Worried - Liver Enzymes Have Become Elevated After Being Normal for Months

[nobhillhepc]

Hi, my viral load has been zero since sometime during first two weeks of treatment, and AST and ALT have been normal since week four, now this week AST is 66 and ALT is 81, I know these are just slightly over normal.  GP I am seeing who works with my liver doc, who is out of town, says it could just be due to this bad infection I developed, got real bad fever and have been out of work for over one week, but have responded well to antibiotics and fever broke within 8 hours after antibiotics and am feeling better now.  Also, responded very well to Neuprogen, neutrophils and WBC have rebounded quite nicely with only one injection, is it possible elevated enzymes could be due to Neuprogen or probably just illness?  Viral load was zero about 10 days ago.  With one week left of treatment to go, something about seeing enzymes go up does make me nervous, glad to soon be done, and we all do have to wait and see if we stay clear during the months after treatment, am I overeacting to this week's elevated enzymes?

[nobhillhepc]

Hi,

just wanted to confirm that the whole time on treatment, and prior to treatment that my doc uses the Quest HCV RNA test you mention, I've settled down about enzymes, 6 days with an infection and fever ranging between 102-104 probably had a lot to do with that.  I was able to get back to work today and yesterday, was nice to be missed, I forget how much of a hoot I am! People said our floor was so quite & boring without me there, cracking jokes, making the daily grind at the law firm more tolerable with my un-professional behavior, I even talked about Hep C treatment with a couple more of the attorneys I support, they were really cool, impressed I made it 14 weeks withouh missing work, just want me to take care of myself and were supportive.  Guess I am done with treatment, hopefully forever, but GP said no more Interferon until he talks to my liver doctor early next week, made 15 weeks out of 16, which is where they said I could stop due to genotype, immediate viral clearance and psoriasis, funny thing, when I was sick with fever and infection, skin did not itch, guess it was too hot or cold when I had the chills, I am do for next viral load test in about one week I think, hopefully I am still clear, if not, I'll pick it up again next fall.

Marcus

[phil]

test

[mremeet]

Yeah I've had elevated enzymes (~50/80) pretty much during my entire treatment cycle so far (currently week 23-24). And I've been UND since week 2 (I'm in the VX950 trial). At one point I had a bad allergic reaction to the VX950 research drug, and it caused my enzymes to shoot up to ~130 or so. But again, I remained UND during the whole ordeal all the way up until today. Also, pln here had an ALT of 120 at the start of her treatment, and it dropped down to ~18-20 within two weeks. She became UND by day 4 and remained UND with normal enzymes all the way through her treatment. But just two days after her last dose, her enzymes shot up to about your levels - and yet she still tested UND with a sensitive PCR good down to 10 IU/ml. I see it happen all the time, people come on scared to death about elevated enzymes certain it means they relapsed/rebounded. And that does happen to be sure, but in a whole lotta cases it doesn't mean that at all. In fact I'd say in the majority of cases it doesn't mean that (during or at the conclusion of successful treatment, that is).

Anyway best of luck during the remainder of your treatment, let us know how you make out.

[jmjm530]

The treatment drugs themselves can cause enzymes to rise during treatment. It sounds like nothing to worry about but I assume you''ll have an end of treatment viral load test in another week which should put your mind at ease. At this point, you should be using the most sensitive test available, down to at least 10 IU/ml. That would be a quantitative test like Quest's "Heptimax", a qualitative test like Quest's "HCV RNA Qualitative TMA",  or one with similar sensitivity from LabCorp.

All the best,

-- Jim

[nobhillhepc]

Hi, thanks for response, that's what doctor told me and it is comforting to here your confirmation of this.  I just did some quick "googling" of neuprogen, elevated liver enzymes and learned it is not uncommon for that drug to elevate liver enzymes, and I did have a fever ranging from 102 to almost 104, and talk about chills, at times I would shake so bad it was almost like a seizure or something, most likely one or both can elevate enzymes, and you are correct, seems like relapse would happen after treatment stops, thanks again, this forum is great!

[mremeet]

I'm not a doctor, but from what I've heard yes liver enzymes can go up as a result of an illness and/or as a consequence of taking antibiotics. And sometimes they just go up for an unknown reason, without there necessarily being a viral relapse/rebound. We see people all the time posting here who are either on treatment, or have recently come off of treatment, who for whatever reason experience elevated liver enzymes. And in many cases it did NOT mean the virus had returned, many or even most go on to SVR. It's true sometimes it can be a harbinger of a resurgence, but in many cases it is not. If you've (1) remained UND during most of your treatment, (2) are approaching the end of your treatment cycle and are still on the meds, and (3) haven't missed any doses or experienced significant dose reductions, then it's probably unlikely you have relapsed. If you do relapse it's more likely that will happen once you come off the drugs. Not that I think you will, but from what I've seen that's usually how it goes.