my ast alt levels have stayed about the same

since I was diagnosed almost 5 years ago, no treatment yet, is this good or irrelevant?

[RobertBeWell]

ALT/AST levels are not generally considered as any kind of quantitative indicator of Hep C damage. They merely indicate the presence of inflammation. Some people have the disease for years and years with normal liver enzymes.

Like me for instance.

Did you have a biopsy to see if there was any damage accumulating?

[Bill1954]

“since I was diagnosed almost 5 years ago, no treatment yet, is this good or irrelevant?”

I guess that depends largely on how you’re managing your disease. If you’re staying in touch with the doctor, monitoring your possible fibrosis with occasional biopsy to assess progression it might be fine.

How do you feel; are your routine labs okay?

Bill

[iwillbeatthis]

Well I feel pretty good actually, I was diagnosed 5 years ago, I'm a 3a, i had biopsy 3 years ago, i was a grade 2 stage 3, my AST has always been in the 130 140 range Alt always in the 70-80 range, I was 2.5 mil VL nov 2009, did a lot of homeopathic and my last test last week was 54K VL, ast 132 alt 76, all the other gamma bilirubin test good. I am going to see a new GI Monday, I know what he is going to say, he is going to say this is a good time to treat.... I on the other hand want to wait to see if I can get it lower? I guess that would be because I'm afraid to treat. I am new here, all I know is I want to get rid of the virus and somehow I am 'ready' to face the treatment.
I hope he says I can wait until the first of 2011.

[FlGuy]

I was able to get a viral load of about 6 million down to about zero in about two weeks.  It didn't even require health foods, natural remedies or homeopathic stuff.  Two weeks, and i was a 3a also.

[Bill1954]

It’s hard to imagine a scenario that wouldn’t allow you to postpone therapy until next year. At least you are infected with genotype 3, which as you probably know is more responsive to treatment than say, genotype 1.

I’m not sure if there’s really any value to reducing your viral load through alternative means; interferon/ribavirin routinely reduce viral loads by millions of copies per week; unless you can somehow take that 54,000 to <5 IU/mL, it’s probably an exercise in futility at this point.

Good luck with treatment; many of us here have done it, and while it isn’t particularly pleasant, it’s something we tend to muddle through somehow.

Take care—

Bill

[iwillbeatthis]

Thank you Bill, yea I have read a lot here, I am somehow 'prepared' now to do the tx. I am grateful for the GT 3a at least, and yea, I figured you were going to say that regarding the 54,000, I guess it doesn't mean much if you can't get it to 5. I have to say though that I was 'encouraged' somehow that I got it down that low by myself. A small but encouraging little victory. And I imagine the GI will say the same thing, treat treat treat, I'm just kinda scared scared scared. Oh well, so many here lived through it, I'm sure I can too. To FIguy, how did you get your 6 mil down to zero in 2 weeks. I'm new here, so am I walking into a naive trap here by biting?

[FlGuy]

It was my second time with treatment, the first time was not a success.  High does of the meds early in the treatment cycle paved the way for eventual success.

There's a lot to know about your disease. Don't be intimidated. And, don't be reluctant to ask.

[iwillbeatthis]

I was able to get a viral load of about 6 million down to about zero in about two weeks.  It didn't even require health foods, natural remedies or homeopathic stuff.  Two weeks, and i was a 3a also.

How did you do that?

[iwillbeatthis]

Thank you FI, I will be here preparing myself, this is something I must do, I know, I am working through the intimidation, working through the fear, and keeping my heart focused on when I am no longer infected with this virus.

[Bill1954]

Welcome to the forum, by the way.

When I started treatment in early 2005, my viral load was 75,600 IU/mL; and I had a dickens of a time with treatment. I didn’t respond quickly and didn’t become undetectable for virus until between weeks 16 and 20. I’m not sharing this with you to further frighten or discourage you; but rather to point out quantity of virus might not be as critical as quality of virus. I must have had a rather tenacious flavor of HCV.

Your viral load is indeed low; at least with genotype 1, low viral load is defined as <400,000. What bearing this has on long term success is still a mystery to me :o).

By the way, I was eventually successful eradicating the virus, as you will be.

