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

[Ekkiemom]

Hi Mike,
Your lower enzyme test results have definitely gone in the right direction.  What has your realtime PCR results say. We're they undetected.  
I understand your being nervous, I was too.  One thing you can do is ask your Hepa if you can have a 4 wk or 8 wk to find out sooner to ease your mind.
The data says that if you are to relapse it will be within the first 4 wk after EOT. Still have your EOT12. If you are still UND @ 4 wks there is something like 70% chance you will attain SVR.
WISHING YOU LUCK
Peace
Deb

[keepingOnkeepingOn]

I treated on S/O and the worst period was from EOT to SVR12. I kept thinking I wouldn't stay cleared and was having to talk to myself to stay positive.  Those 3 months played havoc on the thinking. But I felt good, my bowel issues were gone and returned to normal. So looking at the clues is how you can keep up your spirits. Yes if the AST & ALT are in those low numbers you should be fine. I was told by someone in my docs team that the virus comes back fast and furious if one fails. You would feel that wouldn't you? You should be fine if your urine looks clear and your appetite is returning, etc. You would know if you were not clear. You'd feel it I suppose. It's just so hard to stay positive and not be nervous and worried.

When the Doc told me "You are cured" I about half didn't hear him. I was stunned. I had myself so worried about not clearing that I didn't even hear him tell me "you are cured". He had to tell me a dozen times. He saw I was in shock. S/O works. Do not listen to those who failed. They are generally resistant to all "cures" so far. It doesn't mean the meds failed. There are those who are resistant to clearing. If I had to guess it has to do with lifestyle. Not eating properly is a big one. Or doing something like drinking and not telling anyone. That's just my own opinion. Try and relax. Don't worry. You can deal with whatever is the outcome. I hope you hear the words "you are cured" like I did. Thanks to S/O I have been given a second chance on life. I hope you too get the second chance. It's highly likely. From here on out it's going to be a battle not worrying so try to stay positive. From now until your next labs the emotions get high even if you are silent about it. It's normal. You'll be ok no matter what.

[keepingOnkeepingOn]

PS it's hard not to worry because so many peeps dissed S/O but there are a whole bunch of people cured from it and they are not tooting their horn because of all the disrespect perceived from this drug combo. It's just the peanut gallery getting out of hand. S/O is DA BOMB. Roll with it.

[Sarah1949]

I understand what you're saying Mike. My thinking is the same about if the ALT and AST are low then how could the virus still be there. That is if you were sick enough to have them above normal before treatment.

I treated with S/O also, finished mid-January and did a VL at 3 weeks after eot and was undetected. However, all the tests came back about a week before the VL came back and I was worried sick but then realized exactly what you're saying -- that if my liver enzymes and actually everything else were good, then the virus must not be there. I said something to the nurse about this while I was waiting and she said that it makes sense. I really am not too worried about the 12 week test because of this. Good luck to you!

[hepcandme]

I find it very insensitive that you would blame the people who relapsed for not being cured.I'm just stunned that you would even say that

These people, myself included, did everything by the book, did not drink or eat anything but the most liver-friendly diet that they could, took their meds at the same time each day, monitored their labs, lived through side effects and were absolutely devastated when the virus returned

I am so happy for everyone who reaches SVR. I really am

Many people who are "difficult to treat" are also cirrhotic, some have decompensated and some are facing or have gone through transplant.

Nearly all of those people were not alcoholics or IV drug users. The Hep C virus attacked their liver in a brutal way and the virus continues to attack their livers and other vital organs

We, the uncured, are fighting for our lives every day. Please show a little empathy here

[keepingOnkeepingOn]

I want everyone to be cured. I'm sorry if you read me wrong. The good thing now is that we have more and more choices and options for what combo goes with what person. It's no one's 'fault'. That's absurd. That reference to diet was only a small factor. Sorry if I offended anyone or it came out wrong. It wasn't meant that way.

[can-do-man]

"They are generally resistant to all "cures" so far. It doesn't mean the meds failed. There are those who are resistant to clearing. If I had to guess it has to do with lifestyle. Not eating properly is a big one. Or doing something like drinking and not telling anyone. That's just my own opinion."

YIKES!!!
----------------------------------------
Congrats Mike, it looks as if you made it.

[dragonars]

Keeping-on opinions are like a holes everyone has one no matter how stupid  they are.  

[jules2551]

Unbelievable!  I am having flashbacks of being on triple therapy. Puking, blowing up the bathroom, and taking Neup shots. And then relapsed at 6 month EOT.  I knew it was my fault!

------------------

Congrats Mike you are on your way

[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.

[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.  

[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

[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.

[can-do-man]

"a spike shortly after is common."

For got to add "if we have relapsed".

[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

[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

[mike716]

Thanks for the good words.

M.

[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.

[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]

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

[mike716]

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

M.

[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

[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

[mike716]

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