AST & ALT in TX

[drofi]

Hi,

after 4 weeks of SOC the viral load dropped 1 log only. I got shot no. 9 now, but AST and ALT are still high, even a liitle bit higher than before starting Tx. What does it mean? Bad response? I went to the lab to get the results of a new PCR, but  I would like to know your opinions and experience about enzymes/Tx/success.
Thank you!

drofi

[GoofyDad]

Do you ever experience any burning or rash from that? You biker dudes are hardcore.

[jmjm530]

Doesn't it hurt when you close the lid on the dishwasher?

[mikesimon]

There are better ways to keep your diamonds hairless and sparkling. Try soaking them in a mild dish washer soap next time. Good luck with it. Mike

[jmjm530]

You might ask your doctor next time, how much platelets play into his recommendation. BTW what are your platelets if you don't mind me askin'.
Write a book? First, I should probably read a couple instead of watching "24", "Prison Break" and "American Idol" -- speaking of which the first two are on TV tonight.

-- Jim

[GoofyDad]

At last check platelets were 115 or so. Asprin warnings always come up in the context of varicies, stomach, colon, yah-da-ya. He doesn't tell me to stop whittling, or to stop shaving the family jewels - I guess it could be platelets though. The takeaway for me is asprin is contraindicated in cirrhotics. Except as indicated for heart issues.  

[FlGuy]

Thanks for the discussion on the aspirin.  Seeing the tx this week and will cover those aspirin topics with him, in addition to the gastro stuff he's already seen, which may have some bearing on his aspirin opinion.  Had to postpone a planned appt a couple of weeks ago.  Knowing this guy the answer, no doubt, will having something to do with another colonoscopy.  

[jmjm530]

Stopping calling yourself a "cirrhotic". At worst you're an SVRotic which can sometimes make you Cirroneurotic until you find out the tx has reduced you to a mere Fibrotic ;) That said, I will ask my doc about aspirin, cause it was the one thing he didn't want me to take during treatment. As mentioned, my doc recommended red wine for dinner for the heart but we'll see what he says about aspirin. Personally, rather have the ....:)

Be well,

-- Jim

[GoofyDad]

Definitely a liver issue. Has to do with bleeding, but I think the direct issue is portal hypertension and the propensity for GI bleeds. I think platelets and clotting are secondary issues. Just curious, are you fixin to write a book?

[drofi]

Thank you for your thoughts. Today PCR results came in and VL went down from 2.600.000 to 33.000 in week 8. Not UND, but I am happy that the viral load is falling.

[FlGuy]

Week 19, Merlino too.  Last couple of weeks were a little rugged. Think I actually had the flu, but how do you know? Lot of demands at work too.  Have gotton to the point where hgb, anc are appropriately low but not yet rescue time,  If I can hover where I am, I'd be satisfied.  I thought you'd be chompping at the bit for that pcr.  I imagine you're going for heptimax or something as sensitive.  My last was week 16, still und. About to step into the real dog days of tx.  You've seen enough of those.  Any changes rashes, skin, hair, weight stuff stince you've been off the junka few weeks now?

[nygirl7]

What week are you on (I can't remember already).

How you feeling? How are your numbers? At least this time around...you are an old pro at this right?

I will go get my PCR tomorrow. I'm such a chicken (and so lazy) I have been putting it off.

[jmjm530]

A little unclear why your doc told you not to take aspirin. Is it because of your liver situation (platelets perhaps? what is your platelet count?) or just a general philosophy of his? I thought they were still recommending baby aspirin as part of a heart healthy lifestyle. Thanks.

-- Jim

[GoofyDad]

Just wanted to pass that along in case you want to compare notes with your doc. It was somewhat emphasized to me. I'm not an asprin guy anyway - was always an advil fellow. Problem with avoiding the asprin is the other products containing asprin. Frexample, no Peptobismal makes GoofDad dismal. And, on occaision, somewhat squirty.

[FlGuy]

Good to see you. At week 17ish, plats were down to 84, with a consistent slow curve downward.  At some point, probably in a few weeks, start reducing the aspirin in favor of acetem.  I was alternating more early on but ran out of the acetem. Aspirin are easy to take - I can chew them without water and it has always been quickly effective for me.  

[GoofyDad]

Nice to hear from you. Wanted to point out that I'm on orders for no asprin products. Only reason they would OK would be if I need it to treat heart conditions, but beyound that, no Ibuprfren, and no asprin. Blood thinning and bleeding is the issue, as I understand it.

