alt ast ratio

Hi,
I am just diagnosed, but must of had this for almost 30 years. My doctor said my liver function tests were great, but I am concerned about my AST/ALT ratio and the fact that my AST is higher.

AST = 15    
ALT =  8

I have looked some stuff up and it looks like this means I may have cirrhosis. Could someone help me with this? I am really concerned.

[Bill1954]

Hi there,

It’s really difficult to arrive at any conclusions on your health based on liver enzymes alone. It’s quite possible to progress into and through HCV without having elevated ALT/AST. Off the top of my head, I’d guess that nearly 30% of patients will show liver enzymes in the normal range at least some of the time.

However, I’ve also read that the having a ratio of AST/ALT >2:1 can indicate cirrhosis or possibly alcoholic liver disease. Obviously, the best thing to do is consult with your doctor, and request a biopsy for the final word. There are also other markers that can help with a diagnosis of cirrhosis; low platelets, low albumin, and elevated bilirubin can all be used to ascertain damage.

Take care—

Bill

[Bill1954]

UNOS provides a useful tool for calculating MELD score; if you have had labs recently, you might have the results you need at hand:

http://www.unos.org/resources/meldpeldcalculator.asp?index=98

[peachpath]

Thanks for te information. Everything is very new to me. The terms are also difficulty to comprehend. What is the MELD score?

[Trinity4]

Liver biopsy is the most accurate procedure to determine the degree of damage to the liver and your doctor is right, your numbers are good.  Until you have your biopsy, you can't assume you have may have cirrhosis.   Dr. Google can make us all a little crazy because there is always something we can find that fits our symptoms.  See a good hepatologist and take it from there.  Others may chime in that have cirrhosis and ask additional information from your blood tests that may indicate extensive damage to the liver.  Read as much as you can about hepc.
Here are several good sites:

janis7hepc.com
hcvadvocate.org

[peachpath]

Thanks for the response...
I have been looking this up for hours. It is making me crazy. My PCP wants to send me to a Gastrointerologist. (not sure of the spelling). He says he is good and knows about HepC. Is it a mistake for me to not go to a Hepatologist? Thanks for the websites!

[Trinity4]

If there is any way you can see a Hepatologist than that is the route you should go.  They are mostly located in the larger teaching hospitals.  Their specialty is disorders of the liver and are usually on top of the latest treatment protocols for hepc.  A very experienced GI can be good too, but it is important that they have treated many with hepc.  Some GI's are behind the learning curve with this disease as aren't as aggressive in treating hepc.  You really don't know at this point if treatment is necessary.  You'll need to have additional tests and a liver biopsy will be the tell all as to whether treatment is necessary at this point.  Take it one step at a time.  Don't panic, logically move to the next step but make sure you get the best doctor you can.  Sometimes it's not possible for people to travel many miles to a teaching hospital but if you are going to see a GI, make sure you ask him if he has treated many with hepc and you should find a list of questions to ask the doctor on the websites I posted as well.  Good Luck peach, you'll get through this and come up with the best plan possible for you.
Trinity

[Bill1954]

Yeah, Trinity is right; we can drive ourselves nuts now with the wealth of information available to us. As she says, the best way to determine the extent of damage is via liver biopsy. It sounds like a drastic measure, but it’s generally painless, and yields invaluable information. It’s an outpatient procedure, and the worst part is the waiting after the actual biopsy, so they can monitor for any complications. Bring a book with you; it can take hours afterwards. This is the procedure most of us use to determine whether it’s in our best interest to undergo treatment.

There are some very good gastroenterologists out there, in my opinion; not all the folks in here agree with me, however. A hepatologist is someone that specializes in liver disease; most of them are GI docs that have undergone further training. If you don’t have any complications, a GI doc might be sufficient. If you do have cirrhosis, or have to undergo treatment multiple times, a hepatologist would definitely be in order.


