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Avatar universal

Status of liver enzymes POST TX.

Just wondering about these 2 questions:


1. When and how long did it take for your enzymes to return to normal after TX?

2. Which would YOU choose if you HAD to: A high viral load or elevated liver enzymes?


2hep2it
18 Responses
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Avatar universal
   I stopped all alcohol almost four weeks ago and all sugar at the same time. My GP has refered me the the University of Wa. liver specialists. I should here back from them this week as to when my appointment will be. I am detoxing the liver with Liver detox 1 Which is milk thisel Dandelion root ,Taurine Artichoke green leaf tea , Tumeric root, Phosphatidtlchlorine, salpha lipoic and methionine. I have decided that my life is more important than drinking and I want to live a while. A long while.
        I curved my diet to eating much better and dropped sever pounds in this last month. I guess Im having the most trouble with the sugar. From what  I read the Hemoglobin count is a pretty good indicastor as to how your blood handles the sugar. As Im at 5.3 and below 7 seems to be the acceptable safe zone could I slip over the line now and then or does the sugar affect the liver much harder when the liver levels are already in the elevated areas.  
   So I guess theres really three questions here. Are the detox herbs ok to continue on until I actually get to the hospital's specialists? If so should I add any others to the mix? How does sugar mix in all of this? Lets add one more in there. IS there anything alse I can or should be doing in the meantime before my appointment. Thanks to any and all for some advise with any of my concerns.

  Ps;Are  the new drugs you mentioned being released in 2011 showing signs of some breakthru. Were could I find info on these drugs Please?
    
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Avatar universal
when the liver is damaged it fails to produce cholesterol so maybe that explains why they are low. your high ast & alt suggest damage is being done to liver. Someone with your #'s should not drink alcohol even moderately, NO alcohol will help you live longer when you have HCV. With your bloot test results I think you should see a liver doctor (hepatologist) and consider treating soon. Perhaps have a biopsy and see what stage you are and if minimal damage then you could wait for the new drugs coming out in 2011.
Good luck
Helpful - 0
Avatar universal
Hep c detected twenty years ago. Took tx twice... No avail...geno type 1 ... triglycerides 194... ast 82... alt 130..  hemoglobin A1c 5.3 ......HDL 27... LDL 11 total 77 .....Cholesterol almost non existant ...enzymes high up 30 points in 1.5 years    fifteen pounds over weight 60years old vary active feel good w/ lots of energy love sugar really crave at times and drink moderately .. Are these normal ast and alt levels or is my liver showing signs of inflamation and failure?  Hhy is the chol. so low? THx Steve
Helpful - 0
Avatar universal
Congratulations on being undetected and ALT may be up for other reasons, you know how that goes.  The brain fog is still with me. LOL
Have a happy father's Day.

Beagle
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92903 tn?1309904711
Yes, thanks for asking. Viral load shows undetectable, but ALT has risen. Trying to sort out the emaning of that. Hows that brain fog?
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Avatar universal
Hi there, Did you have your PCR done yet?  ;)

Beagle
Helpful - 0
92903 tn?1309904711
I may be confused about whether it was niave or SVR patients. Doesn't really matter - the point being that raised ALT can definitely point to ongoing viral activity, even when serum shows clear. Hmmmmm....
Helpful - 0
92903 tn?1309904711
As I posted elsewhere, though neg by serum TMA, my ALT is elevated post tx. Started down at 20 in the begining weeks of post tx, and at weeks 12 and 14 it's at the top of normal range. Doc is a bit concerned but of course wants to wait it out. I'm looking for a paper that was posted about PCRing biopsed liver tissue in SVRs with raised ALT and finding viral persistence. Anybody have a link to that one?

One possibility mentioned by my Doc is fatty liver. Frankly, as a geno 3 with history of alcohol, I was surprised initial bx didn't show it. I'm not overweight, but not thin either (164/5' 9"), so I guess initiating dietary measures would be a good idea? I eat pretty well, but there's sure room for reducing fat, though most of mine comes from fish and veggies (and the cheese on my veggie pizza).

Anyway, I'm not good at waiting, so any links or suggestions appreciated.

Thanks,
Ross
Helpful - 0
Avatar universal
This may be the one you are thinking of:

<a href="http://www.medicalnewstoday.com/medicalnews.php?newsid=5130">Persistently abnormal liver function tests: Marker of occult hepatitis C?</a>


Here's another disturbing one where the study group has normal ALT's but are positive for serum antibodies and, have occult in the liver:

<a href-"http://www.natap.org/2006/HCV/060806_01.htm">HCV is Detected in Liver of HCV Antibody-Positive But HCV RNA Negative Patients, so don't assume HCV has been cleared if viral load is undetectable</a>


(from the paper):

"<i>Conclusion. HCV may persist and replicate in the liver and PBMCs of healthy, anti-HCV antibody-positive, serum HCV RNA-negative patients who have persistently normal ALT levels. <b>These patients should be followed up, because they have an ongoing viral infection.</b></i>"



