Blood Test Correlations

[someguy13]

Dear Doctor,

I have a few questions regarding ALT levels, urine protein and IgE in relation to primary HIV infection and seroconversion.
1. How much do ALT levels generally rise, and do they rise in those with no acute symptoms or in cases of delayed seroconversion?
2. What causes the ALT levels to rise in primary hiv infection?
3. Do the ALT levels return to normal either before or after seroconversion? If so, after how much time from the exposure?
4. Is it true that IgE response to HIV peaks before IgG?
5. Does primary HIV infection cause urine in protein (+1)?

As you can probably guess, my blood and urine routine showed borderline ALT levels, high IgE and +1 protein in urine. This was about 4 months after a potential exposure. I had allergies as a teen and young adult, but I can't explain the borderline elevated ALT levels, as I am slim and athletic. I did some research and became concerned about the correlations. Thank for any clarity you can provide.

[Edward W Hook, MD]

Yes, the 4th generation test would be positive if antibodies were not present.  Antibodies would be present however if you had HIV. Take care.  EWH

[someguy13]

Thank you Doctor, I will take your advice. On a parting note, would it be correct to assume that the 4th generation test would be reactive at 3 months if antibodies were not present for whatever reason, due to that the virus would be replicating and producing antigens more or less undisturbed? From a layman's perspective, this seemed like a reasonable suspicion and I was wondering your opinion. Thanks again in advance for the advice and information, it's very helpful.  

[Edward W Hook, MD]

Your question, like those of a number of our clients represents a great example of the power of the internet not only to inform but also to mislead.  While there is much useful information available on the internet, much of it is also taken out of context or a bit unbalanced and some of it is just plain wrong.  Please believe the HIV test. Ther results are conclusive.   Lookfor some other cause for your ALT elevation.  EWH

[someguy13]

Thank you for the explanations, doctor. HIV antibody was part of the work up, as I just moved to China to start a job and they do all of this to you right when you show up. That puts me about 4 months past the exposure date, which would seem to be enough time. However, the other results and the internet concerned me and had me worried about delayed antibody production or possible coinfections, etc. etc. In the few known delayed cases of seroconversion, is there any info on prolonged (mild or otherwise) ALT elevation or the such?

[Edward W Hook, MD]

Welcome to the Forum.  One of the challenges presented to those of us who regularly take care of persons with and at risk for HIV is determining what signs and symptoms (or lab tests) help to predict the presence of HIV. This has proved to be a daunting task as throughout its course the finding of HIV are incredibly diverse and are shared by an enormous number of other conditions.  Thus while there are certain situations which steer us in the direction of recommending testing, ultimately it is the HIV antibody tests that tell the story and nothing else.  This is certainly true for liver function test s (the ALT), urine proteins and IgE antibody levels.  Each of these lab tests can be caused by a long, long list of causes, some infectious, many not.  If you have a concern or wonder about HIV the bottom line however is that you need to be tested for HIV and these other possible abnormalities are non-specific which can ONLY be interpreted in the context of your HIV test result, not the other way around.

With respect to your specific questions:
1. How much do ALT levels generally rise, and do they rise in those with no acute symptoms or in cases of delayed seroconversion?
Alts increase in some persons with early HIV but not all. when they increase the increases are not tremendous but again, variability is substantial.

2. What causes the ALT levels to rise in primary hiv infection?
Primary HIV is a systmeic viral infection which effects the entire body.  Most systemic viral infection (flu, mono, etc.) do the same thing.

3. Do the ALT levels return to normal either before or after seroconversion? If so, after how much time from the exposure?
Yes, the elevations of liver tests which occur with early HIV, when they occur, return to normal relatively quickly, within a week or two of the onset of symptoms.

4. Is it true that IgE response to HIV peaks before IgG?
I don't know the answer to this IgE responses are too non-specific to get much attention.

5. Does primary HIV infection cause urine in protein (+1)?
As above, on occasion however most people with protein in their urine have other causes.

Sorry to be so non-specific in my answer but as Itried to indicate above, the real test for HIV is not a bunch of non-specific findings such as ALTs, urine proteins and IgE levels, it is the HIV antibody test.  If you are worried get one and then believe the results you get. EWH