[mremeet]

I wouldn't be overly concerned about the enzyme elevation. This is a common topic here, seems it gets asked and addressed several times each week. Bottomline is that many HCV patients undergoing treatment have enzyme elevations, or have their enzymes never quite normalize during treatment. And just because this happens it does NOT necessarily mean the drugs are not working. Many who experience these elevations go on to SVR fine.

For instance, I've been experiencing fluctuating enzymes up and down since starting my treatment (currently on week 28). They've been up and down and all around, so don't be surprised if yours come back down later and wander around. And I've remained UND (<10 IU/ml) since day 15, so as you can see elevated enzymes do not necessarily correspond to a relapse or viral presence (and I'm not unique in this sense). My doctor told me that a certain percentage of patients who take Pegasys IFN experience these relatively moderate enzyme elevations. He said they're harmless and they do not by themselves indicate failed or unsuccessful treatment.

Also, be aware that allergies and immune responses can sometimes account for liver enzyme elevations. And as previously mentioned, some people are more "liver sensitive" than others to pain relievers or other drugs we take to deal with our side effects. So I wouldn't rule that out either as a possible cause.

As you probably know, the main thing is to keep an eye on your VL response. Hopefully it will cooperate with the drugs and take a nosedive into UND land within 12 weeks. Have you considered taking extra doses and/or extending treatment if you go UND late? Might want to look into Oxymatrine too. It's a TCM supplement based on the sophora root. Chinese studies claim it has very significant antiviral effects, in addition to being an antifibrotic too. Kalio has been taking it, and HR has spoken with some guarded optimism about it (or at least he hasn't dismissed it outright). Might want to ask her about it and possibly consider adding it to your regimen.

Hope you're getting along ok, take care.

[jmjm530]

The treatment drugs themselves can cause your enzymes to rise like that. A one-log drop per month as in your case is OK. Hopefully, you will be two logs or better at week 8 and totally non-detectible by week 12. Don't worry about the enzymes -- it will not determine tx success. Only your viral load numbers will do that.

-- Jim

[FlGuy]

This is my second round of tx.  First time did 24. Second time it's 48 with more riba.  I realized that in order to survive this tx, be human around my family, be fairly effective at work and not be a hazard in traffic I had to push all aside that I had no control over.  It's just my way to help me pace myself and to not dwell on stuff I can't conrol.  Works for, not for all.

[drofi]

Thank you for the good points. Hmm, after the first weeks of tx I thought to be just strong and nothing could touch me, I just accepted all sides, but somehow my emotional stability is getting worse which each shot. I am more and more impatient with myself, my coworkers and my family, and now I know what people call "paranoia" under tx. Perhaps some SSRI should do a good job, but my thrombos are down below 50.000 too, and SSRI can worsen thrombocytopenia.

drofi

[najeen]

Good point.

I know how every tick up on any blood work can be unsettling.

[BThompson4]

I would not worry about those liver enzyme increases during treatment at all.  The increases are not that high, and many people are higher throughout treatment and still get to svr.  Treatment can be very stressful to your liver, and many people who svr do not normalize enzymes until after stopping treatment.

[FlGuy]

Don't make yourself too crazy about all the stats asscociated with tx.  Sometimes, they are not significant. Pre tx my ast 48 alt 79.  At week 16, ast 57 alt 94 (both higher).  And, I've been udetected since week 2.  Early in tx, I deceided that I would do what I could: take the shots, eat the riba, monitor cbc and manage the sx's.  I purposely did NOT WANT TO KNOW ast/alt.  The doc blurted them out on a phone call.  There is nothing I can do about them, there are no changes from the doc's point of view because of them- therefore, unless I have a viral breakthrough, they are meaningless to me.  The PCR is the thing.  By the way, I take aspirin for sx, a BP med daily and ambien 2-3 nights a week.

[drofi]

I do not take anything else than Pegasys and Copegus. No alcohol, no medicines, no smoking, nothing.
Kalio, the people with elevated levels, have all been nonresponders or relapsers or are there people you "climbed over the wall" nevertheless?

Regards, drofi

[Kalio1]

Sorry you are having this happen. I have seen a number of people who visit here have their enzymes go up on tx. It seems to me this happens more frequently from Pegasys, but that is just my observation. Im sure it is unnerving. Hopefully they will begin to trend down soon.
Let us know how the PCR turns out.