TnHepGuy
Helpful - 0
Avatar universal
The first one I linked above is probably not the one you are looking for, since the patients in it are not post-tx'ers. I haven't run into the one you are thinking of (hopefully "willing" can remember), but here's one of SVR's with normal LFT's:

<a href="http://www.hcvadvocate.org/news/reports/AASLD_2005/11%2015%20treatment%20-4.htm#Treat_4_39">HEPATITIS C VIRUS PERSISTS AND REPLICATES IN THE LIVER OF THE MAJORITY OF SUSTAINED RESPONDER PATIENTS TO ANTIVIRAL TREATMENT</a>



TnHepGuy
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Avatar universal
<a href="http://www.natap.org/2006/HCV/060806_01.htm">HCV is Detected in Liver of HCV Antibody-Positive But HCV RNA Negative Patients, so don't assume HCV has been cleared if viral load is undetectable</a>
Helpful - 0
Avatar universal
My enzymes normalized in two weeks after tx.  I was in the 400s before starting, they got down to high normal after a few weeks ON treatment and settled out in the high 80s during tx.  We thought it was the drugs that did it and as it turns out it was.  My enzymes are right on the button now.  

As to your choices, is there a third choice - no viral load?  If not and the question is whether if I have active disease would I rather have low enzymes or high viral, I might choose high viral if I am not thinking about treatment again.  I am not sure that viral load directly influences how you are functioning.  It does correalate with tx success I hear so I am not sure.  If I am considering tx, go with enzymes.  If not, take the high viral. Would be nice if there was a button to push on the liver to choose one or the other - less fillng, tastes great! Two blondes fighting over a sloppy old liver as they fall into the swimming pool!  Nice.
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Avatar universal
That's a good question and I'm facing this dilemma right now. I have 5 weeks of TX left and my liver enzymes have never been normal during the whole course of tx so far.

But if I had to make a choice...I'll pick VL. My VL has never climbed back up. I've been undetectable for months. I get a sense of comfort knowing 3 things:

A) the liver has an amazing ability to heal itself.
B) the TX is working for me..at least for 48 wks, I'm winning the battle against HCV
C) I have gallstones and maybe that's what's causing the high enzyme levels...I'll get that sick gallbladder removed as soon as tx is over.

I have no control the outcome of my war with HCV...but I can take comfort in know that at least for 48 weeks I fought back.

I have to take my shot now.
Peace
br007
Helpful - 0
85135 tn?1227289772
My enzymes were only slightly elevated at the start of tx. By midway of tx, they went down in the normal range and started to climb back up (?). At the end of tx, the enzymes were very much higher than ever before and I was worried that something was wrong. Well, at 6 weeks post-tx, my LFT showed that my enzymes were smack dab normal (whew). Strange but true.
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Avatar universal
And just to add to the mix, I've had elevated enzyme levels throughout treatment. I started in the high 200's and didn't drop to below 100 until about 30 weeks of treatment. I'm still hovering around 90 on both but have been undetectible (<10) for 20 weeks. My doc (and at least he admits it) isn't sure what it means, but he is reccommending another biopsy following treatment whether I relapse or not.
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Avatar universal
Thanks. I asked is  because mine just keep going higher. Now its three - Alt,Ast, and GGT.  I can't wait till next month.
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Avatar universal
My liver enzymes normalized at week 2 or three of treatment which is a good sign. However, many here never had normal enzymes during treatment and still cleared the virus.

As to which is worse, it really depends. Pre-treatment, I'd prefer to have lower enzymes than a lower viral load, because higher enzymes suggest the liver is stressed out although there may be other causes. On the hand, the day before treatment I might prefer the lower viral load as studies suggest a better chance of SVR.  Post treatment, I'd prefer to have no virus over lower enzymes because that meand less chance of fibrosis progression and also that I won't have to treat again.

But in the real world, the above is sort of meaningless because isolating factors like enzymes/VL has limited clinical use. So many more factors are at play and one important bottom line is whether your liver damage is progressing or not. Biopsies and less invasive tests help here.

BTW I believe NY Girl is overstating the significance of high enzymes in her post above, especially during and after treatment, when the treatment drugs themselves may influence levels.

Personally, I had elevated liver enzymes for close to 40 years and did not reach cirrhosis (stage 4). Others have had elevated enzymes for similar amounts of time and only reached stage 1 or 2. And then, some did reach cirrhosis. So again, one size (or in this case one set of criteria like enzymes) does not fit all.

-- Jim
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Avatar universal
My liver enzymes went to normal during the first few weeks of treatment - started in the 200s and dropped right away to the 20s / 30s throughout the whole course of treatment.

Chosing I would take the high VL because it doesn't mean much and high Enzymes mean that your liver is being KILLED.  When the cell is killed it RELEASES the enzyme...so the higher the enz the more damage is being done.

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