT
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High Level of AST & ALT

Hi,

I'm 29 years Male with chronic Hep B. My HBV DNA levels 2 years back was around 157,000 IU/ML and ALT, AST where under normal limits. Doctor suggested to start the medication with 0.5 mg of entacavir as the DNA levels werr high . Since then my DNA level has reduced to  less than 100 IU/ML for the past 2 years. Also my ALT/AST levels were normal for the same period, but when i got these checked again last month they were high AST -44 U/L ALT -111 U/L. My doctor said that Hep B is not the cause for these high levels of ALT/AST. so he suggested few more tests Lipid profile, ANA-IF,Ferritin and ceruloplasmin. In Lipid profile only HDL cholesterol was low 23 (less< 40) and CHOL/HDL Ratio was high 4.8, ANA was negative, Ferritin was 178.2 ng/mL (range 22 - 322 ng/mL) was normal, ceruloplasmin was normal 0.23 g/L (Rangel 0.2-0.6 g/L).

I don't understand what is the cause for my ALT, AST to be high. Please help.

Thanks
Raj
32 Comments Post a Comment
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Avatar_m_tn
The reason for elevated alt could be fatty liver. Are normal bmi? No obesity? No alcohol abuse, junk food, chemical drinks?
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Avatar_m_tn
The reason for elevated alt could be fatty liver. Are you of normal bmi? No obesity? No alcohol abuse, junk food, chemical drinks?
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Avatar_m_tn
I'm 5feet 5 inch in height with 68Kg Weight. Might be slightly obese but not a significant one i believe.

Let me know your thoughts
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Avatar_m_tn
I used to drink occasionally before 2 years back, but have completely stopped it. I eat occasionally junk food. I did not understand what do you mean by chemical drinks. Please elaborate.

Right now i'm on 0.5mg Entacavir for the past 2 years. Is it possible that medication could have caused this.
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Avatar_m_tn
It is better for the liver to get your bmi to 21-22.
I mean by Chemical drink all industry packed drinks like juices, colas etc. they all contain some chemicals and  sugar.

I think that high alt is due to hbv mainly. Alt flares can happen while on entacavir, retest in 3 months.
Alt = 100 is not too bad, it is probably your immune system killing infected cells. While your liver is ok by Fibroscan, alt = 100 is not a big problem.




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Avatar_m_tn
if you test hbsag quantity in iu/ml (abbott architect) 2 times at about 1-2 months one from the other, you ll see if hbsag is going down...if so you are clearing infected cells and clearing hbv definitively (during this time hbvdna must be und)

if hbsag is stable than is toxic chemicals in food or as said being obese/fatty liver
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Avatar_m_tn
Thanks Stef and Rome

I will get the Fibroscan and Hbsag quantative test done and see how it progresses.

Thanks a lot for your advice.
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Avatar_m_tn
Hi Stef,

Thanks for providing help previously.

Need your guidance on how to progress ahead.

HBV DNA Quantitative(RealTime PCR)
05/9/11 -667197 IU/ml
22/03/12 - 192 IU/ml
11/09/12 - 100 IU/ml
02/07/13- <20 IU/ml
12/06/14 - <20 IU/ml
10/01/15 - Not Detected

HBsAg Quantitative(CMIA)
26/12/14 - 34268 IU/ml
20/02/15 - 16066 IU/ml

ALT
10/09/11 - 24 IU/ml
05/10/11 - 23 IU/ml
20/03/12 - 44 IU/ml
10/09/12 - 48 IU/ml
29/06/13 - 105 IU/ml
19/07/13 - 110 IU/ml
21/08/13 - 111 IU/ml
23/09/13 - 112 IU/ml
21/10/13 - 102 IU/ml
16/12/13 - 120 IU/ml
03/02/14 - 106 IU/ml
08/03/14 - 98 IU/ml
04/06/14 - 78 IU/ml
18/08/14 - 99 IU/ml
09/10/14 - 88 IU/ml
10/01/15 - 92 IU/ml

AST
10/09/11 - 20 IU/ml
05/10/11 - 18.4 IU/ml
20/03/12 - 21 IU/ml
10/09/12 - 23 IU/ml
29/06/13 - 41 IU/ml
19/07/13 - 44 IU/ml
21/08/13 - 44 IU/ml
23/09/13 - 39 IU/ml
21/10/13 - 36 IU/ml
16/12/13 - 44 IU/ml
03/02/14 - 49 IU/ml
08/03/14 - 38 IU/ml
04/06/14 - 30 IU/ml
18/08/14 - 40 IU/ml
09/10/14 - 39 IU/ml
10/01/15 - 36 IU/ml

I haven't got the fibroscan done yet. I'm planning to get it soon.

I recently met my doctor and he suggested that we can give a shot at interferon and there could be a chance that if HBsAg decreases then it might clear.

My ALT and AST were pretty high from quite some time and I saw my HBsAg decreasing even without the interferon. I know there isn't much of an option I have here but to give interferon a chance.

I just wanted to get your thoughts on this and any pre-condition tests to be performed before I go for Interferons.

I'm currently on entacavir 0.5mg since 2011

Thanks again
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Avatar_m_tn
I also got Vitd 25 hydoxy and PTH done recently

PTH(CLIA)
10/1/15 - 92.08 pg/mL

Vitamin D 25 Hydroxy (chemiluminescence)
10/1/15 -  10 nmol/L

Seems like Vit D is way to low and PTH high.