There’s a list of frequently used acronyms in the column “most viewed health pages” in the right-hand margin of this page, or you can go here:


http://www.medhelp.org/health_pages/Hepatitis/Common-Hepatitis-C-Acronyms/show/3?cid=64

Good luck, and stick around and continue to ask questions—

Bill

[can-do-man]

I've had cirrhosis now for some time, your liver function test look great, As for my blood test the only thing that is always way off is my platelets. I would also try to get into a hepatologist. The bx is the best way to go but it sometimes takes awhile to get into a GOOD hep-c doctor. So i had my family doctor write me and rx for a fibrosure test at labcorp. Just a smiple blood test and you get the results in about 2 weeks. Its a good guide for little damage and late damage.

Between that and your blood tests you could almost rule cirrhosis out. But i would still want the bx............ Best to you

[peachpath]

I just wanted to thank you all. I haven't told anyone yet and this is really my first contact with anyone regarding what is going on. I have a grown daughter and a teenage son and it has really been difficult acting like everything is fine. I don't want to tell them anything until I know more. This is so hard to deal with that I don't want to put it on them. So, Thank you all for responding and giving me just good information.

[can-do-man]

Bill your right if you can find a good GI doctor who has tx many hep-c people, scary thing is though most of us when dx don't have a clue about hep-c. My family doc recomended what he thought was a good GI in hep-c.

So i went to him, my first question was what geno type i was, after he fumbled through the paper work he gave up and barked "whats it matter" you have hep-c. Didn't want to do a bx, said it was a waste of time. Told me if i drank to limit it 2 a couple beers a day and all this time i was cirrhotic.

My point his if i had just took his word for it and hadn't done any research i would have been tx by a quack............. Hope all is well Bill

[jmjm530]

Patients with cirrhosis often (but not necessarily) have normal liver enzymes. For that reason, your doc's statment that your liver enzymes "look great" must be taken in a broader context. Is your doc a gastroenterologist or hepatologist (liver specialist). If a gastro, do yourself a huge favor and go see a hepatologist for proper diagnosis. Gastro's often know far less than people here on some very basic HCV issues.

Until then, a better (but imperfect) cirrhosis calculator will be found here:http://www.haltctrial.org/cirrhosis.html

All you need is INR and Platelets, both of which you should have been tested for. Ask your doc for those numbers and plug them in along with your ALT and AST.

You should also know that there are other clinical signs of cirrhosis a hepatologist will look for including hardness of liver (through palpitation) as well as size of spleen (via ultrasound). And then, as mentioned, is the gold standard, the liver biopsy.

Bottom line, do not think things are "great" solely because of your low and normalized ALT and AST. They may be, however, as you originanally suggested --  the ratio suggests a possiblity that they may not be.

-- Jim

[jmjm530]

Oh lord, I see you're not even seeing a gastro but a GP LOL. Sorry for the levity, but you mine as well ask your mother what those enzymes levels mean than a GP. As others suggested, skip the Gastro and go right to a liver specialist (hepatologist). Or ask your mother :) BTW Hepatologists can be found at your larger, teaching hospitals. Meanwhile, no harm getting those blood values mentioned or having your GP order those tests cause the hepatologist will want to see those numbers.

[jmjm530]

Bill: There are some very good gastroenterologists out there
---------
Bill, you are probably correct, but how do you know the good from the bad. From what I've read here it certainly isn't the HCV patient load. Maybe you were lucky that you found a good one but to suggest someone seek out a GI IMO is like hoping they find (forgive a little exargerration) the needle in the haystack. On the other hand, if they start with a hepatologist, they at least have a much better chance of getting both better diagnosis and guidance.

[JennyPenny]

I've used a gastroenterologist since my diagnosis of cirrhosis in 1992. He is fabulous and knows as much as any hep doc I know. It is sometimes difficult to find a hepatologist unless you are near an academic center or in a big city. In the mean time the AST/ALT ratio only holds true for elevated enzymes. In normal enzymes it doesn't work. That info comesdirectly  from Dr,. Hoofnagle, a hepatologist at NIH.

