Slightly Elevated ALT/AST

Hello everyone. Newbie here. Can you stand it? A new day on the forum,another dx of HCV.

A little background: Tested positive with HCV 3 weeks ago by HCV Antibody Reflex Test. Liver panels were within normal range for the past 25 years, then the last 3 times tested, they were slightly elevated. The last readings were: ALT-52, AST-41.

Now my doctor says this has been simmering for years(20-30 years), unbeknownst to me. 2 years ago, I was taking Diamox for several months, a sulfa drug that is extremely damaging to the liver, and one month ago, I was popping Motrin like it was candy (also damaging to the liver, from what I understand.)

My question to the members of this forum are:
I have read more than one article while surfing the web that states a "cirrhotic" liver usually shows ALT/AST levels to be in the normal to slightly elevated range. Because of my present mental state--which is fragile, to say the least--I need some feedback on slightly elevated ALT/AST levels, and the potential damage I have caused by taking the above-mentioned medications.

I have an appointment in 3 weeks to see a GI, but in the meantime, I am going crazy.

Thanks to all of you in advance.

[jmjm530]

Sorry about your diagnosis, we've all been there, but by the tone of your post you seem to be handling the news it in a very level head way.

I've also read that many cirrhotics have normal or not very elevated enzymes but the converse is not true -- in other words you could have normal liver enzymes and also have very little if any liver damage.

As to the drugs you mentioned, one could only speculate.

The gold standard for liver damage is the liver biopsy, but other blood markers can tell part of the story, and newer blood marker profiles and devices in trial like Fibroscan can also add to the mix.

Best thing is to see a good liver specialist (hepatologist) who will help you sort things out.

I can tell that the "20-30" years thing is bothering you but just from what I've read here, we have some people with 20-30 years with the virus with almost no liver damage and others with significant liver damage. It's a slow moving but very individual thing. Personally, I've had the virus for close to 40 years and my biopsy showed somewhere between stage 2 and stage 3.

All the best moving forward.

-- Jim

[memwis]

Wow, Jim! You are fast! Thanks for the speedy reply. I suppose the ol' saying "It's a c*** shoot" rings true with HCV.

Thank you for the well wishes. I know this will be a journey, and the outcome will depend on how I choose to react. (Now if I can only get over feeling like a leper--received a call today from GP's office notifying me to expect a call from the Health Department. I know this is necessary, but upsetting, nonetheless.)

Thanks again. All the best.

[jmjm530]

Mem: (Now if I can only get over feeling like a leper--received a call today from GP's office notifying me to expect a call from the Health Department. I know this is necessary, but upsetting, nonetheless.)
------------------------------------------
Never heard of that one? Anyone else have?

[doglover28]

No, I haven't.  
Try not to feel like a leper.  The people on this forum are great and have really helped me.  I was diagnosed in April.  Probably had it for 25 years.  All my blood work has been fine and ultrasound was normal.  I get my biopsy next week.  I thought it was a death sentence at first, but it's not.  
Pam

[can-do-man]

Yep, i got it in the mail. Jeez took them long enough for you. Mine came within a couple months.

[amirtracy]

yup. i got one too in the mail. right after dx. the hepc police are onto me. dammit! hopefully they don't know about all the other stuff i've done...

[amirtracy]

hi there. sorry about your diagnosis but we're all right there w/ya. it does take some time for it to sink in and for the information to get sorted out. i'm a "support" member here. not as knowledgable as many but can only offer my own experiences and a shoulder. alt's and ast's can be all over the place and don't really explain much as far as damage. www.janis7hepc.com explains alot in simple terms. try not worry. HA! (sorry) it's hurr-up-and-wait w/ this. we're all here for ya.   tracy

[jmjm530]

Got what in the mail? What did it say? I throw most of my mail away so maybe that's it.

[amirtracy]

I got a letter from the local health department in my county saying i had been reported by my doctor(pcp) to their infectious disease department w/ a number to call. THEY called me first. (he even gave them my unlisted number)told me about spreading hepc, about hepa & b vaccines, about not giving blood, etc...I am officially on the registar.

