AST/ALT Indicative of SVR at EOT+8 weeks?

[mike716]

Hi, all.

I hope everyone is being treated with the new DAAs and getting cured. It's a new world out there.

I finished 12 weeks of Tx with Sovaldi + Olysio at the end of January. I'm slated for a VL at the end of April (EOT+12), but I am a nervous wreck from waiting. Also, I have to go back to Buenos Aires for the VL at my hospital there as the test is prohibitively expensive in New York if, like me, you don't have U.S. insurance. And if I'm not cured I'll have to turn right around and come back to New York again. Kind of a catch-22 situation.

But I can get a blood test including hepatic enzymes quite inexpensively here in NYC and I was thinking that maybe the results would tell me if I'm cured. Surely if I've relapsed the AST & ALT would be back up again, no? (They were around 100 before Tx and then down to 21 and 10, respectively, at week 8 on the meds.)

Anybody here have experience with this? Help will be much appreciated.

Cheers.

Mike

[hepcandme]

"If I have seen further, it is by standing upon the shoulders of giants"

Sir Isaac Newton

[mike716]

Thank you, Kim.

[mike716]

Thanks, Susie. You're right, it's a whole new world for people with hep-c. I remember well what it was like, with only the horrors and uncertainties of INF/RBV, cirrhosis, and eventually transplantation to look forward to. I hope I made the right choice by waiting and that my liver has not been too severely damaged already. And we must not forget those for whom the new therapies did not arrive in time.

Mike

[Livelife777]

You made it .....
Congragulations
......Kim

[AWorriedMom]

Mike, I am thrilled for you! (This is Susie). What great news. A few short years ago, you and I would never have believed this could happen. And look at all of us now!

[mike716]

I posted the results of my blood test on another thread, but for those here who are interested, my AST/ALT have remained low at 24/11 (they were both over 100 before Tx and down to 22/10 at two months into Tx). I still have to wait for the EOT+12 VL, but I think that low AST/ALT at EOT+8 is a good indication that the therapy worked.

Another good thing from the blood test is that my plateletsa, which have been below 100k for over two years, came in at 147k, almost in the normal range. This was a big surprise, and an added bonus.

Maybe I shouldn't count my chickens before their hatched, but I think I'm SVR. If so, I will have to celebrate somehow. After seven years of struggle with this (I was diagnosed in 2008), to be able to finally put it on a back burner and resume my life will be a godsend.

My best wishes to everybody here. God bless you all.

Mike

[mike716]

Hi, frijole bean, and thanks for your good wishes.

I was extremely lucky indeed that the DAAs came around when they did, because I couldn't have held out any longer. A year ago my AST/ALT shot way up and my platelets dropped to 80k, and a Fibrotest gave a readout of F4 (cirrhosis). I would finally have had to treat with INF/RBV if the DAAs hand't been approved. I got lucky.

Now, as you say, I'll have to see what the price is for waiting and letting the fibrosis advance. If I end up with liver cancer or portal hypertension and varices, it won't have been worth it. For now, though, my liver seems to be working okay.

Cheers.

Mike

[frijole]

Well, I had to show my face just to say, Holy Cr*p - MIke finally treated!!!!!

I don't know how many years you held out while the rest of us tried and failed and tried again, but you were always poking your head in, checking on the various treatments and fibroscans and the like.  So, I thought this was another one of those posts,  but I was all smiles when I saw that you had finally done it.

And, in the long run, I think you were right to wait as long as you did for these current meds.  As one who treated on traditional and then triple (with Victrelis) I didn't wish those side effects on anyone.

I found, like Can-do and Hector that an elevated AST and ALT after treatment was an indicator of relapse.  Mine spiked up 10 weeks post, but that was the first test I had run.

So my hearty congrats, as you seem to have succeeded.  I hope your liver was not damaged too much to recover.  With enzymes in the 100s, it would seem that there was significant damage.  Good luck to you going forward.

My best
frjiole (bean)
and a big HI to Hector and Can Do

[mike716]

Hi, Kim.

The blood test kit arrived today, so I'll do the draw on Monday and UPS it in. Pretty nervous about it, but it's better to know the truth ASAP.

M.

[mike716]

Good luck with that transplant, Hector. 15 months in, sounds like it's gonna work for you.

