Cirrhosis and normal liver enzymes

I was dx last tuesday with hep c - going for liver bx in am.  I have had symptoms for 12 years - so obvious now.  But the past two months have been very bad- so, so, many symptoms.  I am concerned it may be cirrhosis but the last liver enzymes were normal. Can one have a normal liver panel with cirrhosis.

[FlGuy]

Yes, you can have normal liver enzymes and still have cirrhosis.  More often AST and ALT are elevated, even if they are in the high end of normal range.  Most here have had bx's - and it's not as bad as it sounds.  The worst part is laying around for a few hours after the procedure.  The procedure itslef takes a few minutes.  They'll probably deaden the feeling at the target site (sort of the upper right back side), do an ultra sound to make sure they have the target in sight, and then take a core sample with a syringe.  You won't feel anything, but the 'click' of the syringe is kinda weird.  The result, report from the pathologist, will give you a clearer idea of where you stand with respect to liver damage.  That plus the other labs you've already had will help you and doc make a treat or no-treat decision.

[copyman]

i had a question to add: can you have cirrhosis with normal LFT's, pro time, ultrasound and no other physcial symptoms?

[honey11]

See..It depends on the past 12 years,,,,have you done bloodwork and did you know what your alt was then each year?

Copy,,,Very unlikely in that case to have cirrhosis..

[Kalio1]

Can you describe the symptoms you have been having? Please describe your stats also.
Try not to worry yourself sick until you have more info.

[pvk]

I'm in a similar situation, wondering if I have cirrhosis as I wait for the results of my liver biopsy.  All my blood tests are normal and I have no symptoms, except for a little spider angiomata on my chest.  My VL is 100,000, genotype 1b.  My doctor says that with the low VL and lack of symptoms I probably don't have cirrhosis.  But of course I've read that you can have cirrhosis with no symptoms at all...also I've had the virus for 30 years, which is (I believe) longer than the average time to get from infection to cirrhosis. So, I worry.  Any thoughts?

[FlGuy]

When I first met tx doc, at that time enzymes were high and hep c was strongly suspected but not vet verified.  The first thing he notices was the spider stuff, also on upper checst, and guessed right then that I had hepc and that there was an amount of liver involvement. Turned out, geno 3a and early or beginning cirrhosis.  I had hep c for about 32 years at that point.  Not to alarm you, the bx will tell the tale, but you should begin to get full understanding about treatment and the meds.  In case your doc suggests treatment you should become a student of the disease to include the drug trials in your area, side effect and remedies for the sides.  Good luck.  Sounds like it might be time to deal with it.  I think I've seen you posts before, welcome back.

[motheroffour]

Alcohol consumption plays a part.  A moderate drinker with Hep C  will have more liver damage over 25 or 30 years than a non-drinker with Hep C. If you don't consume alcohol at all and your test scores have been normal 'til now, you've a very good chance of only having mild liver damange.  If you drink alchohol, you won't be certain until you have the bx and even then it will depend on how much consumption and how often and even that is a variable thing. We all know you are anxious and we all hope for the best for you.

[Kalio1]

I had some spider angioma, normal liver enzymes a very low viral load and fatigue. Mu doc told me not to worry about cirrhosis. I finally talked him into a CT scan after relapsing my first tx. The finding was CIRRHOSIS. I'd push for further evaluation. See if you can get a biopsy or at least a CT scan with contrast. Cirrhosis can be very sneaky.

[way]

That was the longest wait in the world...waiting for genotype and biopsy results.

[Pdilly]

So you did not have a bx until the ct scan?

[Kalio1]

No. I am a geno 3 and had decided to treat so there is "no need" for one according to both the doctor and the insurance company. this is what happens to many geno 2 and 3's, they view the biopsy as a decider in the treat or not treat scenario. So frustrating. If I was a geno 1, their protocol is to do a biopsy but geno 2 and 3 who are planning to treat aren't. I have heard this from other geno 2 and 3's that their docs say they don't need a biopsy.  Unless you have certain signs indicating you need one in your bloodwork. I didn't, I had normal bloodwork so even with spider angioma and palmar erythma they didn't think it was necesssary because my bloodwork did not indicate cirrhosis. Heh.