Good luck—

Bill

[iwillbeatthis]

Thank you Bill, and the other, and to Bill or FI or anybody, the one nagging question is this, WHEN someone gets rid of Hep C, and you are SVR (I forget what that means but I know its good) can your liver reverse the damage that was caused? Can it ever really get back to 'normal'?

[Bill1954]

I think there’s all kinds of evidence that a stage 3 liver will not experience additional fibrotic progression if SVR is achieved. Perhaps less that it completely revert to it’s normal state, but I don’t think that is impossible either.

Doctor’s don’t generally recommend additional biopsy after SVR is achieved; that should say a lot right there, eh?

Stick around and continue to ask questions; you’ll get through it all okay. One day soon, you'll change your nickname to 'ihavebeatthis' :)

Bill

[iwillbeatthis]

I like the name Ihavebeatthis, I will use that when this is over.
By the way, I was grade 3 stage 2, not sure what the the grade part means really but it is still stage 2 I take it.
Anyway, I will be here, readying mostly and posting when I think I should or have a question. I know there are some wonderful people here. Thank you again and I am keeping a stiff upper lip.

[Bill1954]

Oops, my bad; I read through your stats too quickly. Much better, hang on to stage two, okay :)?

Good luck; we’ll be around whenever you’re ready to go with this. It might very well surprise you and you’ll find it’s not as bad as you’ve built it up to be. I did over 150 weeks of treatment, and my biggest single complaint was fatigue… and that was mostly toward the end of it all.

Take care—

Bill

[iwillbeatthis]

What a sweetheart, thank you Bill. And 150 weeks, God bless you, I hope my biggest complaint is fatigue. I will keep you in mind, if you can do 150 weeks, I think I can do 24 (I'm hoping that's all it is, I can hope can't I?) I know I am to see what the GI says, but I'm thinking low VL, GT 3a, I'm just going to tell myself it'll be 24 weeks and that'll help me. I'll be here, reading, thinking, ramping up, and getting ready.
Thank you all in advance.

[Kristina538]

I was 3a and had early cirrhosis.  When I achieved SVR, my specialist said my liver would improve over time.   Having had an ALT in the 90's, the last test showed 15.   I was terrified to treat, but did it... and would do it again if I had to.   Good luck.

[copyman]

Not sure if anyone touched on this but I would consider treating now. What would concern me is having an AST double the ALT and that studies have shown 3's can progress with fibrosis faster then other genotypes, Also higher chance of fatty liver. Having a low VL helps and is in your favor to treat now. Not sure if the new drugs are for 3's so no sense in waiting for them. Best of luck

[iwillbeatthis]

Thank you Kristina, that gives me hope, and copyman I was thinking the same thing, it wories me that my AST has always been double my ALT. I got up this morning thinking that maybe I should just treat now instead of waiting until Jan. I was thinking Jan because it would be cooler. I'm in a hot area. Was thinking of more comfort, may sound silly ... but....maybe I'll see what my new GI says tomorrow, I hope he's good.

[Trish77]

It doesn't sound silly to choose the most beneficial time to treat. When I was preparing to do treatment with my first doc, we decided to get through Christmas first so I could enjoy that time with my kids.  That worked in my favour as it gave me more time to read and learn and I ended up going for a second opinion and changing doctors and treatment teams.  Treatment is a challenge so to put as many variables in your favour as possible is a good idea.  

ALT and AST  are not completely irrelevant at all...just not completely reliable indicators.  For a number of people, a rise in those numbers has been what indicated there is trouble, it just doesn't always co-relate.  Sometimes the lack of change can indicate trouble as well, when there is considerable damage so less to die off and less change in ALT and AST occurring.  It's been three years since your last biopsy - I'd consider doing another one.  I would expect that since you've been paying attention to your condition that your minimal change means minimal change in your status however a biopsy after 3 years when you were a Stage 2 at the last one would tell you for sure.  Just a thought.

Trish

[iwillbeatthis]

My thinking too Trish, another biopsy would probably be good, I'm guessing my doc would think that too, after 3 years, maybe that would be the deciding factor as far as when to treat, now or a little later....
I am just not biopsy crazy, and I know my 'homeopathic' doctors are just about completely against them, but bottomline, aren't they just about the most important thing right now given my situation, to find out where I'm really at?