[DoubleDose]

I agree with Jim's comments, and you should not worry too much at this point.  I think your normal LFT's over the years point more likely to little damage, than to more damage.

My question is this:  Do you have any idea when or how you contracted the virus?  Were there any high risk factors in past years?  (intravenous drug use, transfusion, surgeries, etc.)
Also, have you had any idea over the years that you might have HCV, or a liver disease?  Any symptoms that have caused you concern??? (fatigue, gastric problems, anxiety or depression, migraines, autoimmune issues, dry eyes or swollen glands, etc., etc.?)  

Many people with HCV seem to be without symptoms, yet many others have dealt with years of unexplained issues that are never fully explained until the HCV diagnosis is made.  I would really like to hear more about your history.

Also, anyone else in your family or close contacts that you are aware of who have suffered either from HCV or similar liver disease?  

Keep in touch with the forum, it can be a great support, throughout your dealings with the virus.  Thanks for any feedback.

DoubleDose

[Upbeat]

was the elevated alt/ast the reason you tested for hep-c? Or was the reason other symtoms (symptoms)?

                                                          Ron

[Pdilly]

I heard that all doctors are required to report anyone with Hep. Not sure if it is Just HepC and HepB or one or the other. I read it in the doctors office once or maybe in an article I read on the net.

[jmjm530]

Just an unrelated "thank you" for your tireless efforts to look outside the box for more answers to this thorny disease. Hopefully, one day there will be a magic pill -- way beyond the Protease Inhibitors I'm thinking -- that will make all this a thing of the past. But until then, we need all the help, answers and questions we can muster. Unfortunately, too many hepatologists feel their job is over when we SVR. But as you well enough know, for a lot of us SVR's, it ain't over yet.

-- Jim

[memwis]

Hi upbeat--
No other symptoms prior to being tested. Just a routine liver panel/CBC when Dr. prescribed an AD. Take good care.

[DoubleDose]

Thanks for the additional history.  I hope you find that the situation is not at all serious, and your liver is in pretty good shape.  I suspect you will feel better when the results are in.

I am even MORE curious about your sibling now, after hearing your story.  I have long suspected that the virus is sometimes, or even often ,transmitted in very 'unremarkable' ways, possibly among family members or intimate partners, and that it may take decades to show up, or develop into a true HCV infection.  If your sibling had non-A, non-B, I would assume that eventually they were diagnosed with HCV?  Since there were Hep. B tests available, I can't think what else it would have been.  I wonder if the virus could have been passed in childhood, and not become detectable in yourself until later years?  This is something that I personally am concerned about, since I have read recent accounts of people with family members who had HCV long ago, and now these individuals have become HCV positive.

I don't want to get too carried away in speculation, but I think the odds of both you and your sibling developing HCV independently of each other, with no risk factors, has to be very remote.

I also wonder about the numbers of HCV infected people who experience depression, and/or anxiety.  I suffered from both, frequently over decades, before I ever knew about the HCV, and later realized the connection.  I have read countless accounts of people with HCV who had pronounced, chronic depression.  I also believe my mother may have had this illness, and died from related causes almost twenty years ago.  This has caused me to really ponder the possibility of casual, intra-familial transmission, which may show up many years later.  My HCV developed slowly from late teens onward, without risk factors, and in looking back I now see the slow progression in symptoms, even though never diagnosed until the late 1990's.  I had some early LFT fluctuations in my twenties that doctors could not explain, but did not take to be anything to worry about.  Little  did they, and little did I, know what the real cause was at the time.

Anyway, I wish you the best in determining your current liver status.  I would again, like to hear more about your sibling's previous liver virus diagnosis, subsequent problems from it, and what came of it over the years.  Was there follow up? Any HCV tests performed later?  Any ongoing problems now?  Did the infection resolve long term?  Could they be one of the HCV infected who spontaneously clear the virus after an acute infection????  In that case there would still be antibodies to HCV on testing, but NO viral load.  This is something you may want to thoroughly investigate.  It could answer your questions about how you got the virus!

