High ALT

Having done 48 weeks with normal ALT etc., I just got partial bloodwork back on my 3 month PCR. The ALT was 98, about 2x normal and about what it was when I was diagnosed. I am a littled freaked by it. Anyone have any info about high ALT after tx? I get my PCR next week so I'll know for sure then.

[DonL]

No other medications. Stress, yes, but organic. Thanks for the thoughts.

[DoubleDose]

PLEASE NOTE:   The study makes a distinction between 'bio-chemical responders' and 'virologic responders'.

The bio-chemical responders, which only means that ALT/AST levels (LFT's) normalized after tx, WERE THE ONES with HCV in their livers on biopsy, years later.  WHY?  Because they still had virus in the blood, most likely, immediately after therapy.

Notice, the 'virologic responders', who were negative on testing for blood levels of HCV, all were undetected for virus in the liver, years after therapy.  This is exactly the point that I made yesterday.  Blood level/ serum eradication of HCV by PCR testing, six months after tx, CORRELATES almost 100% to Liver eradication.

Bio-chemical clearance is a different thing altogether.  It merely means that the liver functions have temporarily normalized.  This has nothing to do with viral eradication from the blood.  Those bio-chem responders, were all most probably POSITIVE for HCV in their blood shortly after therapy ended.

All of this is in accordance with recent medical research and current wisdom regarding eradication of HCV.  This makes much more sense.

[Califia]

I'd have to agree w/ Chev, as I've heard the same from two treatment nurses.   No one has adequately explained post-tx enzyme spikes in patients who go on to achieve SVR, but apparently they are not all that uncommon.   Hope you can find some pleasant distraction before the PCR results are in.

[DonL]

That'll do. You know how these things go. Thanks all.

[honey1616]

Sorry to hear that you are now faced with aggravation of the waiting game.  I have seen here at this forum,,,people reporting that after stopping tx,,,they had a spike in their alt but went on to SVR 3, 6 month....I will be thinking of you this next week as I know nothing any of us say is going to make your totally relaxed,,,until actual PCR..

[cuteus]

"HCV was not detected in biopsy samples from 15 sustained virological responders taken 5.9 to 12.5 years after pretreatment biopsies, the researchers note. However, all but one of the 15 biochemical responders who had repeat biopsies had HCV detected in the liver."

I don't get it, the way I read this, the svrs show no hcv in the liver and the biochem responders did, except for one. This is quite a confusing statement as it seems to be talking about the same 15 subjects.
does any one else see svrs with detected hcv in livers in this study? please point out where it says so because I don't see it at all. If doctors themselves are not reading this correctly how are WE suppose to?

[jonihs]

It might be something as simple as fatty liver. I wouldn't sweat it

[Tallblonde]

The more I learn about this, the more I wonder if the term "relapser" is even accurate.  It sounds to me as if "relapsers" are actually "non-responders".  Again, the limitations of testing may lead us to believe for awhile that someone achieved a SVR, when actually they didn't fully respond to the treatment.  Success has to be all or nothing when it comes to SVR, doesn't it?  

Susan

[DoubleDose]

I agree with you.  Testing only determines if the virus is beneath a particular threshold...so we never really know if or when it is truly 'gone', until after we complete therapy and wait to see if there was indeed any virus remaining.  If so, it makes itself known in a big way, pretty quickly.

I also think that all who respond to therapy, or in other words, those who see a decreasing viral load, all decline at differing rates.  That is the biggest obstacle to using cookie-cutter approaches in tx.  Also, as the load declines, there is ongoing replication at all times, so even when we test as undetectable, there are small amounts of virus spread throughout the blood and liver, that are still replicating.  Getting ALL of them, down to the very last one, is really what takes so very long, after we first test undetected.  For slower responders, getting those last virions can take a year or more of constant pounding, after undetected status, because for every 1000 that you kill, there may be 925 being reproduced...so it is a slowly dwindling situation.