[Livelife777]

Hi Mike.   I'm going to approach it from a different angle which should also give you some thoughts to ponder.
I was one of the first participants  to start Sovaldi  (other then the clinical trial group) once it hit the shelves.   Because of that my Bloodwork was closely watched once the treatment was started.  Two weeks after starting Sovaldi my AST/ALT dropped 40-50 points right outta the gate.  With that correlation in mind along with the post #s it would appear that these 2 liver functions would surely be indicative of a relapse.  Therefore as mentioned even further verification that a low # would be cause for celebration.
I go along with the pack.   Ease your stress and get those values.
Personally, I think you've got it in the bag!
......Kim

[HectorSF]

Your doctor makes a good point and if you don't have health insurance, periodic viral load tests during treatment tell little. Viral test are not as important as they used to be. Which is why the hepatitis C guidelines only recommends VL testing before treatment, then at week 4 and only at week 6 or 8 if still undetectable. These tests are used to test for patient compliance they tell nothing about the odds of SVR. SVR rates are based on a patient's profile BEFORE treatment and the treatment prescribed - genotype and subtype for some, treatment experienced or not, cirrhosis or not these are the biggest factor for success. What happens with the viral load is irrelevant unless you are not taking the treatment meds consistently.

All people who treat with a DAA based treatment become undetectable on treatment and stay that way as long as they remain treating. No non-responders, viral breakthroughs, etc. like in the good "old days". All people that fail treatment do so by relapsing after finishing/stopping the treatment meds. By the way it doesn't matter when you become undetectable, week 1 or week 8 SRV rates are the same.

By now if you relapsed by week 4 I would imagine your ALT and AST would be going higher assuming you had raised levels prior to treating as can-do pointed out.

ALT and AST lab tests is a cheap way to have peace of mind. If they are still low the odds are huge you will be cured. Of course you must be prepared for bad news if by some small chance you have relapsed. But even then, why wait around for weeks not knowing? I personally would rather know one way or another. I know everyone may not.

I am okay. Cured of hep C but still dealing with post liver transplantation issues now 15 months since my transplant. I am the co-Community Leader for the Cirrhosis forum so that is where I am on MedHelp pretty much.

Take care.
Hector

[mike716]

Thanks for your encouraging words. I will do the AST/ALT test.

M.

[mike716]

Hi, Hector. How the heck are ya? It's been a while. Thanks for your posts and the helpful info. I'm gonna do the blood test for AST/ALT.

Congratulations on clearing the virus at last!!! I am so happy for you.

I hope you will still be around in the forum. There aren't many of us old-timers left.

Cheers.

Michael

[Ekkiemom]

Hiya HepC.
gotta go with your statement...I believe that those of us absolutely know the risk of not following Tx protocol.
And in my opinion, I tend to believe that those who have not decided to treat are either not informed enough to know there is a cure,sadly or are just not ready to commit, and on the other side of that when you finally come full circle and decide to treat you know the small side effect risks but are willing to treat and will forgo this in order to cure no matter what...in for the long haul.
Choosing a healthy does help the  liver to not work so hard, like abstaining from red meat especially loaded with growth hormones, not drinking is a gimme, IF you are a serious treater....
It is the Tx combo type and genotype that primarily predicts the outcome.  Yes it may be harder in some cases than others, as we have seen on this very forum which is truly unfortunate. But they too will clear..
And as I said its my opinion, and some common sense, that's it

Wishing the community well
Peace
Deb

[mike716]

Thanks, Sarah, I'm glad you agree about the AST/ALT. I'm going to do them.

Good luck with your EOT+12 VL.

M.

[mike716]

Thanks for the good words.

M.

[mike716]

Hi, Deb.

I forgot to mention that I have not done ANY VLs since starting Tx in October because I have no insurance to pay for them. Also, the MD in New York who helped me through Tx told me not to waste my money paying for expensive VL PCRs when the only one that counts is the EOT+12 (which I can do at my hospital in Bs As).

Glad to learn that relapse usually occurs during first month post-EOT. Since I am now 2 months post-EOT, a liver enzyme test seems to make sense.

Cheers.

Mike

[HectorSF]

Thanks can-do for the good info! Good point about folks without raise levels prior to treatment.

Here are my ALT& AST and viral load results after finishing 12 weeks of Sovaldi, Olysio + Ribavirin. Before treatment my levels were in the 60s-70s range and I was having labs weekly during treatment when I saw then drop.