By the way, some of my speculation about transmission is just that, speculation.  I do not want to create the impression that I am claiming HCV is being transmitted casually among family members, but I have some suspiscions, and have seen and read several accounts (and studies) that make me wonder if there are other more 'benign' modes of transmission.  I am still trying to explore and research this issue, and have tried to get the HCV medical community to objectively research and investigate this possibility.  There is not much interest at this point.

DoubleDose

[memwis]

Thanks to all for your caring and supportive stance. Thanks, amirtracy, for the genuine belly laugh.(I live in a very small town, and now that I am on the HepC "hitlist" at the Health Dept., what other things will they dredge up? Nothing to hide, really. ha Reminds me of the dreaded "Big Brother is watching YOU!" mindset.)

Doubledose, you asked that I disclose a bit more of my history, risk factors, etc.: I lived with a sibling back in the day when HepC was diagnosed as "Non A, Non B hepatitis, and that is exactly what he was diagnosed with. He was hospitalized and treated because his case was acute--he became very ill. I have since worked in the health field for several years, and was exposed to HepB. If I remember correctly, blood-borne pathogens did not become an issue, as far as in-service training and awareness, until the 1980's.

Believe me, I have traveled down memory lane one hundred times to pinpoint when I contracted this, as well as died a thousand deaths. But this is of no importance now--I need to know my prognosis, and I need to know it yesterday. Waiting is the hardest part.

As far as symptoms go before dx, I am blessed with relatively good health. What signs I did notice, however, was attributed to getting older. An occasional joint ache--was it from working out or from a "flare" of HCV? Fatigue--was it from working nights or was it from HCV?

And the depression! It has never been far--a constant companion.

Forgive this long-winded diatribe--no real support where family/friends are concerned. I will be lurking at times, and checking in at times--just to experience the wonderful feeling of caring/support.

I sincerely hope all who have been dx, or going through tx, will receive a complete clearance of this virus you so aptly call "the dragon." To live is worth the fight.  All the best.

[memwis]

Hi DoubleDose--
You may be on to something! But as you said, it is strictly speculation. Again, to prevent any panic, I emphasize speculation.

Your history sounds similar to mine, regarding depression/anxiety symptoms. I had believed--until recently-- there was a genetic factor involved, given my mother struggled with depression/anxiety herself. She passed away from pancreatic cancer several years ago.

As for my brother, yes, the non a, non B hepatitis was later dx as HCV. I was young at the time he was being treated in the hospital, but I can remember my mother being given strict orders by the doctor to sterilize glasses,eating utensils, etc. that he used, and cooking a "bland" diet for him--which translated into nothing "rich"--no dairy, fats, etc. And that was it. Can you believe how far we've come?

He cleared the virus, spontaneously, but not without cost. Things have cropped up throughout the years--borderline diabetic, among other things. He is very health conscious now, and addresses problems as they arise. The human body ia an amazing thing--nothing short of a miracle--considering how resilient it can be.

Since my recent dx, I am grappling with all the same questions as you. I would appreciate any insight you may have.  

[DoubleDose]

We are on to something indeed!  I have long wondered how much of the HCV out there came from the previous generation, though they were  undiagnosed in all probability.  I suspect many passed away in prior decades due to direct or indirect effects of the virus, but were probably considered garden variety liver disease cases, or stroke or heart attack victems, etc.  I am convinced that the long term ramifications of HCV, without treatment, were probably deadly in many cases, and probably not recognized as being caused by a virus in most cases as well.  The liver failure deaths might be telling, but I suspect there were plenty of problems from other deadly effects of HCV as well.

I have posted in the past a number of times about my concerns that the virus might transmit casually in families, in ways other than involvement with liver or blood.....such as salivary or mucosal infection, gastric tissue infection, sexual tissue infection, eyes, etc.  If these modes of transmission were indeed fact, the virus might remain sequestered in these organs or tissues for some time, until finally 'breaking through' into broader systemic HCV blood/liver infection, under various circumstances (immune system glitches, heavy alcohol abuse, extreme stress, drug abuse, etc).  Maybe it could also just remain isolated in these tissues in those casually infected, and never provoke a full blown HCV blood infection.

