My latest blood test result

Dear Doctor,

Would appreciate if you can comment on my latest LFT result. Does it indicate liver damage or something else?

Protein, Total : 73
Albumin: 46
Globulin: 27
Bilirubin, Total : 3 (it is indicated low, as I normally get 7-10)
Alkaline Phosphatase, Total: 67
Alanine Aminotransferase : 114 (high)
Aspartate Aminotransferase : 207 (high)
Gamma-glutamyltransferase : 28

I am Hep B carrier under lamivudine treatment. I am also recently start weight lifting training, and remember I have sore muscle during the test.

[Vaibhav Banait, MD]

Dear scaredman2010,

Thanks for your query.

From the liver function test which shows elevation of AST and ALT and the fact that you are on lamivudine, I presume that you had chronic hepatitis b.

The interpretation of your current report will require previous data from your liver function tests, HBV DNA titer, HBeAg and ultrasound report.

Do get back to me with these reports so that I can answer your question satisfactorily.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards.
Dr. Vaibhav Banait

[scaredman2010]

My previous LFT is all normal. I actually happened to test ALT four days ago before the above report. It was 42. (But I did not test AST). I tested every four months and I normally has ALT <40.

My last DNA report was one year ago, with undectable.

My HBeAg is -ve (the same time with the above report). Ultrasound report is mainly normal. But I have fatty liver, but I always have fatty liver.

Moreover, I felt great and do not any symptom yet. I really do a lot of exercise try to stay fit. Went to gym 2-3 times per week. However, also have ate more and actually surprise to find that I gain weight and fat ratio in my body.

Hope this provide your more information.  Thanks for your answer, doctor.

[phihungmd]

Thank for your query
According to the information you provide, I know you are being treated for hepatitis b chronic by lamivudine. HBV DNA undetectable, and HBeAg negative a year ago. Recently you have muscle pain so your doctor perform blood test for  you.
I see the results of AST> ALT, bilirubin is normal, and a few days ago ALT was normal .
According to my personal opinion, you can become inflamed muscle. But for sure you need to be done quantify HBV DNA to exclude case of lamivudine resistance.

[scaredman2010]

actually I am still HBeAg negative now.

[phihungmd]

Dear scaredman2010
Can you give more information on HBeAg positive or negative before using lamivudine. You have been using lamivudine for how long?
If you are HBeAg positive before taking lamivudine, now you have achieved seroconversion HBeAg. In this case I think you have an inflammation of  muscle more than lamivudine resistance.
If you have before taking lamivudine HBeAg negative, you may have chronic hepatitis B virus but HBeAg negative. In this case, you should test to quantify HBV DNA to exclude case of lamivudine resistance.

[scaredman2010]

Yes, I was HBeAg positive before taking lamivudine, archieved HBeAg negative about 2-3 years later. My doctor decided I should continue taking the med and it has been about 8 years since I started taking it.

[phihungmd]

Dear scaredman2010,
Fortunately, you have achieved HBeAg seroconversion.
According to some clinical guidelines when patients with HBeAg seroconversion to continue to take lamivudine for 12 months and consider stopping the medication. But unfortunately, lamivudine and nucleosides other control viral replication very well with variable levels of long-term durability. However, viral replication typically returns to detectable levels after nucleos(t)ide therapy is stopped, even in patients who are initially hepatitis B e antigen (HBeAg) positive but who undergo HBeAg loss and develop antibody to HBeAg (anti-HBe)—HBeAg seroconversion—or who lose hepatitis B surface antigen (HBsAg) during their treatment. Therefore, although chronic hepatitis B virus infection can be controlled with these agents, it is rarely, if ever, cured by them. The probable explanation lies with a viral form termed “covalently closed circular DNA (cccDNA),” which plays a key role in viral persistence and viral reactivation after treatment withdraw. I think you continue to take lamivudine and quantitative HBV DNA testing every 6 months to detect drug resistance.

[scaredman2010]

thanks. doctor.
Just to get back to your previous opinion, do you think it more possibility inflammed muscle? I happened to have heavy training on my leg muscles, which I haven't done too often before.

[phihungmd]

Dear scaredman2010,
As I mentioned above, I still think you have myositis.

[scaredman2010]

Thanks doctor. I sincerely hope it is the case, instead of I am starting to develop lamivudine resistance.

[phihungmd]

You should quantify HBV DNA testing every 6 months for early detection of drug resistance.

[scaredman2010]

I should let my doctor know.
They are testing my LFT, CBC, (every 3 months), and HBsAg, HBeAG (every 6 months).

[phihungmd]

Yes,you are taken care of by a good doctor !

[scaredman2010]

Hi Doctor,

Do you know why my Bilirubin is low... Is Bilirubin high bad or good?

Thanks.

[phihungmd]

As i mentioned above, u dont has hepatitis, so bilirubin is normal range. Bili high is not good.

[scaredman2010]

Thanks again, is there any explanation why Bili is so low?

[phihungmd]

Bilirubin is converted from old red blood cells die. In erythrocytes contain hemoglobin, which is degraded into heme and globin. Heme is converted to bilirubin, albumin it is transported in the blood to the liver. In the liver, usually the bilirubin conjugate (associated with) before glucuronide is excreted in bile. Bilirubin joint hoop called direct bilirubin; also unconjugated bilirubin (or bilirubin, free) is called indirect bilirubin. Total bilirubin is included the sum of indirect bilirubin and direct bilirubin.
  When the liver is damaged or broken red cell mass to be the bilirubin will increases in blood . So when the bilirubin in the blood at normal levels, it means your liver function is still good.

[scaredman2010]

Thanks...
Just curious. phihungmd, are you a doctor?

[Vaibhav Banait, MD]

Dear scaredman2010,

Technically we call a person with HBsAg positive and with normal ALT and negative HBeAg as a carrier. Normally carriers are not treated, but your doctor must be having a sound reason to put you on Lamivudine therapy. It can be chronic Hepatitis B. You should try to find with your treating doctor and provide the final diagnosis.

The recent rise in ALT & AST ( Alanine & Aspartate Aminotransferase) may indicate one or more of the following:

1. You may have developed resistance to Lamivudine which is very common. Mutation analysis may clear this opinion
2. You may be developing Non Alcoholic Steatohepatitis (NASH)
3. You may be exposed to any other infection / medicines which can rise temporarily raise the ALT. You can wait and repeat the tests following your doctor’s advice.

Hence you can speak to the treating Hepatologist / Gastroenterologist about mutation analysis / Lamivudine resistance testing. A liver biopsy is required to know the status.

Hope this information helps and hope that you will get better soon.

Best Regards.
Dr. Vaibhav Banait

[scaredman2010]

Dr. Vaibhav Banait, do you think sore muscle after weight training could be one of the reason? There were some studies showing AST/ALT elevated after worked out. Thanks!

[scaredman2010]

More information:
I just have an ultrasound, it is normal but I have fatty liver. (but I always have fatty liver, even at the time with AST/ALT normal).
Fiboscan: 4.0.