Elevated ALT + Abdominal pains: Are my days now numbered?

[Dimidine]

The rate at which these figures are rising is worrying, yet Doctors here are saying all is well. I have been having mild pains around the lower right abdomen sinec February. I keep complaining every month to Drs, but they keep saying all is well, yet these figures are rising. In fact, a time came when I wanted to start using Lamivudine myself, but I cautioned myself against self-medication. Now I don't trust these Doctors again. This ALT figure is elevated. The pain in the abdomen is not as mild as it used to be months ago, getting a little more discomforting, though not affecting my daily activities. I have read cases of people being assured by Drs that all was well until they were diagnosed of Liver Cancer. I don't want to take chance again. These figures are rising, I have never been placed on any treatment. Are these Doctors waiting for it to get worse before they start treatment? Although USS and CT Scan are still showing normal organs, I'm seriously worried. Is this pain not what will lead to liver cancer? I'm afraid. Guys, pls advise me. I'm from and in Nigeria.

Here is my LFT trend:  

NOVEMBER 26, 2010
AST                                     32 U/L
ALT                                      46 U/L
ALK PHOS                           55 U/L
GGT                                     32 U/L



SEPTEMBER 2010
AST                                      24 U/L
ALT                                      33 U/L
ALK PHOSPHATE                 45 U/L
GGT                                     23 U/L


JULY 2010
AST   18 IU/L
ALT   17.2 IU/L
GGT   24 IU/L
ALK. PHOS. 45 IU/L



APRIL 2010
AST  41 IU/L
ALT  19 IU/L
GGT   31 IU/L
ALK. PHOS. 20

FEBRUARY 2010
AST   27 IU/L
ALT   39 IU/L
GGT   39 IU/L
ALK. PHOS. 44


HISTORY: Diagnosed Hep B positive October 2009
HEPATITIS B VIRUS  TEST                       RESULT     REFERENCE RANGE          
HBsAb                                                             0        mIU/ml
HBEag                                                    Negative
HBEab                                                    Positive
Hepatitis B core IgM Ab                            Negative

HBV DNA as @ May 29, 2010: 20,682 copies/ml

I have not been on any drugs, but takes plenty fruits and vegetables.

[JoieTan]

If your ALT / AST stay low and no liver damage detectable from fibroscan, then you dont need to worry
I understand that the Hepatitis B vaccine wont have any negative effect if previously you have Hepatitis B.

The fear usually comes from not understanding how the disease work. And doctors tend to scare us rather than educate us. But that does not mean we can be ignorant of the disease. Once you understand and read alot from this forum, you'll calm down and start planning a better lifestyle to manage the hepatitis.

Some doctors at Indonesia suggest to have your future babies from Hepatitis B mother to be vaccinated immediately (may be within 24 hour after born)

Stay calm and focus =)

[joc2011]

Hi People i dey Naija too. Inbox me ur number and i will give you a call

[Dimidine]

If you dont mind, you can call me on phone. Check your inbox for my mobile.

[mee79]

Its 77K..i did it about and hr ago.
Im hsag+, hbcore total +,igm -,hb e antigen -, alt 14, ast, 18...i havnt done the ultra scan yet..
Last october 2010.my bf took me to a lab for a general blood work..hsag was non reactive (even though i didnt know what hep was)..on feb 2011 some healthcare workers came to my office and insist we get hep vaccine..they gave us a shot without a pre test and they promised to come back after a month..they didnt show up until july 2011 for the 2nd shot..this time around they took blood samples and i tested positve..i panicked n went to lab for a confirmatory test n it came back positive..the doctor @ the lab told me not worry bout it .and that i shud just make sure i check hbeag every 6 months.i wasnt convinced so i went to a hospital and i was asked to do the test again including hiv and hcv (hiv n hcv came -). the doc asked my bf to do d same test (all came -) he was vaccinated instantly.thats how i found myself in this forum..im 32..im planing to get hitched by december..but with my current situation  i dont know my fate.i dont know how  i contracted it and for how long..it makes me to think that the first test i did was unreliable.i dont even know who to confide in cos im scared of bein stigmatised.my confidant is GOD!!!the only ONE  i cry to everynite !!(

