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ALT / AST post TX with DAA's
Hi All, I completed a 12 week trial with sofosbuvir + GS 5816 five weeks ago. Trial is blind however I did get my liver function test results all the way through, both by ALT & AST dropped into the normal range and have stayed there - ALT dropped very quickly, AST was slower to decrease. At the end of the trial ALT was 25, AST around 30 - I've seen much lower numbers posted by people but I do have cirrhosis. 4 weeks after finishing the trial my ALT & AST were more or less exactly what they were on the final day of the trial, I think both were up 2 points, to 27 & 32.

My question is this; How quickly would ALT & AST rise if TX had not been successful? Both were around the high nineties, one hundred level before TX. A PCR test is $450 and while I'm busting to find out if I have achieved SVR I'm thinking my ALT & AST are a good guide. Am i wrong?
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317787 tn?1473362051
Hi there! You are right, your numbers are a good indicator of SVR.  If I were you and I had to pay for the PCR myself I would wait until you are 12 weeks EOT.  That would be the best way for you to get your moneys worth and would be more conclusive. Your AST/ALT are headed in the right direction :)
Congratulations!
Dee
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Congratulations on completing treatment. Funny you should ask about ALT/AST. I just had a similar conversation with my primary care physician. I went for labwork (I have been clear 2 years) and noticed that my ALT
and AST were in the high 20's. Actually they were right around there at my one year PCR as  well, and I was still undetected. They had previously been around 18-20 while treating. I asked the doc if people in her practice without liver disease have values in the high 20's or even 30's and is that considered normal for those without liver disease. She said emphatically it was fine and many patients have liver enzymes in the upper range of normal and are completely well. I hope that helps allay some of your fears.
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Thank you both for your responses. I figured given that I have cirrhosis an ALT in the mid twenties was pretty miraculous - to me ALT is more of a key indicator than AST, though I know they are both important.

Not long after I reach 12 weeks EOT the trial will be unblinded so at that point I will be tested and given the result anyway., I was only thinking of getting a PCR test done now to spare myself another 8 weeks of wondering if I have cleared.

To be honest the signs are good but for all the promising results from Liver Function Tests I imagine there is nothing quite like confirmation that HCV is no longer detectable in your blood.
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Dario.  My LFT never did get into the teens and have always been in the high 20s to low 30s even tho I reached SVR.  Quoting Howie but he has always said that's why they have a range.  You can be in the upper #s and perhaps that's your normal.
Best Wishes for SVR
......Ki,
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That's very encouraging thanks.
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Best wishes, great odds to achieve SVR.  What was the range of your ALT & AST during the year before you started the trial?
Is this the trial you are in?

https://clinicaltrials.gov/ct2/show/study/NCT02201940

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Hey Jimmy,

Yup, that's the trial I'm on.

Both my ALT and AST were in the 90's at the start of the trial - ALT came down quicker than AST. Very easy trial, no major side effects.
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Sorry, missed part of your question; the range for the year before I'm not so sure, from memory AST & ALT have never gone over 120 and were mostly around 100.
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It's a double blind trial with placebo or real drugs. Anyone with a consistently high (2x+ normal) AST & ALT over the year prior to treatment, should be able to guess correctly that they are on the real deal, if they see those numbers drop to or come close to normal within a month or so of starting tx.  Many times there's not much differences in many of the side effects of these new drugs than those who got a placebo.  It's hard to imagine the "placebo" effect causing such a drop in AST & ALT.  
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