Sudden increase in ALT level , Shocking

[scruples]

Hi i am in week 15 of Tx. My ALT levels raised suddenly upto 41 from 26 in just 4 weeks. I am really worried about that. why this happened ???? are meds not working properly or virus getting strong and replicated again ???? I have appointment with my doc after 15 days. Should i contact him and describe this fact immediately ??? History of ALT is given as follows.
Pre-Tx                 46
at the start of tx   67
After 4 weeks      46
After 10 weeks    26
After 14 weeks    41

Please advice if it is common or a strange thing which should be discussed with doc immediately.

[alagirl]

I had astronomical raises in my liver enzymes during treatment.  Some of that could have been due to my elevated iron (I had a lot of transfusions), but I STILL have elevated iron and my enzymes are just fine now, a little over six months after tx.  They didn't go down until some time after tx.  

They went up so high that my gastro (prob without thinking about my iron levels) asked me if I had recently been binge drinking.  He wasn't kidding.  (For the record, I've never been a drinker).  Its so common for enzymes to be labile or to just stay up during tx that I have to think the tx drugs are difficult to process, particularly during times of lowered immunology and lower hgb, and that this may mix with other issues, high iron, etc.

Anyway, 41 is not that elevated and I would wait until after tx to worry excessively about your enzymes.

[GoofyDad]

Meki: Uhm --- nothing personal - but that's not a very big raise...


Sadly, I've heard these comments before :(

[nygirl7]

One week I got my test results back and went literally running and screaming to my doctors for an emergency appt. My enzymes did just what yours had and I KNEW it meant I had relapsed.

He laughed at me so hard I'm surprised I ever went back again.  Of course I was fine and have been SVR for almost two years.

It happens, relax and breathe again I'm sure you too are fine!

[GoofyDad]

My ALT/AST went up to the 40's at 4-6 weeks and stayed there until a while after tx was done. No big deal, I'm SVR and ALT/AST are now about 20 . I did have very high ferritin during tx, which fits into HCA's theory. I was told ferritin is a meaningless number on tx.  

[FlGuy]

Yeah, what's your viral load?  That's the only number that you should concern yourself with. If you are either responding well or are undetectable the liver enzyme results are merely a temptation for you to make yourself crazy.  There is only one number to focus on and it's ZERO. So, what's your viral load?

[dorsey15]

This happened to me in treatment.. I freaked out...went from 20 to 40-- so just like you I got on this forum and posted.. told my doctor I wanted an immediate Viral Load test--Ultra Sensitive.. I was in week 20 then-- now I'm in week 39...
the freaking out was all for nothing...
Actually, interferon and Riba CAN bring your ALT & AST up as well as food, smoking, other meds you take ect., just like Meki said...
You are still within "normal" range...so I would definately take it easy...my freaking out was nothing to worry about..just like everyone told me on the forum...hee hee
Hope you can have a calm day today.
Dorsey

[Bobby1952]

   Going up from ALT of 25 to 41 is nothing. This can happen to people not on treatment also. It is natural. As long as someone doesn't have a constantly elevated ALT it is nothing to worry about. I am sure your Doctor will tell you the same thing.
   While on tx you have worse things to worry about such as side effects etc. Hang in there and don't worry about minor fluctuations in your blood counts. Save the worrying for serious things.

Just curious....when was your last PCR and what was it.

All the best

Bobby

[meki]

Uhm --- nothing personal - but that's not a very big raise...

We've seen folks in the hundreds.

Anyhow - yeah --- check the sheet --- usually the mid range is either in 20's or 40's based on the type of test (brand of test or how it gets the info... and whether it's fasting - etc.)

ALTS - ASTs --- change very fast sometimes --- take an advil --- smoke a cigarette - have a glass of wine - eat a steak --- and poof --- up or down....

a change in the range less than 30 pts is usually fairly normal depending on conditions -  HOWEVER --- if they keep going up --- and you stay in the high range and keep moving up --- TX CAN AND SOMETIMES DOES CAUSE WORSE PROBLEMS WITH YOUR LIVER --- and this is something your doctor should be aware of.

OK?

So if you already have damage to your liver - etc. make sure your doctor is keeping an eye on it.

Hugs,

Meki

[scruples]

Is there any hard n fast normal limit of ALT. I have reports of three different Labs (doesnt mean that i am being tested each time from a different Lab) but all have different max normal i.e. 43, 55, 40 and lower limits are 0, 10. If you know any defined lower and higher limts then plz do tell me. Moreover i have also heared that there are some other factors which also affects the test result like if you feeling hungry at the time of test the result will be changed or if you have if you are short of sleep. is it true?????

[HCA]

Your ALT is hardly raised,although I'm sure you would like to see it lower.
A possible cause of raised ALT during treatment is excess iron caused by interferon.Your doctor can test your ferritin level.
Here is an article;
http://content.karger.com/ProdukteDB/produkte.asp?doi=10.1159/000122604
Your levels are at the high end of normal,and I wouldn't be too worried.
Your next PCR test will confirm that you are not experiencing viral breakthrough,but more likely a side effect of the medication.

[sierranvgrl]

Hi there Scruples,
Interesting...I would like to know what you find out. My ALT went from 42 (week 9) to 58 in week 12.  Both are nominal compared to where I started, but it does seem odd. My Viral Load went down from 3.6 million to 252 at week 4, so I was surprised my enzymes went up recently (as of 9/24/08). I am waiting on my 12 week VL test now. I don't see my doc for 2 more weeks either, so please post whatever you find out.

SNG