[jboyhk]

Believe me I have done alot of research on this.

I have yet to see any positive correlation between 'moderate' drinking and progression of disease. It may be wise to not drink at all, but I have yet to see any study showing there is a strong correlation.


Your liver is constantly dying and processing toxins. That is its job and why evolution allows it to regenerate itself. The problem comes when you overload it.

I would love to see a report showing moderate drinking and progression of Hep C. The ones that I have read never came to that conclusion.

Now it is entirely different scenario if you have cirrhosis.

[Kalio1]

alcohol accelerates the virus and causes the virus to replicate faster. Any alcohol is helping the virus to grow. It is like fuel to the fire. there are tons of websites that talk about how important it is to avoid alcohol when you have Hep C or are on treatment for Hep C. goole alcohol + hep c and you will get 10,000 pages on it. If you clear the virus and have little or no liver damage, then drinking for you is no better/worse than for the average person but with the virus you are feeding it when you drink alcohol. I sure don't want to feed this virus and help it feed on my liver, do you?

[jboyhk]

I don't want to get into a big debate since people have strong opinions on this issue.

But I just want to point out I have never seen a report saying moderate drinking is a risk. Heavy drinking (which is > 5 drinks a day) is definetely a risk.

If you have the link showing increased risk with moderate drinking (<2 drinks a day) I would love to see it.

[jboyhk]

Again I am in know way promoting alcohol use with Hep B or C. I am just stating the known risks. If you read very carefully any of the studies they all say 'may' increase the risk with moderate alcohol use. That means from a statistical point of view the correlation is not strong enough. You never see 'may' increase the risk with heavy alcohol use since there is a statistically significant risk.

Just look at his site


http://www.aidsmeds.com/lessons/Hepatotoxicity.htm


What's the deal with alcohol?

There's no shortage of information concluding that heavy alcohol use

[Kalio1]

People will convince themselves of anything to justify continuing to drink alcohol. They search for "evidence" to back up their need to continue to drink even a little in spite of being diagnosed with a liver disease such as HCV. If alcohol isnt a problem for then why is it SO important to continue to drink? I'd say having a liver disease is reason enough to not even have a desire to drink and risk your liver by drinking any alcohol. I was told by several doctors personally and have read TONS of top heptologists' opinions on the subject and they all say alcohol accelerates the HCV virus and should not be consumed. Nothing that can potentially harm your liver should be consumed. It's your liver and your life. If alcohol was a take it or leave it thing to you indicating you dont have a problem with stopping it then you wouldnt have asked about how much a person with HCV can drink safely. The answer is no alcohol is the safe way to go. ALL the top hep docs say NO alcohol if you are HCV positive.

[pigeonca]

Although I'm playing it safe and abstaining from my beloved vino until I've treated and cleared, I do have some questions.  Every expert says not to drink, but all the studies I've seen deal with heavy drinkers.  I've never seen any studies of people who have one drink a day or one drink a week.  If I were a scientist, I'd undertake such a study, but I'm not. so I can't.

[jboyhk]

Final line should read

don't support it for moderate drinkers

[Kalio1]

Many of us were moderate drinkers and had no idea we had this virus, that is a very common situation. Try not to worry about damage being great, you just might be pleasantly suprised and have very little. Even though I didn't discover I had HCV until I had early cirrhosis I am still very grateful I caught it before my liver failed. There are some excellent options being tested as I type that show promise in reversing liver scarring even in cirrhotic patients so don't despair. The sneaky, insidious nature of this disease will be lessened if we can educate the public and work to have EVERYONE tested as a matter of course. We can't do anything about the things we don't know we even have! I too have had regrets over by glasses of wine in hindsight but there was no way for me to know I had a deadly virus that was being fed by the wine and neither did you. What is your doctors name and where are you located?

[pvk]

I'm in Los Angeles and I was referred to the Pfleger Liver Institute at UCLA, where I saw Dr. Sammy Saab.

[FlGuy]

Kalio is so-cal gal. So is Foreseegood - and others .They may know a few.  But if you hook up with a hepatologist, with hcv being all the rage these days, you'll probably find that all hepatologists do a brisk hcv business.  And, with hcv, lots of experience is a very good thing for a doc to have.  Sometimes insurance requirements will drive doc selection decisions too.