[mee79]

Its 77K..i did it about and hr ago.
Im hsag+, hbcore total +,igm -,hb e antigen -, alt 14, ast, 18...i havnt done the ultra scan yet..
Last october 2010.my bf took me to a lab for a general blood work..hsag was non reactive (even though i didnt know what hep was)..on feb 2011 some healthcare workers came to my office and insist we get hep vaccine..they gave us a shot without a pre test and they promised to come back after a month..they didnt show up until july 2011 for the 2nd shot..this time around they took blood samples and i tested positve..i panicked n went to lab for a confirmatory test n it came back positive..the doctor @ the lab told me not worry bout it .and that i shud just make sure i check hbeag every 6 months.i wasnt convinced so i went to a hospital and i was asked to do the test again including hiv and hcv (hiv n hcv came -). the doc asked my bf to do d same test (all came -) he was vaccinated instantly.thats how i found myself in this forum..im 32..im planing to get hitched by december..but with my current situation  i dont know my fate.i dont know how  i contracted it and for how long..it makes me to think that the first test i did was unreliable.i dont even know who to confide in cos im scared of bein stigmatised.my confidant is GOD!!!the only ONE  i cry to everynite !!(

[Dimidine]

Yeah, I do do my HBV DNA in  Pathcare(Lagos) too. It's even 77k here. I have done twice there.
The first one I did was at NIMR Yaba but I'm not so confident about them and it takes longer time before results out too, although it's far cheaper.

My HBV DNA has been falling successively, and I've not been on any anti-viral.
3500 IU in May 2010; 2500 in December 2010; 992 in June 2011.

I was also stiff scared when I was diagnosed in Oct 2009, since then I have run to this forum and I have gained extensively from advice here, even more than doctors I have visited in Nigeria.

My ALT has been fluctuating, once reached 46 in Nov 2010 and began to drop, now 19(July 2011).


I have been experiencing mild pains in my right abdominal region since Feb 2010 and ultra sound later revealed enlarged liver in June 2011, and as advised by Stef, I have shipped a drug called Heptech products(hepatitiestechnologies) from USA through my friend there. It costs about $300 and my friend in US helped buy it and sent it to me in Naija thru his family coming back to Naija. I'm on that drug now, and Stef assured that it should be able to relieve my pains and normalize my enlarged liver.

Anyway, I have moved on in life and continue the battle. I have been battling it for 2 years now and spent 500k to date in regular monitoring(regular lab tests, LFTs, Ultra scans, CT Scan once, viral loads, hbsag quanitification, etc plus the cost of Heptech).

Do you work?
How old are you?

[mee79]

Naija o ni baje o...i thot im the only one in naija fighting this battle lol..i got to know my status recently and it has been so traumatic for me..the world is crashing before my very eye..ive not been having pains yet but what i feel is more than that..anxiety attacks, head throbbing, insomnia, chills to  mention but a few..im having my hbv.dna done tomorrow @ pathcare (o boy it cost 75k to do that).yeah stef is a blessing to this forum...i pray GOd to heal him just like everyone eles...i think fibro scan can only be done outside naija..our healthcare is really meSsed up..May God see us through

[Dimidine]

I be omo Naija o.
Fibroscan is not available in Nigeria.

You can start by checking via abdominal Ultra sound scan, but the limit is it may not reveal damage at early stage, like fibroscan, but it still should be able to reveal liver enlargement(I did mine in Mecure, Oshodi, Lagos), which can be reversed before serious damage.

Have you been feeling pains in your right abdomen?

This forum will be useful to you, especially the member stef2011.