I have read too many studies of spousal transmission rates, outside the USA, where for the first decade or two the HCV transmission rate was in the typical 1% to 3% range.  In these same studies there seems to be a point in time where the spousal transmission rate jumps up to the high 20's, percentage wise.  I have read of 25% to 29% transmission rates for spouses after thirty or more years together.  I cannot see the logic in deciding that sexual transmission is very rare, 2% or so, when after 30 years together there may be a huge jump in infection.  Why?  Is it really an accidental, new infection?  or was it just a prior infection making its way into the blood?  There have not been any US based studies that I have seen that demonstrate this anomoly. Again, all theory and conjecture on my part....but there has to be a reason for such a big jump in rate! Do people married for 30 years suddenly develop a strange ability to pass the virus sexually???? (highly unlikely, of course)

I have been concerned about symptoms I have seen in family members in recent years, that mimic my pre-tx HCV symptoms.  The symptoms have developed over the years, while at the same time my family members ALL test NEG. for HCV.....for now.

I also have several other related observations that also support my concerns, but will not elaborate at this point.

I have to believe that YOUR HCV infection was possibly somehow transmitted within your family, from what you have said.  Do you suspect your mother could have had the virus.  Any transfusions giving birth?  Any known liver problems, or similar history of HCV-like SX?

I am more and more sure that my Mother probably had and died from HCV, and it is a very 'eerie' thought.  Maybe this virus is VERY slow to emerge, and maybe antibodies to the virus develop slowly over the years to finally becoming detectable at some point!  I think my history went along those lines, and I remember some very strange, questionable childhood illnesses that were not like the typical flu.  They lasted about three weeks, on two occassions, and I slowly got back to normal...then fifteen years later my LFT's began to elevate!  Odd history, and no risk factors that I know of.  I started feeling fatigued in a very different way in my late high school years.  No LFT problems during those years, though.  

Fodder for thought!!!  What do YOU make of all this.  A LOT to digest, I am sure.  I have been pondering these issues for a few years now, and the more anecdotal stories I hear about, the more nervous I become.

DoubleDose

[memwis]

Is it worth mentioning my other siblings have slightly elevated ALT/AST levels also, but have written it off as "a (insert surname) thing." They have not been tested, but I intend to ask them to reconsider.

I won't bore you with any more family history, but I truly think your theories have merit. Most definitely.

After being diagnosed, may I ask what your next step was? Liver biopsy or no? Treatment, if any?

[DoubleDose]

I had an early biopsy about ten years ago, Stage 1/2, and then started therapy in 1998.  I did a 15 month escalating tx, which became daily infergen and riba after a few months and finally got undetected after nine months, only to relapse one month after ending tx.  I began a new tx in 2001 using high-dose Peg-Intron, and Ribavirin (and Procrit), cleared at 19 weeks, (which is slightly late), and did extended tx for a total of 18 months.  I was undetected on finishing, and have remained undetected for almost three years (SVR).  My LFT's are now totally normal, but I seem to have a good many post-tx interferon induced (I believe) after-effects.  Overall I feel much better, but have a variety of lingering sx including joint pains, periodic depression and anxiety, sun sensitivity, frequent bouts of fatigue, dry eyes, etc.  It was all well worth it though, and I believe I saved my liver by doing tx (and my life).

The question now being asked by many is: Does SVR really mean CURE? Reports of persistent minute amounts of replicating HCV isolated in various organs after SVR abound in recent research studies.  What does this phenomenon bode for our health, for the future, and could it reignite a full HCV infection?  Nobody really knows at this point.

Many doctors, by the way, believe that there is NO residual HCV after SVR, and disagree with the recent research!!!  Though I never here arguments from them on what grounds they disagree.  They just seem to not believe the studies.

When did you first realize you had a problem when you were younger?  Any early elevations in LFT's?  Strange viral illnesses when young?  Unexplained fatigue, lack of energy or stamina???  When I was a teenager I had several illnesses characterized by fatigue, dizziness, vertigo,(no real fever), anxiety, nightmares, and a strange feeling of doom!  They lasted about three weeks, and were VERY unsettling. Veru unlike flu or typical illnesses! I would bet they were early signs of HCV, in retrospect.