[Kalio1]

Hey we are practically neighbors, I live in Santa Barbara. Your doctor sounds great. Google him, he looks like a fine doctor.Plus he must be pretty young and that is a good thing, they are learning a lot about Hep C in med school these days. My Primary is young too( and also a UCLA grad) and he was very on top of HCV, suprisingly so and he told me they were educated extensively on HCV. I'd say you are in good hands, that is if you like the guy and he seems to be well informed. It's hard to say by reading their Cv's what they are like as doctors and if they are good communicators or not but from the looks of his credentials you have a good doctor and a good facility in my opinion. So many doctors are no longer taking Hep C patients on as they already have so many be glad you have a good doctor and secured a spot! My doctor said they can't take on any more and I hear that a lot lately.

[tbag]

i'm 63 yo. i had hep c type 2, took the treatment and am now undetectble. however, i've been told that i have compensated cirrhoses. yesterday, i read about sulphasalazine a drug that is supposed to reverse liver scarring.  does anybody know anything it. i would appreciate any info.

[jboyhk]

I am not 'convincing' myself of anything. I just want the facts.

Instead of yelling at me, please show me a study that has a positive correlation between moderate drinking and increased risk. Not a 'maybe', because in statistics that means 'insignificant'.

Let me give you an example. Heavy drinkers die earlier than moderate drinkers. This is a statistical fact.

From this, you would make the conclusion that moderate drinkers die earlier than non drinkers.

In fact, it is wrong. Statistically (not 'maybe'), moderate drinkers live longer than both non drinkers and heavy drinkers.

You cannot just 'extrapolate'.

All I ask if for you to show me ONE study that shows a 'definite' increase in risk, one that is statistically significant.

Dr's say many generic things all the time just to be on the safe side. Of course you shouldn't drink if you have a liver disease if you want to be super safe, but the research and studies I have seen don't support it.

[pvk]

Thanks for your responses.  I'm anxiously waiting for the results of my biopsy.  I expect that despite my lack of other symptoms the news isn't going to be great.  30 years with the virus and many of them spent as a "moderate" drinker don't put me in a good position.  I'm pretty sure I'm headed for treatment.  Do you guys have any advice on how to go about finding a good doctor?  I've seen a hepologist but have no idea whether he's good, bad, or indifferent.  Thanks.

[Kalio1]

You said one study, so here is one but there are plenty more where this came from. Again, anyone who needs "proof" to justify drinking with hep c is too concerned with continuing drinking in my view and willing to ignore ALL the top docs in the field who say to stay away from it. You accused me of "yelling" and I didn't yell at all I just voiced my opinion like you. YELLING LOOKS LIKE THIS ONLINE. Because a person states their position doesn't mean they are yelling. I get so tired of people trying to justify drinking with hep c, it is like a person with emphesema saying a few cigs are ok.
I don't think it is a good idea to suggest moderate drinking with Hep C is ok as you are doing particularly in a Hep C forum, stating there is no "proof" it isn't ok when there is. It can give the ok to people who are having a hard time stopping alcohol a green light when the facts DO support stopping alcohol if you are Hep C positive. I was going to give you a list of references but it's late and Im going to bed, plue I dont think any anount of info will convince you, your mind seems made up already to me. If you really wanted to find this info, it is easy to find.

http://cat.inist.fr/?aModele=afficheN&cpsidt=14954579

[Kalio1]

Inotice the site of the link I posted i down at the moment, but it is a good link. They must b doing maintenance.
Here is another link that shows the dangers of even moderate drinking and Hep C.
http://www.webmd.com/content/article/83/97883.htm?lastselectedguid=%7B5FE84E90-BC77-4056-A91C-9531713CA348%7D

[Kalio1]

Here's another one showing moderate drinking with hep c increases fibrosis progression. I could do this all day long thre is so much info showing it is a bad idea to drink at all with Hep C.
http://www.blackwell-synergy.com/links/doi/10.1046/j.1365-2893.2002.00356.x/abs/

[Kalio1]

Comprehensive detailing of the many dangers of ANY alcohol to the HCV positive patient.
http://www.medscape.com/viewarticle/488940_2