Week 4 after EOT
Aspartate transaminase 17 - 42 U/L 18
Alanine transaminase 12 - 60 U/L 17

Week 8 after EOT
Aspartate transaminase 17 - 42 U/L 16
Alanine transaminase 12 - 60 U/L 19

Week 12 after EOT
Alanine transaminase 12 - 60 U/L 17
Aspartate transaminase 17 - 42 U/L 15

HCV Real Time <12 IU/mL <12
Not detected
HCV Log IU/mL; <1.08 <1.08
Log10 IU/mL
Not detected

SVR12

Hector

[can-do-man]

"a spike shortly after is common."

For got to add "if we have relapsed".

[can-do-man]

Hector said..."How quickly ALT and AST rise after the virus return, I don't know as I was lucky enough not to have experienced that."

When I failed my first treatment my Hepa and I had a feeling 2 weeks post treatment as they were starting to rise. Due to being anemic and taking Procrit shots I had weekly labs drawn the first 4 weeks post Tx. We looked at the 4 week post labs results both my ALT and AST level was higher then pre treatment so we knew pretty much I had relapsed before the PCR was in. My second time treating it was like hectors post 4 weeks. They were normal so we felt very good about it. and the PCR showed UND.

Only a PCR will tell for sure. A lot of folks go into treatment with normal or near normal levels and don't have that rise but for those of us the have higher levels then go to normal during treatment a spike shortly after is common. So your news sounds encouraging. Wishing you the best.

[HectorSF]

Hi Mike.

You are correct about the enzyme level equating to the virus coming back. ALT measures the levels of inflammation of the liver. So as you have seen, as you treated and the treatment began to work by stopping the viral replication of your hep C your enzyme levels dropped and have remained low all of the time you are undetectable. Should the virus return (relapse) it will again start to injure your liver causing the release of liver enzymes into your blood which will show up as rising enzyme levels.

After my Sovaldi, Olysio and ribavirin treatment ended in December I had my viral load taken at weeks 4, 8, and 12. At my lab it would take 2-4 days for me to get my viral load results. But, I would get my ALT and AST results that same day. So I would watch my enzyme levels which were down to around 20 after all of my previous lab work. My levels stayed about 20 after each 4 week test. So when I had my 12 week EOT lab I opened my ALT and AST results that afternoon and saw them still low. So I was pretty sure I was cured. A few days later when my viral load result finally did come back after 10 nervous minutes I opened it and learned definitively I was cured. A happy moments after 7 years and 3 treatments.

How quickly ALT and AST rise after the virus return, I don't know as I was lucky enough not to have experienced that.

As was mentioned a study was done showing when people relapse after treatment with Sovaldi. The results showed what we have all experienced (I relapsed after my first Sovaldi treatment) that the majority of folks who relapse do so within the first 4 weeks after stopping treatment. To quote the study..."(77.6%) had relapse by post-treatment week 4". When the treatment drugs aren't there to suppress any small undetectable remaining virus it rapidly replicates and its reemergence shows up as a rising viral load.

By the way in this same study "SVR12 was achieved in 779 of 796 patients (98.0%) with SVR4, including 296 of 302 (98.0%) with HCV genotype 1 or 4-6". Which means if you are undetectable at week 4 you have a 98% chance of being undetectable at week 12 and cured.

As far as "296 of 296 (100%) with HCV genotype 1 or 4-6 who were undetectable at week 12, were undetectable at week 24. No one relapsed between week 12 and week 24.
This is why SVR12 is now considered cured.

Since you are already post week 4 EOT if you could be a PCR done in NY you could be pretty confident you are cured at this point and have less stress. Is there a clinic that does more than an antibody test? It might be worth checking out.

Best of luck being cured.
Hector

[Bilrac]

When I relapsed on prior treatments (INF + RBV) my liver enzymes rose very fast and very high, within a week if I remember correctly. The fact that ALT and AST are still in range is a hopeful predictor I would think.  

[Thess60]

WOW, I feel for any that relapsed as I worried so much about that.  Having had hepc for 40+ years I felt would work against me, but, even though I had a high viral load the treatment worked.  I did the sovaldi and ribavirin for 12 weeks because I was treatment naive and geno 2b.   In my readings i have seen so many opinions as to why some relapse and others do not.  Some believe genetics play a  role, some say condition of liver and other health issues person may have.  Whatever the reason I have read that there are even better treatments  coming that will treat all genos cross the board and that is a good thing for us all.