[JennyPenny]

Sorry, my post should have been directed to peachpath. Sorry Bill.

[zazza]

Those liver enzymes do look great to me as well. They are not only within normal range, they look healthy. What tests have been taken so far? Maybe your doctor has only tested you for antibodies, and in that case your hep C might actually have been resolved in the acute stage so that you never developed chronic hepatitis.

You should get tested to see if you have a viral load or not. If your viral load test comes out UND (undetectable), you do not have hep C any longer.

[zazza]

I have always had liver enzymes within normal range. I am now cured from my hep C. When I still had chronic hepatitis my ALT would be around 30 and my AST around 25. Once I got cured my ALT went down to 10 and my AST to 21. See what I am getting at. Your numbers remind me of my cured numbers.

[peachpath]

They are doing the PCR test now. I have a bad feeling I am going to be positive; however, I have a full feeling where my liver is and have read that is a symptom. I should now next week. I cannot tell you how wonderful this is to talk about this. I have really been isolated. My PCP said with my numbers being what they where he wouldn't do a biopsy or treatment! I really want to do treatment. I am hoping I don't have a problem getting the doctor to approve it since my alt and ast are within normal. Thanks again

[zazza]

I think you are one of the lucky ones who cured your hep C in the acute stage. Please report back when you get your PCR result. It is interesting for us to know.

Good luck,
Za

[peachpath]

Hi everybody

I wanted to update you on my test results. My PCP called and said the PCR test came back undectable. He is sending me to the Gastroenterologist and said that it could come back. What do you think?

[nygirl7]

If you have great liver enzyme numbers and your PCR came back UND I think that you no longer have the disease and therefore I am not sure how it could 'come back'.  Even with a very very low PCR test result you would have numbers most likely in the hundreds of thousands so to have an UND is highly unlikely without having done treatment.

Makes NO sense to me. I've been cured for two years and certainly didn't have an UND until much after I started treatment.

[JennyPenny]

"If you have great liver enzyme numbers and your PCR came back UND I think that you no longer have the disease and therefore I am not sure how it could 'come back'.  Even with a very very low PCR test result you would have numbers most likely in the hundreds of thousands so to have an UND is highly unlikely without having done treatment."

Unless I am missing it, peachpath has never said she had hep C. She said she tested positive and I think she may have meant she had a positive antibody test. She could have a false positive test or she could have cleared the virus on her own. 55-85% of people with hep C antibodies will clear the virus on their own.  

[nygirl7]

Whether she had it and cleared it spontaneously or it was a false pos it appears that she does not have Hepc at all - not with enzymes that great and an UND to her credit.

Most likely she was told she had antibodies and just assumed that meant she was diagnosed but now has found out that she cleared it or didn't have it.  They could rerun the antibody test I guess but I never heard of a false antibody test before.  Even I had a false positive after I was already SVR - that does happen but I do have antibodies present of course so I'd guess that is her case.

[zazza]

"Most likely she was told she had antibodies and just assumed that meant she was diagnosed but now has found out that she cleared it or didn't have it."

I agree with nygirl.

This is what I told you all along. Your liver enzyme readings are healthy. You probably cured your hep C in the acute stage long ago.

Be happy!

[Trinity4]

"55-85% of people with hep C antibodies will clear the virus on their own."

That is incorrect. 55-85% of people with hep C antibodies will become chronic. 15-25%
of those who have a reactive positive antiobody test will clear the virus on their own.

[Jakied]

Like most of the people on this thread, I belive you are definitely

virus free as of now.  I wonder if you ever were infected.  If I were you,

i would ask your doctor for the Riba confirmatory antibody test.  this is

VERY specific for HCV antibody and if negative, you were never exposed

to Hcv and your immune system never produced Hcv antibody.