[Kalio1]

and another one - http://www.drugabuse.gov/HepatitisAlert/HepatitisAlert.html



here is the conclusion:
"Persons who test positive for HCV should be given information regarding the need for preventing further harm to the liver, reducing risks for transmitting HCV to others, and obtaining medical evaluation and followup for chronic liver disease and possible treatment. It is important that physicians know if a person is infected with HCV so that medications that may have side effects involving the liver can be avoided. To protect the liver from further harm, HCV-infected persons should be vaccinated against hepatitis A and B, if susceptible, and should be strongly advised that even moderate alcohol consumption may adversely affect disease progression. All persons should be advised not to use illicit drugs."

[jmjm530]

Jboyhk,

We used to have passionate discussions on both sides of this issue, but apparently most have gotten worn out on the topic. This is unfortunate because all side should be heard not just the last man (or woman) standing.

IMO you are absolutely correct.

A careful read of recent studies show that liver damage was only associated with *heavy* drinking -- like 4 or more drinks a day, and not light or social drinking.

Even the study cited above -- actually a questionaire review -- hedges on what the headline writer suggests: "The damage was less than with heavy drinking, (caps mine) AND MAY HGAVE MINIMAL OR NO EFFECT -- but the chance of damage was there." In fact, most of the "warnings" against drinking can be traced back to older studies in the late 90's that only collected data on heavy drinking.

Here are some recent studies that suggest light or moderate drinking has no effect on either the progression of fibrosis or viral replication.

I should also add that I spoke to several nationally known hepatologists and all allowed me to drink in moderation after finishing treatment. In fact, I was allowed to drink prior to treatment as well, not just during treatment.

CITATION 1 (From esteemed Cleaveland Clinc -- Fifth article down) http://www.clevelandclinicmeded.com/hcv/litreview1.htm

"...What does this mean for our patients with HCV? It seems to this reviewer that the stern warnings we have previously given about the possible dire consequences of even modest alcohol intake now must be tempered. Alcohol abstinence may be the safest course of action, but an occasional drink appears not to harm the liver in those infected with HCV"

CITATION 2: http://tinyurl.com/l7c8h

CITATION 3: http://gut.bmjjournals.com/cgi/content/abstract/54/10/1468

As I've said previously, statements like "I get so tired of people trying to justify drinking with hep c, it is like a person with emphesema saying a few cigs are ok." are the worst kind of propaganda because they play emotions and personal bias against studies and facts, with the inference being that anyone who thinks it's OK to engage in light social drinking with HCV somehow has a drinking problem.

I personally find the insinuation insulting, others have as well, I have so mentioned it the past, as have others,  but so be it, one of those topics :)

Jboyhk,

I'm not posting much these days and will not post more in this thread, but please feel free to use these studies in any future discussions on the matter.

All the best.

-- Jim

[Kalio1]

I knew Jm would show up on this thread. I am through on the subject, If people with compromised livers from being HCV positive or from established liver damage are determined to drink alcohol, nothing I say or anyone says will change that.

[Kalio1]

Here is a good link about sulfasalazine I found helpful.
http://www.wellcome.ac.uk/doc_WTX033662.html

Here is a link that talks about caeolin-1 and it's influence on liver regeneration.

http://bio.com/newsfeatures/newsfeatures_research.jhtml;jsessionid=S31LSW40TRMBPR3FQLMCFEWHUWBNSIV0?cid=21900014

[jmjm530]

On re-reading, the sixth paragraph of my previous post is confusing.

It should read:

"I should also add that I spoke to several nationally known hepatologists and all allowed me to drink in moderation after finishing treatment. In fact, I was allowed to drink prior to treatment as well. I was not allowed to drink during treatment."

[jboyhk]

Kalio,

I have read that study you posted already a while a go.

It would be considered garbage in the world of statistics and scientific research.

Any study that is dependant on soley patients reporting in flawed and useless.

I can post you thousands of links why. The main reason is that people LIE.

People that say that they are 'moderate' drinkers may be ashamed to admit they are 'heavy' drinkers and hence the outcome is meaningless.


The researcher even admits it in the last paragraph "His results may be somewhat skewed, since each patient reported his or her own medical history and drinking habits, he says."