ALT increasing but DNA Stable

[twinboys1girl4me]

Hello,

It's been a while since I've been on the board.  I am an almost 44 year old female that has had HBV since birth.  I'm e-antigen negative.  I've had monitoring for the past almost 20 + years.  My labs have been checked every 3-6 months, with ultrasound and MRI alternating every 6 months.  

My ALT's have consistently always been in the 20's, with the occasional very low 30's.  In the past 6 months my ALT has gone up to the middle 30's, and last week had labs again and my ALT now is 43.  I know the numbers are not horrible, but they are not normal for me either.  I met with my liver specialist today and she thinks it's time to start treatment, since there is no other reason we can attribute the ALT increasing to.  

What I don't understand is why the ALT seems to be slowly increasing but my viral load is not (viral load fluctuates between 300-800 iu).  Last week my viral load was in the low 300's, so on lower end of normal for me, even though ALT went up.  

My question is, can the ALT increase be attributed to the virus, even though the DNA is staying within my normal range for me?  She is wanting me to start with the new Vimledy but it already looks like my insurance is going to give me issues and require me to start on Viread.  The insurance said the only way they will pay for Vimledy is if I fail Viread.  I hate to start treatment if the ALT is not attributed to the virus, but at this point she said going on treatment will mean that it's one less thing that we can possibly attribute to the rise in ALT.  If ALT stays as is on treatment I don't know what they would even do, since I am thin, eat super healthy, work out regularly, do not drink or smoke, etc.  

Thank you for any and all help!

[yasint]

Hi,
Well for me, its strange, its been more than 7 years when i got to know of my hepatitis; since then my ALT are above 40 even to 50s but yet DNA level less than 100 or undectable.

My father and my brother, they are tested neg for hep b and living wonderful life;yet higher ALTs.  Its may be family part. I heard of people are proactive sexually might have hight ALTs in case.. i dont know

[StephenCastlecrag]

I agree with you that there is not enough indication to start treatment. First of all, ALT can be elevated due to strenuous exercise, together with rise in your AST. Your viral load remains below 2,000 iu/ml. According to guidelines, with ALT greater than  2 x UNL and hbvdna below 2,000 iu/ml, treatment decision should consider state of your liver and your fibrosis score. Since you do not have significant fibrosis (less than F2), treatment can wait.
If you do start treatment, there is no reason to go on Vemlidy, Entecavir and Viread are equally good unless you have proven kidney issues.

[Royal36]

Twinboys1girl4me when the Alt starting to raise may be your immunity is fight back the virus to clear it. Finger crossed!

[twinboys1girl4me]

I've also had 2 biopsies, both good and last one in 2014.  I've also had 2 fibroscans.  2015 was 3.7 kpa and 2016 was 4.3 kpa.  Doctor said the slight change was an insignificant finding.

[hepbcurepls]

hi Twinboys1girl4me its been a long time and I am glad your back. I remember when I tested my ALT in 2010 it was low and dna was low and in 2012 when my dna lvl started rising my alt went up first to 40's and then my dna went up in the range from non detectable to 500 and when my alt hit 60s my dna was 5000.  My blood testing was inconsistent at those times only checking once every few years but the difference was seen in the alt and dna between those 2 years.

[Liverpatient]

I think there is a correlation between ALT and hbv dna. Last year my hbv dna wa 2700, and ALT was 40. This year the hbv dna has decreased to 1100, and the ALT to 27.