Can ALT/AST levels rise because of taking steroids for a certain period of time?

[Tom2013]

Hello my mother has been a patient of chronic hepatitis b right from her birth.She has also been a patient of anemia.For the last 1.5 years she has been on lamivudine 100 after her hbv dna crossed 86 lacs. iu/ml in 2012.So far everything has been fine,the liver enzyme levels(AST/ALT/ALP) have nearly normalized,platelet count has increased.But one day ago she underwent a blood test and found that:Sgpt=206,Sgot=131,Alk. phosphatase=88,serum bilirubin total=0.9...While alk. phosphatase and bilirubin levels have remained the same as they had been 3 months ago,the AST/ALT levels have drastically increased from 41 and 38(December 2013 reports) respectively.She has been on a steroid Danazol 50 since the last 6 months inorder to counter anaemia/thrombocytopenia.Can anyone tell me whether this steroid has resulted to the adverse effect on her sgpt/sgot levels.She is feeling completely normal now as she had been three months back...We can't guess how come these two levels have suddenly increased within such a short period of three months.    

[Thomas D Schiano, MD]

it is possible the danazol itself can cause the rise which is more likely that the steroid causing a flare.  however, lamivudine carries a very high rate of mutation formation, especially when people have been on it a long time--you should check HBV-DNA

[Thomas D Schiano, MD]

hopefully with ongoing treatment of the HBV, the spleen will gradually decrease in size and the platelets will increase.  It would take a long time as the spleen may have developed some fibrosis so may actually never normalize in size even if there is fibrosis regression in the liver.

[Tom2013]

Thanks for your reply Dr.Schiano.Actually my mother is asymptomatic but her platelet count is low(65000) right from the time when her hbv became active.Her leucocyte is also low for a long time(varies between 2500-3400).They have not risen so much even after treatment with danazol and multivitamin iron capsules.That's why we are guessing if this enlarged spleen and active hbv are responsible for such low counts?Can you give me any advice of how to deal with this enlarged spleen?Thanks in advance...

[Thomas D Schiano, MD]

i think that she is responding to treatment.  the spleen may not return to normal size for a long time.  Her kidney tests should be checked on a regular basis--if they are normal at baseline she shouldnt have any problems with this medication

[Tom2013]

After having been on entecavir 0.5 for 4 weeks her sgpt/sgot levels are 66 and 60 respectively(last month they were 206 and 131 respectively).The USG report states1)heterogeneous liver 2)enlarged spleen.Dr. Schiano, is my mother responding to treatment?Will the spleen become normal after treatment with  entecavir 0.5 for a certain period of time?Do i need to check for urea,creatinine levels while on entecavir?

[Thomas D Schiano, MD]

that is OK but sometimes there is shared resistance with lamivudine

[Tom2013]

We consulted a hepatologist who prescribed to try out entecavir 0.5 mg for 3 months with repeated LFT tests after every 1 month starting from the first dose of the same.  

[Thomas D Schiano, MD]

she has probably developed resistance to lamivudine which is not unexpected.  Entecavir is an option but i would prefer viread or truvada--this should be started ASAP.  The URSO will not help--the lamivudine is no longer working

[Tom2013]

Hello doctor,my mother's hbv dna report has arrived.Even after taking lamivudine 100 for 1.5 years her hbv dna is 1800000 iu/ml(which was 8700000 iu/ml in Aug. 2012).Will more potent drugs like entecavir/tenofovir work in decreasing the viral load?Just within a span of 3 months,the sgpt and sgot have increased so much.Don't know whether its due to the steroid or the high viral load...Any advice doctor?Should she start taking a liver supplement ursodiol 300 to reduce the alt/ast levels?

[Thomas D Schiano, MD]

ok great

[Tom2013]

Thank you Dr.Schiano for your quick response.We have already done the hbv-dna test and it's report will be available within the next 5 days....