I wish that doctors were more clear on this issue with patients, because many people assume that when they read 'undetected' they are pretty much home free.  That assumption can be the cause of terminating tx way too early, or unduly reducing drug dosages, so that the effectiveness equation changes, and you may no longer be 'killing' more virions than the body is producing.

[Tallblonde]

Very well put.  

Susan

[jonihs]

One thing you guys are not seeing is, I think, alot of those relaspsers are re-infections. Just because most of us on this forum who had at risk life styles, have changed them, the percentage of relapsers in drug addiction, even after several years clean, is 60 to 65% according to the last treatment center I went to. Joni

[honey1616]

Also,,,I don't think we can classify relapsers as non responders because look at the people that have gone through tx 2 or 3 times and then finally reached SVR.

[snook_man]

Whats up my political partner? Haven't seen you on the other side of the table in awhile. Don't run from the crossfire.
I really do not know what to take it as. ALT's have been shown to fluctuate. Mine actually went up first couple weeks of tx, and I'm waiting on my first PCR. The only real definate answer will be your results. Got my fingers crossed for you.

[jonihs]

maybe not 40% but I bet it's a significant percent. I went to alot of NA meetings a few years ago in a very large community, and it was really rare to find anyone w/ over a year clean. Also other HCV sights I checked when I first was dxed, alot of people were trying to figure ways to get txed and still keep using. I also know from experience that people tend to use in select groups, the same ones all the time. Needle users share the same water, even if they would never think of sharing needles. And snorters share straws. If they are all using alot, that's alot of inflamed membranes. Relapsers(users) go back to the familiar when they relapse. I've been in treatment 8 times, and heard the same stories over and over.  Joni

[DoubleDose]

What the study says is that there were 38 virological responders (with NO HCV in their serum), AND 37 biochemical responders (WITH HCV in their serum)....two different groups entirely.  The virologic responders were the true SVR's and did not have HCV in their livers in subsequent follow up biopsies over the years.  The biochemical responders (who are not really SVR's) were the ones that all had HCV in their livers down the road...and that is exactly what you would expect...since they never fully cleared the HCV from their blood at the end of tx.

The two groups were different, and mutually exclusive.  

All studies that I have read also show this same consistency.
Those who are TRULY SVR, that is: those who are serum negative by highly sensitive PCR, 6 months after ending tx, are almost 100% HCV negative in the liver also...whether you biopsy in one year, or in seven or ten years. THIS is why they all rely only on the blood PCR to determine SVR after therapy, and they do not biopsy the liver to see if there is SVR.  The two tests are almost 100% coinciding...or are the same.

I am still waiting to see any studies that contradict these almost universal findings.  Why would HCV now show up in the livers of SVR's when it has not done so in the past ten years or more.  They do run these tests on both blood and liver, to make sure that the theory is correct.  So far (despite what revenire's doc may have stated) I have seen NO study that shows otherwise.  If that were the case, then the blood of SVR's would pretty quickly also become positive for HCV, from the liver infection. Again, ALL studies have demonstrated that if the virus is fully 'gone' from the blood, then it also is gone from the liver.  If it is still in the liver after tx, then you get RELAPSE>

Doubledose

[cao]

I'm still in tx (a little over halfway done), but my ALT numbers were perfect when I was viral and have gotten higher only now that I've cleared the virus.  I'm not sure that ALT and viral load are highly related & I wouldn't worry too much about the ALT numbers in of themselves.

[cuteus]

snook, I meant to say how LOW did your range(pcr test) go on those years you tested negative?, if your vl was always low and the range was not at least <50iu/ml, your negative might not have been so.

DD: on the subject of the study mentioned, where do you find the definitions of the terminology used; i.e. what chem responder means.
TY

[snook_man]

I am not sure. Back then, HCV was not really a concern for me. I kind of brushed it off. All I was told, is that it was not present. Don't even have a copy of labs, as I didn't know then to ask for one. But the first VL I kept, was 5463.. Next was 4000. My next at week 12, 0!!!! Don't worry, I let you in on the dancing.