[Trish77]

In a nutshell, yes.  It would be a very important deciding factor for you to have a biopsy done right now, in my opinion....even whether you'll wait until it's colder to start treatment.

[iwillbeatthis]

Thank you Trish, I will discuss this tomorrow, and try to do that ASAP. Then go from there. Something tells me I'm going to need this place quite a bit. Thank all of you who have had this, and have cleared this virus, and continue to stay here to help us new people. You are priceless individuals.

[copyman]

if you are going to treat I don't think a biopsy would be necessary at this point.

[iwillbeatthis]

I just thought that maybe it would be good to know where I'm at? Don't I ever want to know what kind of damage I have (since the last biopsy 3.5 years ago) because if I treat, and when I clear, a biopsy will even be less likely then? And I guess also what I mean is a biopsy will help me decide if I should treat like now or in Jan. Doesn't that make sense?

[Trish77]

I know some people look at it that way...that a biopsy is not necessary if you're going to treat.  However, I look at that in another way....that if situations arise while you are in treatment, the decisions you make while on treatment will be influenced by what you know about what liver damage you have.  I tend to prefer that people go into treatment with their eyes wide open than having them half closed and then wondering how much of an impact it will be if they stop treatment if that decision comes up in the midst of it anywhere.  That's my take on it.

[iwillbeatthis]

you said what I was thinking, knowing as much as possible before tx, and that the tx is really a life saver might just give one the extra push that you need.

[copyman]

i dont think a biopsy after 3.5 years makes much sense.  If it was 5 + years then I would be all for it. Not saying it is totally wrong just my opinion. My point is that you should treat either way no matter what the biopsy result. If you are the same or advanced to cirrhosis, you still should treat soon. A biopsy is not needed to make this decision. A good Hepatologist will be able to tell where you are just by your labs & physical exam.

[iwillbeatthis]

funny but I was just chatting with someone and we came to the same conclusion.
I guess it's just comes down to now, or 6 months from now, and somehow my gut is telling me now. No time like the present is nagging me.
Thanks you all, I'll know I think tomorrow.

[portann]

Typically, Geno 2's and 3's are not biopsied because they respond so well to treatment. If I were a 2 or 3, I would biopsy only if I wanted to wait a significant amount of time.

So I'm of the opinion that biopsy is not needed if you're going to treat soon (and soon includes this January). Having a biopsy would be important for a genotype 1 (or maybe even 2 or 4) who wants to consider waiting for the protease inhibitors to come to market. Unfortunately, for some weird reason, protease inhibitors  are not effective for genotype 3's.

It may be very important that your hepa puts you on weight-based ribavirin instead of one-size-fits-all ribavirin (800 mg) often prescribed to geno 2's and 3's without regard to weight . This is something you should discuss with your doc. My vote is with weight-based riba for G-3's.

It sounds to me like you're ready  to get your feet wet. As scary as it seems, believe me, if I can get through 48 weeks of treatment, you can get through 24. I kind of hated every minute of treatment and took a big hit compared to tough guy Bill (sweetheart,  indeed) but I'm now so totally glad to be clinicaly cured. Feels great, totally.

Best wishes,
Susan

[Diane12855]

You say you are considering waiting till Jan. to start because you live in a hot place. If your tx takes 24 weeks, then it will be June, and very hot when you get done, and then it takes a while to get the meds out of your system and feel better. If the temperature outside is a deciding factor, I'd go from fall to spring... cool to cold the whole time.

Just my thoughts,
Diane

[iwillbeatthis]

I had written down the weight based riba info for my doc today, made sure of that. And yea, I went through a rough night worrying about to biopsy or not to biopsy and I realized this morning that that exercise of mind torture was a waste of time because I'm sure that won't even be a choice, (I'm hoping) the doc will just say let's go, I wish he would just give me the first shot in the office today. Anyway, as for the waiting for Jan. Diane you right, and I can't wait, my head is ready, I might ASAP, even if it is a little warm (Arizona hot).
Thank you all for your great insight and loving attitudes.

[FlGuy]

If you are committed to do the treatment, the biopsy is not necessary.  More than anything, it is a piece of information to deceide to treat or not.  If you will no doubt and for sure pursue treatment there is really no further information that a bx will provide.