Acheived SVR at 4wks but now high liver enzymes

[Tiffyt333]

Any help from anyone out there that has any experience with the following would be much appreciated...

So I was diagnosed with Hep C - 1b in January of this year (2012).  I started triple therapy with Incivek on March 15, 2012 and ended treatment on August 29, 2012, with my last injection on August 23rd, 2012.  I was UND the entire time with no elevated enzymes after starting treatment, until a blood test on 9/24 that had elevated enzymes - AST @ 39 and ALT @ 51.  So my doc said not to worry and we shall see on the next round what happens since I was still UND.  Well, last week I saw my doc on 11/5/2012 and my labs (no PCR this time) from the previous day showed even more elevated enzymes - AST @ 115 and ALT @ 219.  Of course after that appointment she had me go get new labs done with a few different other specific tests but also included another PCR...  It has only been a week so I have not heard whether or not I am still UND but she seemed very concerned, without giving me much info.  I asked a series of questions but she said, "Let's get these labs back and we'll go from there.  Meanwhile do not worry about it."  After reading more about the possibility of what little she did share with me, of which, included words like, autoimmune, muscle something or another, family history, abdominal pains, joint pains.  She is suspecting either AIH or virus is coming back or I suppose both... (My original ANA test(s) came back positive but I believe the docs believed this to be a false-positive since I had no other signs of the autimmune thing)

My question is for anyone out there who has any ideas, thoughts, suggestions, and/or experience with a similar situation, please let me know anything that maybe relevant.  I go back to see her next Tuesday 11/20 but am not sure if she'll be able to tell me what her educated guess is... especially since her exact words were, "We're not sure what this could be because they have never seen this in any of their other cases."  Doesn't give me much hope other than the possibility that my body is still adjusting from the 24wks of hell I just put it through and it's nothing. (I have to throw in that I am very sorry for anyone who has gone through 48 or more wks, I am not sure I would have made it).  I am happy to hear so many people have sucessfully been treated and no signs of anything coming back!  Cheers and best wished for all :).

[BoceprevirGal]

  Whew-hooo, that is great news about your 3 month post UND!!!
   Yeah, there are so many different reasons why liver enzymes can elevate. That is good that your Doctor is digging around though~Happy Thanksgiving back atcha :)

[Tiffyt333]

Hello all,

The results of my viral test are still undetectable!  Yay! That was a 10wk post test so they did another one at my appointment last Tuesday, 11/20, which will be my 12wk post treatment as will as some other various tests for a couple of different autoimmune diseases.  My liver enzymes are still high but have dipped since my last 2wks ago so my doctor is still not sure what to make of that, which is why she opted to dog a little more.  My ANA tests from 2wks ago came back too and that too was a little high so there is something def going on with my muscles but I am hoping that my body is just having a hard time after the triple therapy and all will return to normal in due time.  So far looks like the virus coming back is not the root cause, which as you all know, is a big sigh of relief.  I was also thinking AIH but there were no signs of that during treatment so theyve mostly ruled that out...

I hope everyone had a great Thanksgiving and enjoyed much needed time with friends and family.  Cheers to all, I will post when new labs come in, in a couple of Weeks.  Take care and thank you all once again for your support and encouragement with this confusing time.

[Tiffyt333]

Thank you all for your input as it was all very helpful.  I am trying not to worry but as you all know it is not a very fun game but it is the majority of it so... we shall wait.  Hopefully my doc will be able to tell me tomorrow if I am still UND and/or if anything else has appeared.  I will let y'all know what I find out tomorrow.  Regardless of what happens I will try to have positive thoughts and be grateful for everything in my life.  Y'all please try to do the same and enjoy lots o friends, family, and good times as the holidays roll on!

[willbb]

Elevated liver enzymes are one of  many markers that tell a doctor to investigate further  what may be causing liver inflammation ,especially if they stay elevated.

there are many cause(ie(most drugs ,alcohol,stress and even muscle injury to name a few of many)

and yes unfortunately sometimes when virus returns upon cessation of therap this happens(but not always)

The 12 week .end of treatment PCR will give you a definitive answer and is 99.7 % predictive of  overall success if UND.

If the PCR is UND. (which I suspect it very weel may be since you RVR'd )  and your enzymes are still elevated then your doctor should run all the appropriate tests to get to the bottom of this..best of luck...