My mother had a slow progression into illness and finally death, from her early fifties onward.  Fatigue, depression, skin eruptions, anxiety attacks, strokes, finally water retention then death by major stroke.  Her ALT's were elevated but the doctors at that time attributed it to circulatory related and heart problems???  Seemed odd to me, especially with the huge weight gain and water retention, seemed like liver disease.

Anymore connections you make or thoughts you have are welcomed!!!
Let's keep in touch.

DoubleDose

[memwis]

Hi DoubleDose--
You write with such knowledge. You have helped answer some nagging questions, and I appreciate your patience.

To answer your last post, no, there weren't any strange, unexplained, chronic sinus inflammation, throat clearing or eye irritation among family members or myself.

The similarities (between us) began when I was a teenager. Depression mostly, along with anxiety and lack of energy. In my early twenties, I experienced several unexplained bouts of flu-like symptoms, one of which specifically stands out in my mind: An extreme feeling of "doom," along with terrible joint aches and fatigue. No fever or nausea. In my early thirties, I sought help for depression through my GP, was referred to an endocrinologist for possible thyroid imbalance(although my thyroid panels were normal). Once at the endocrinolgist's, blood tests were ran, and you guessed it--a very slight increase in ALT level. Two more LFT were ran a month apart, and baffled, the endocrinologist explained "some people's ALT levels have a tendency to run a little high." No hepatitis antibody tests were offered, yet this was in the mid-nineties.

LFT were within normal range on subsequent visits to the doctor.

Which brings us to the present--a month-and-a-half ago, I complained to my doctor of joint aches that would come and go, extreme fatigue, and dizziness. He performed the perfunctory physical exam--testing reflexes, feeling lymph nodes, looking in mouth/ears, etc. and CBC and LFT were ordered. His diagnosis:"I think you're depressed." After 3 ALT/AST tests came back elevated, HepB and HepC antibody tests were given, and the rest is history.

DoubleDose, it is wonderful to know you have achieved SVR! May you continue to possess outstanding health. Keep living a happy life, and know you have helped others who have been terrified from being dx, and calming some of the fears of the unknown.

I do have one other question. Please bear with me, because I'm grasping at straws here(at least until I see a gastroenterologist)--What do you think of the supplement Milk Thistle? Help or hindrance? Snake oil or "Patient, heal thyself" to a chosen few?

Thank you for your time. I look forward to hearing your views.

[DoubleDose]

Just another quick question:  Did or do you or your siblings seem to have any chronic, daily, year long sinus inflammation, throat clearing / clogging, eye irritation problems over the years???  If so, do you correlate them to the HCV?  If not, what other physical symptoms do you notice?
Thanks.

DD

[DoubleDose]

I went through a phase where I tried alternative medecines years ago, including Milk Thistle.  I have since read much about this and other supplements, and have formed my own personal beliefs about alternatives to tx........They do not work.  Milk Thistle MAY lower LFT's in some cases, has NO effect on the viral load or damage from the infection, and in my estimation is just like all the other herbal, vitamin, supplemental, mumbo-jumbo alternative treatments....not worth the money spent, and all in all a huge waste of time.  Some doctors humor their patients by allowing for use of Milk Thistle while waiting to begin tx, but I do not think any doctors think the stuff does more than make people feel like they have some control and are doing something.  The ONLY thing that currently 'cures' the virus is interferon/ribavirin treatment....there's just no way around it.  Its not fun, it doesn't ALWAYS eradicate the virus, it can cause some nasty post-tx sides in some....but all in all...it can get rid of the virus.  I did it twice until it worked....and spent quite a long time on higher than normal dosages in order to rid myself of the virus.  I am glad I did, and would do it again. Make sure that you have a highly experienced, very knowledgable HCV doctor, who can successfully tailor treatment according to your needs, and your response to interferon and ribavirin.  Everyone is a unique case, and needs to be treated according to their genotype, their unique response curve, and their side effects on therapy.  Should you choose to undertake therapy, choose a very good doctor.  It makes a huge difference.  You want to succeed in ONE go-round!