Thanks


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Avatar_m_tn
absolutely start vit d3, you can t live with such levels of vitd and intact pth.that levels of chronic pth makes osteoporosis and immune suppression

take one dose of vit d3 300.000iu and then daily 10.000iu, take also vit k2 mk7

once vit d and pth are: vitd25oh 100ng/ml (or higher if pth stays too high), intact pth at least 20-30pg/ml, it is very good to try pegintf add on
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Avatar_m_tn
if you go over 100ng/ml follow the no dairies diet and 2.5l of low calcium water daily
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Avatar_m_tn
Why he needs to cut calcium (dairies and water low calc) on higher vit D level ? Because calcium absorbtion will be very efficient than ?
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Avatar_m_tn
Because calcium absorbtion will be very efficient than ?

of course, and because most food is too rich of calcium which is not healthy at all.
the main problem of today general health is the extreme deficiency of vit d and vit k2 and the toxic calcium in foods which goes to organs and vessels and not bones, and the toxic drugs which milk is full of
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Avatar_m_tn
yes I know milk nowdays may have antibiotics and other ****, I don't drink milk since a few years, but processed milk like kefir seems to be a bit safer.
how you distinct good calcium from toxic calcium ? good from vegetables, toxic from milk and diairies ?
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Avatar_m_tn
in my coutry milk is very popular and ostheoporozis as well, so there no connection between drinking milk and prefention of this, like people belived years ago.
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Avatar_m_tn
there are even studies linking osteoporosis to milk
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Avatar_m_tn
You think eggs (organic) will be ok ? It's hard to replace diairies so looking for some good protein alternatives. Lots of meat probably wouldn't be good too.
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Avatar_m_tn
Hi Stef,

Doctor gave me Lumia 60k once every week for a month and then 60k once a month.

Is it necessary to get to the required Vit D and PTH levels before going for pegIntf. If that is true then how much time it might take with the above medications.

can you tell me how much vit k2 mk7  i need to take and what would be dosage.

Thanks
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Avatar_m_tn
vit d must be taken daily, weekly not studied and monthly only worsening health
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Avatar_m_tn
vit k 2 mk7 at least 90mcg
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Avatar_m_tn
Hi Stef,

I recently got the Hbsag Quantitative test done.

HBsAg Quantitative(CMIA)
26/12/14 - 34268 IU/ml
20/02/15 - 16066 IU/ml
03/03/15 -  27602 IU/ml

I see lot of variation in the results, is it normal. I get the tests done from the same lab and only thing that changed between 2nd and 3rd report is that I started taking Vit D tablets.

Let me you what you feel about this. HBV DNA was undetected recently.

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Avatar_m_tn
yes it is normal that it goes up and down, it is best to test every 24 weeks like for pegintf to have a clear picture

it is not vit d because it requires months to get stable.results, good or bad, from vit d can be seen after levels are stable with intact pth 10-20pg/ml (when normal range of the lab is 10-80pg/ml) for at least 6 months.i dont indicate vitd25oh because it is different person to person to make pth that low

if pth does not reach that low there is vit d deficiency whatever the vitd25oh results are
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Avatar_m_tn
hi Stef

I have started my pegintf 2alpha +entacavir treatment from today.

I'm experiencing high fever.  is it normal to experience this

Thanks
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Avatar_m_tn
Yes it is normal for the first few days, on hcv the higher the fever the better the responce to peg, maybe for hbv too

i had 3 days of fever 39.5 i had to use a lot of paracetamol, then it lessened to only 37-37.5 few times after injection.

the fever  goes away after the first few weeks for almost all patients
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Avatar_m_tn
i also have severe headache with vomiting.

How do control this. It has become unbearable.

Not able to sleep in the night

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Avatar_m_tn
Stef, I was told if I had to use painkillers someday for any reason I should not to use paracetamol but ibuprofen, because it's safer for the liver.
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Avatar_m_tn
Didn t the doctor advise on paracetamol before the injection?

you sshould have taken paracetamol, the first injections are like a very strong flu and the best thing is take it one hour before the injection and then if the fever is very strong take it again when you feel paracetamol is losing its effect
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Avatar_m_tn

No doctor did not mention that, but i did ask him about the side effects and he mentioned there would be some mild side effects. I forgot to ask him what to do in severe cases.

But now it has settled down, but still have slight fever. I did not take any paracetemol as of now.

Also my fibroscan results came, result is 4.1 E(Kpa) with 2.4 as IQR and   149 CAP(dB/m) with IQR 76. Device was 502TOUCH F60077 and Proble M7 70318. There were a total of 12 readings and 5 of them where in the range of 5-7Kpa.

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Avatar_m_tn
His sounds very unexpert of peg, the first inections have heavy flu effects on almost all and paracetamol is given before the injection.....you are lucky you were strong enough to stand that
after 1 to 3 days fever goes away so if it is low fever now dont take paracetamol

you also habe to make blood tests during therapy, thyroid, blood counts etc did doctor mentioned that?it is also mentioned on pegintf box or instructions
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Avatar_m_tn
I know that he is treating lot of guys on pegintf. But not sure why he did not mention that.

Yes, he told me to get complete blood count(CBC) test before the next dose.

Just from your experience. Does the 2nd dose will have similar effect or will it be a bit lighter.
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Avatar_m_tn
Lighter or no fever at all
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Avatar_m_tn
Thanks stef. Will keep you posted on the progress.
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