Will

[jules2551]

I am just starting wk 19 on triple with Vic.  I was DET @ wk 4 but 2+ log drop and UND 9,12, and 16.  The last 4 wks my AST has been rising and out of range and my ALT is heading out of range.  (I know ALT and AST's do fluctuate during tx).  But my NP was concerned enough and said she was going to run AIH again.  I tested negative before starting tx.  So we are running those this Thursday.  

Also I was dx with hemochromatosis and PCT before starting tx and my % iron is rising also.  So this could be the reason also.

Try not to worry...that is what I am trying not to do!  lol :)

[frijole]

My question is for anyone out there who has any ideas, thoughts, suggestions, and/or experience with a similar situation, please let me know anything that maybe relevant.


I wish you luck, but be prepared.  These numbers are very similar to mine after my first treatment.  ALT and AST throughout treatment (and in fact, throughout my whole adult life) have been in the 20s.   About 10 weeks after treating with SOC for 56 weeks in 2006 I had to have bloodwork done for another matter and my ALT and AST were 58 & 52.  Sure enough, two weeks later when I had my 3 month post PCR, I had relapsed.  The enzymes rose up to 114 & 83 ( my guess was, as the virus returned) and then subsided back to their pretreatment 20s,

It is an indicator, to be sure, but inasmuch as you were undetectable at week 4 of treatment, there could be something else going on to spike those enzymes.  Maybe some medicine??

I wish you the very best
frijole

[Tiffyt333]

Thank you to you all for such quick responses.  I really appreciate looking at the positive side and hoping for the best.  As far as stating that I was svr at 4 Weeks, I was incorrect.  I meant to put rvr or ervr.

I know worrying about it and speculation is the worst before you know too much, that's why even the doc didn't go into detail until they know more.  It's just way worrysome since she said they have not had any other patients that have had this happen to.  I typically don't respond in most situations as most but the fact that everything seemed to be going great until possibly now, is just plain disappointing.  I will wait and see, best case - it is nothing and my bodies way of telling me thanks but don't ever do that again, lol.  

Thanks again to all the responses thus far.  I will keep y'all posted on what happens in the Weeks and months to come.

Cheers and best of wishes in your recovery! Do not hesitate to ask if anyone needs anything, a kind word of hope or just saying hi never hurts.

[Idyllic]

Hi I would wonder as well. I agree with the others: the best (though not the easiest) thing to do is wait. Speculating with such little info can be a dangerous thing.

I hope this works out and you are OK
Please let us know how this works out ♫

★★Could you mean eRVR at four weeks (???)

From the Incivek web site:

eRVR = Extended Rapid Virologic Response; undetectable HCV RNA (Target Not Detected) at Weeks 4 and 12.

SVR (virologic cure) = sustained virologic response; defined as HCV RNA <25 IU per mL at last observation within the SVR visit window (i.e., weeks 32-78 for patients assigned to 24 weeks of treatment and weeks 56-78 for patients assigned to 48 weeks of treatment).

Treatment-naïve = received no prior therapy for HCV, including interferon or pegylated interferon monotherapy

http://www.incivek.com/hcp/extended-rapid-virologic-response-ervr

[nightbeacon]

I tend to agree with copyman.  When I was active in my addiction my ALT was 1700 once! I've never worried about my enzymes (save for the test I just mentioned) and feel comfy with letting my docs handle it.   I would push your doc for a better answer - I realize they don't want to alarm us, but "let's wait for the labs" never makes me feel better, either.

Try not to worry too much; it sounds like you're doing everything you're supposed to be doing.  Cheers and ciao!

[copyman]

I wouldn't worry about the high LFT's. The only concern at this time should be UNDETECTED on your PCR results.
It is great you have been UND throughout TX.

You can do a 12 week post and if you are UND then chances are like 98% that you are SVR and 6 month will be the same.

Best of luck

[HectorSF]

last injection on August 23rd, 2012
Sorry but there is no SVR at 4 weeks. Only detectable still. It's now November.
You haven't waited long enough to find out if you have achieved SRV yet.
About January, if you have no viral load then you will be SVR.

" 6 months after your treatment has ended: Test again.
Your healthcare provider must be sure you have cleared the virus. "

I agree ""Let's get these labs back and we'll go from there. Meanwhile do not worry about it."
Until you get the data from these tests no one can say. First try to be patient. Get the data. Then see where it leads. And take it from there...

Worrying about it I'm afraid will not change your lab results. You were able to complete 24 weeks of treatment. That is an accomplish that I would take note of and congratulate yourself for doing. There are no guarantees when it comes to hepatitis C treatment. You did your part. It is now your doctor's turn to find out why your AST and ALT are elevated.

Good luck with your tests.
Hector