If the Riba is pos, you were exposed to Hcv at some point in your past

but the neg Pcr means your immune system cleared it.

This is an important distinction for insurance reasons.

I have a feeling your Riba will be neg and that would be the best news of

all.  Good luck.  Most people with Hcv antibody but no virus will have the

antibody for life.

[nygirl7]

"That is incorrect. 55-85% of people with hep C antibodies will become chronic. 15-25%
of those who have a reactive positive antiobody test will clear the virus on their own. "


Yes Trin is right.  Wishful thinking that that many people could actually spontaneously clear the virus what a great wondrous thing that would really be for the world.

[peachpath]

Hi,

I am sorry I wasn't more specific in my post. I was given two antibody tests. One was  the Riba and it was positive. I have had one PCR RNA test and they told me that the virus was UND. They are sending me to the Gastroenterologist to do more tests I guess the PCP wasn't very specific about that. I do have another question there was a comment regarding insurance from Jakied. Could you elaborate? Thank you so much for your responses..It is so helpful for someone who feels like they are completely in the dark and have no one to really talk to about all this!

[GreatBird]

If the virus was UND then it isn't there. Your test results indicate that you were exposed, but your immune system fought it off. That's why you have antibodies but no virus.

Sounds like your PCP is confused.

[Jakied]

Well, if you want to purchase, say, a life insurance policy, a complete physical will

often be required.  If you receive a Std panel of tests (hiv/hep/herpes/syph etc), the

antibody for hep c will show up, if you are pos.  Some insurance companies will reject

anyone with Hcv antibody, even though they are virus free.

The pos Riba means you were definitely exposed to hep c at some point in your past.

The neg Pcr means you, probably, have cleared it without treatment.  I believe most

doctors want to see a second neg pcr to confirm someone is virus free.

May i ask if you have ever received a blood transfusion ?   Blood transfusion before

1992 is a very common way to transmit Hcv.

[peachpath]

Thanks for the information about the insurance. Actually, I got it from a "bad" period in my life through drug use. It was the late 70's and I was experimenting  with things. I also think there are a lot of other professionals out there today that also experiemented with drugs, got over it and went to college and are working adults who don't even know they might have it.  I have a masters degree and I don't think I am the only one who did some bad things in the past...It is looking like I might be a very lucky person right now...I am concerned about the second PCR test.

[Jakied]

  EVERYONE makes mistakes.  Try to relax.  A single neg Pcr is VERY encouraging.

Your doctor may not even recommend a second test.  I believe you are Virus free but

antibody pos.  The good news is you do not have Hcv and the antibody is not a health

concern.  Good luck with everything.  All will be well.

[peachpath]

Thanks for the encouraging words I am trying to be positive. It is like a skeleton in your closet coming out with a Vengeance! I was thnking about what my PCP said and it seems like you all know more than him...I would think he should at least know some of the basic stuff. He said I couldn't ever drink again and to be careful not to expose anyone...That seems strange when he just told me I was undetectable on the PCR...He said my antibodies were winning and I didn't want the hep to raise it's ugly head again....

[JennyPenny]

"That is incorrect. 55-85% of people with hep C antibodies will become chronic. 15-25%
of those who have a reactive positive antiobody test will clear the virus on their own."

Thanks for the correction. I got my numbers backwards. I'm seeing numbers in my sleep since we just finished our update for the 2009 Hep C training program.

However, 15%-45% clear the virus. 15%-25% does not add up to the number who become chronic.

Also there are definitely false positive antibody tests. That is why we used RIBA to confirm and now use signal to cutoff ratio as well as PCR for confirmatory tests.

Peach, your doc is wrong as the antibodies to hep C are not protective so they can't be winning. Also, if you don't have the virus, you can't give it to anyone. I think you would be smart to repeat the PCR test and if it is undetected (and it 99% will be) you do not have anything to worry about.