Just keep following this forum and seeking advice here.

[mee79]

Are u naija? I have a similar problem too.. I dont know where to get fibroscan..i was diagnosed hbsag + 3weeks ago ..i live in abj and i dont know where to get a good hepatologist.. ..im scared ********

[mee79]

Are u naija? I have a similar problem too.. I dont know where to get fibroscan..i was diagnosed hbsag + ..im scared ********

[Dimidine]

That response was golden!!!!
I'll speak with Doctors here on how to go about Fibroscan or Biopsy.

[stef2011]

My latest HBV DNA is 15,000 copies/ml and alt 27

these flactuation are normal on cronic hbv but the most important test is liver damage by fibroscan or biopsy that you haven t done.liver damage is the key to choose if therapy is needed or not

Can anyone help explain this, especially the lowering ALT and DNA?
no meaning in terms of virus infection.the liver damage is very little or none with hbvdna and alt so low, but we know you are not having damage now, we don t know if you have accumulated damage in the past....

most of cronic hbv carriers have normal alt and hbvdna und with flactuation from time to time, the percentage with continuous active replication is very low, unfortunately itmight be most of us in the board since all others probably don t worry about it

do check your liver damage and if possible hbsag quantity which might tell us how the infection is going-also follow our results with alinia and with interferon combos with hbv eradication

at 99% you don t need any therapy and don t have any damage to the liver to worry about but we cannot say 100% unless a fibroscan or biopsy is made, at least one check in 5 years

[Dimidine]

My latest HBV DNA is 15,000 copies/ml, 5,000 lower than the one I did six months ago, although from different lab. My ALT has also reduced from 46 last month to 27 today.

I ahve not been on any drug, only using what is called Essential Forte which Dr told helps protect liver.

Can anyone help explain this, especially the lowering ALT and DNA?

Thanks

[chanthou]

Don't rush to treatment. Stefano suggested you take fobroscan that is good. If fibroscan shows your liver good, then there is nothing to worry. ALT at this level is not high though out of range.

[Dimidine]

Sorry, HBV DNA last time was 20,682 copies/ml, not 35,000. Forgot, but just confirmed now.

[Dimidine]

1, I don't drink alcohol, so the rising ALT appears to be from HBV activities. Around what figure does ALT correspond to Liver damage? Remember 46 is out of range(0-40)

2, What is Cirrhosis regression pls? I have done HBV DNA and still expecting result. The last time it was 35,000 copies/ml

Sorry for my too much questions pls. I'm naive.

[stef2011]

But is this rising ALT not a cause for worry?
no it is nothing, when people drinks alcool alt gets much higher than 40......., liver damage on such low alt is very very rare

you only have to worry about hbvdna level, you can have cirrhosis regression even if alt is more than 40

[Dimidine]

Thanks very much with this. But is this rising ALT not a cause for worry? Especially since I hear it bears relationship with liver damage? Is this how it will continue to rise?

[stef2011]

you are perfectly alright, the pains are due to little enlarged liver that pushes on other organs but it is not clinically relevant.being very thin and low whieght helps to avoid these pains

it is not possible to say 100% that you have no fibrosis without a fibroscan or biopsy but if you have had alt lower than 40 for many years it is extremely rare to have liver damage (although not impossible)

in your situation you might try the following:

monitor veery 3-6 motnhs

nitazoxanide 1.5-2g daily (alinia) and see if hbvdna and hbsag get lower in 6-12 months, if you have diarrea take probiotics

strongly not suggested for now because disease activity is very low but a good option anyway:
ntz+interferon, but interferon is expensive and might have sides
ntz+tenofovir (kidneys function monitored)


not suggested now and ever:
all other drugs like lamivudine, adefovir, telbivudine must not be used absolutely because they make hbv mutants and worsen disease

[Dimidine]

Also, can an elevated ALT be brought down? What can bring it down? Please help with candid advice.

Thanks very much.