ALT constantly on the high end

[Sydney2014]

Hi another question following my previous post.
My ALT was elevated to 350 as on 10th July and the specialist asked me to monitor the level for 6 weeks. Yesterday I did my first blood test after I saw him and ALT is down to 234 and AST was down from 230 to 103. I emailed him the result today but he said it was abnormal and ask when I will see him again. I know this is normal but he acted like he saw this result first time and then I email again telling him the monitoring arrangement. He said ok then keep monitoring for 6 weeks.
Apart from that, he is concerned abt my previous ALT were always on the high end 37,41,44 etc.

Question: is ALT always ing on the high end a serious issue? Ultrasound are all normal.

My husband thinks I should be on drugs right away instead of waiting for 6 weeks.

Thanks!

[Sydney2014]

Congrats! I think it will be maintained just keep monitoring. Such a good result!

[mustthinkpositive]

My treatment finished 4 weeks ago.

[mustthinkpositive]

No. The hospital I was being treated does not measure numbers, just whether it's detected or non-detected. Mine turned non-detected at week 36 of IFN.

I have developed HBV surface antibodies from IFN. Fingers crossed that it will be maintained.

[flyinsky]

tonefovir or barclude for life!!!!
this is the only way to keep our liver conditions well,and we have the chance to have such treatment and avoid the worst

[Sydney2014]

I haven't asked my specialist if they check HBSeg number in sydney. Do they check in WA?
How is your treatment going?

[mustthinkpositive]

When you have your next holiday in Singapore, you might want to test your HBsAg numbers. Not sure whether Sydney does it?

Food discomfort in Singapore is quite common so I think that is not related to your HBV.

HBV have no symptom. I got diagnosed by chance. My ALT was elevated and HBV DNA at 840 millions, so Dr started treating.

High ALT is not common. Hence if you are HBV or HCV, treatment criteria usually revolve around high ALT. Anti-viral such as TDF and ETV can knocked ALT down to normal. Peg-IFN can knocked HBV down and developed you surface antibodies. All up to your circumstances. If you have young children, then IFN would be tough due to tiredness and fatigue.

[Sydney2014]

You will be under treatment for 3 months. Can I know what treatment that is? May not be an antiviral as it will be long term
Thanks

[Sydney2014]

My viral load ranging from 400iu to 4000 in the previous years until July 2014 it raised to 200000 when my ALT was raised too to 280. 10 days later iDNA dropped to 14000 so did ALT. This all happened after I had holiday in Singapore and I had some strange stomach flu symptoms like heartburns, fullness stomach and diarrheal. Now these symptoms almost disappear, the ALT dropped again. But still high 234.

I am in sydney. I will try to do a fibrescan. Flyinsky, is the scan conclusive or you still need a biopsy after that?

Thanks.

[mustthinkpositive]

Which part of Australia? I am from WA. Where were you born? What is your HBV DNA numbers?

You are definitely a candidate for treatment because of the high ALT. What you go for is up to you. IFN could wiped out the disease but has side-effects. Anti-virals such as TDF and ETV can control them and might even knocked down your HBsAG down, like one of our posters here with his son.

In 2008, like what Stephen said, biopsy is a criteria before treatment in Australia. Not sure about now though.

[flyinsky]

hi
i think your doc should ask you to do fibroscan first then biopsy:in my case i did 2 fibroscan in period of 2 monthes
then my doc ask for monitoring and in october i will do biopy after be uder treatment for 3monthes
fibroscan is an eccelent exam at least shows if you have cirhosis or not
what about  your viral load?

[Sydney2014]

Thanks all for replying and I am going to see another specialist to get second opinion

[StephenCastlecrag]

In Australia, because antiviral treatments are subsidized by the government, a biopsy is required to conform that treatment is required. So a specialist will not prescribe treatment without a biopsy. However, I am not sure whether you can now have a fibroscan instead of a biopsy.

[Sydney2014]

Yes I am hep b since born

[mike9111]

Do you have hepatitis? Usually when alt is high it means your imune system is fighting infection and if not treated you will have scar tissue. First you need to know what type of infection before treatment

[mike9111]

Do you have hepatitis? Usually when alt is high it means your imune system is fighting infection and if not treated you will have scar tissue. First you need to know what type of infection before treatment

[Sydney2014]

I am on Australia and I vaguely remember in some patient manual that biopsy is a requirement

Also do you think alt on high end is an issue? Ultrasound in July is normal and even showed slight improvemt from 2013

[mustthinkpositive]

Hi Sydney,

Which country are you being treated? Some country require biopsy pre-treatment. I would suggest fibroscan and an ultrasound first.

And also, which treatment are the Dr suggesting?

[Sydney2014]

Email specialist again as my husband thinks I should start treatment as my ALT is always high. The specialist said yes I can start the treatment without waiting for 6 weeks but ideally do a biopsy first.

Is biopsy safe while your liver is inflamed? And is it necessary??