I am amazed at the parallels in our stories.  I discover more all the time when I look at my history and realize what my odd childhood symptoms and illnesses represent.  It really makes you feel sad for that child back then, who had no clue until decades later as to what was going on.  I would bet there is a LOT more of this out there than the medical community realizes.  I really fear that it (HCV) may 'germinate' or 'incubate' over many years in many of us, and become detectable only after a long time (except for those that inject drugs or are transfused, when they receive the virus directly in the bloodstream, and the infection explodes almost immediately).  I also wonder about the insidious modes of transmission that may be taking place that do not fit into the official HCV establishment line of wisdom (blood to blood only).  

I would like to hear more about your ongoing management of the virus, and more about your past history, and potential family infection history.  Where do you think the infection came from?  Your mother maybe?  Sibling only, a possibility?  Were your mother's symptoms very similar to yours, and anything in her history that pointed to liver related disease?

Do you currently have a spouse and any children?  Any concerns if you do???  I worry about mine almost non-stop.  Even though they have tested negative for HCV on several occassions!!!  I still fear a 'hidden' infection that might come to fruition in the future.  I have read several anecdotal stories that indicate a similar path to infection:  parent or family member who WAS HCV positive long ago, and now the person has become HCV positive long after the family member passed away, or after being away from them for years.  Several accounts claim to have been tested for HCV several times, and been negative, only to have become positive at a later point in time!!!!  I find these accounts very disturbing, as far as potential for transmission.  Not at all what you would expect!  Anyway, sorry for the long winded reply.  Keep in touch.

DoubleDose

[memwis]

Hi DoubleDose--
Thanks so much for your reply. I halfheartedly suspected Milk Thistle was only a "band-aid" in the interim, and not a cure--it's just that the waiting is really wearing on me, and I feel I have to do something, even if it only has a placebo effect.

Yes, absolutely, I strongly think my mother could have possibly been a carrier, and I also agree many of the deaths of our parents, grandparents,etc.could have been related to HCV. This is such a "new" disease--identified a mere 17 years ago, and I believe that not only will we witness more discoveries in the future made by medical science about HCV, I also think their projection of HCV diagnoses increasing en masse as each year passes is, unfortunately, right on the mark. This is only my opinion, of course.

At birth, I was severely jaundiced and my bilirubin level was off the chart due to my mother's Rh- blood factor, and in the eleventh hour, I barely escaped a total blood transfusion. Now I can't help thinking my poor liver didn't have a fighting chance from the get-go.

Yes, I worry about my spouse--and God forbid, an HCV dx coming out of the blue years down the road. I think it is only natural for you and me to feel distressed at times, given our history of thinking our maladies were strange and unexplainable--but not this!

I am devastated. And can't stop worrying. Please,won't you cross your fingers for me?

Stay well. Thank you for everything.

[DoubleDose]

I trust you will find the forum to be a GREAT help to you as you grapple with the realities of this disease.  I would assume that treatment may soon be on the radar screen for you, and you will want to solicit the forum members for their thoughts and personal experiences, as well as opinions on your planned strategy, and your response to treatment, should you decide to move forward.  Please do make sure that you have a very experienced HCV doctor, who is accustomed to tailoring the treatment to the specific needs and responses of the patient.  Also, a doctor who has a pretty good track record of helping patients, especially the difficult cases, to achieve SVR.

There is lots of support, and optomism abounding on the forum, and many members willing to share their time and thoughts to help new members, and those contemplating treatment in their decisions, and coping with the illness and tx.  

Stay very hopeful, and prepare yourself to do whatever is necessary to rid yourself of the virus.  If your liver damage is very minimal to non-existent, you might have the luxury of waiting and closely monitoring for a few years to see if the new inhibitor class drugs (combined with Interferon/ riba most probably) will make a big difference in the length, effectiveness, and difficulty level of therapy.

Good Luck.

DoubleDose