High Level of AST & ALT

[Raj185]

Hi,

I'm 29 years Male with chronic Hep B. My HBV DNA levels 2 years back was around 157,000 IU/ML and ALT, AST where under normal limits. Doctor suggested to start the medication with 0.5 mg of entacavir as the DNA levels werr high . Since then my DNA level has reduced to  less than 100 IU/ML for the past 2 years. Also my ALT/AST levels were normal for the same period, but when i got these checked again last month they were high AST -44 U/L ALT -111 U/L. My doctor said that Hep B is not the cause for these high levels of ALT/AST. so he suggested few more tests Lipid profile, ANA-IF,Ferritin and ceruloplasmin. In Lipid profile only HDL cholesterol was low 23 (less< 40) and CHOL/HDL Ratio was high 4.8, ANA was negative, Ferritin was 178.2 ng/mL (range 22 - 322 ng/mL) was normal, ceruloplasmin was normal 0.23 g/L (Rangel 0.2-0.6 g/L).

I don't understand what is the cause for my ALT, AST to be high. Please help.

Thanks
Raj

[SafiSifa]

See how I am cured


See my results: http://www.medhelp.org/posts/Hepatitis-B/My-All-Test-Result-After-12-Months-Treatment-of-Entecavir-I-am-cured/show/2355051

See my story: http://www.medhelp.org/posts/Hepatitis-B/Urgent-Advise-for-Entecavir-Usage/show/2044528

[stef2011]

by the way mine was 106pg/ml when vitd25oh around 90ng/ml.my resistance is so strong that the only way to lower pth was 150.000iu daily but this needs diet and expert doctor monitoring.hope you dont have such strong resistance as me

[stef2011]

unless pth gets to 14pg/ml when vitd25oh is 100ng/ml, you are still severely deficient
that high pth points to vdr resistance, what is vitd25oh level when you had pth 92pg/ml?

if you want to help peg response this is very important because i saw this on myself too

Doctor told that pth could for other reasons also.

no it must go down if you are fully sufficient on vitd

[Raj185]

Yes, I'm Hbeag Positive and Hbeab Negative

[Raj185]

Yes, I was Vit d3 deficient so I increased my Vit D3 to a sufficient level before i could start the PegIntf and also checked Pth which was slightly on higher side( 92 pg/ml. standard range is14-72). Doctor told that pth could for other reasons also.

[stef2011]

are you also supplementing vit d3 and checking both vitd25oh and intact parathormone?

[stef2011]

i'd suggest to wait 24weeks if you are not having bad sides, are you hbeag positive?

to say peg is working we need at least 0.5-1log decline, in your case 1log decline is less than 10.000iu/ml, best response would be 1000iu/ml

i also think you are not responding to lower or clear hbsag but since hbvdna is und and alt is high i d wait and see what happens between 12 and 24 weeks

[Raj185]

Hi Stef,

My Hbsaq levels is ranging from 16k to 34K IU/ml

HBsAg Quantitative(CMIA)
26/12/14 - 34268 IU/ml
20/02/15 - 16066 IU/ml
03/03/15 -  27602 IU/ml
09/04/15 - 31029 IU/ml

At the start of my pegIntf it was 34K and recent ones is 31K, my doctors suggests to continue with pegIntf only if the Hbsag levels decreases.

He said he is going to access the difference only after 12 weeks, currently 4 more weeks are pending to complete 12 weeks and after that he would suggest whether to continue or not.

With so much fluctuating results , how much difference in hbsag levels from the initial reading should be there to continue with the pegIntf.

I also read on the other threads and some research papers that PegIntf is more effective only if the Hbsag levels are under 1000 IU/ml or low Hbsag, so my question is how does one figure out whether pegintf is having any effect or not on me and what indicators to consider here.

My HBV DNA is still undetected and Both ALT and AST are still high.

[stef2011]

change doctor, not expert

hbsag baseline, 12 weeks, 24weeks and 48weeks

[Raj185]

hi Stef ,

How often do you do the HBV DNA quantitative and hbsag quantitative when you are one pegint considering that I have started just 3 weeks ago.

My docto suggests to look at th wbc count only

[Raj185]

Thanks stef. Will keep you posted on the progress.

[stef2011]

Lighter or no fever at all

[Raj185]

I know that he is treating lot of guys on pegintf. But not sure why he did not mention that.

Yes, he told me to get complete blood count(CBC) test before the next dose.

Just from your experience. Does the 2nd dose will have similar effect or will it be a bit lighter.

[stef2011]

His sounds very unexpert of peg, the first inections have heavy flu effects on almost all and paracetamol is given before the injection.....you are lucky you were strong enough to stand that
after 1 to 3 days fever goes away so if it is low fever now dont take paracetamol

you also habe to make blood tests during therapy, thyroid, blood counts etc did doctor mentioned that?it is also mentioned on pegintf box or instructions

[Raj185]

No doctor did not mention that, but i did ask him about the side effects and he mentioned there would be some mild side effects. I forgot to ask him what to do in severe cases.

But now it has settled down, but still have slight fever. I did not take any paracetemol as of now.

Also my fibroscan results came, result is 4.1 E(Kpa) with 2.4 as IQR and   149 CAP(dB/m) with IQR 76. Device was 502TOUCH F60077 and Proble M7 70318. There were a total of 12 readings and 5 of them where in the range of 5-7Kpa.

[stef2011]

Didn t the doctor advise on paracetamol before the injection?

you sshould have taken paracetamol, the first injections are like a very strong flu and the best thing is take it one hour before the injection and then if the fever is very strong take it again when you feel paracetamol is losing its effect

[sorte]

Stef, I was told if I had to use painkillers someday for any reason I should not to use paracetamol but ibuprofen, because it's safer for the liver.

[Raj185]

i also have severe headache with vomiting.

How do control this. It has become unbearable.

Not able to sleep in the night

[stef2011]

Yes it is normal for the first few days, on hcv the higher the fever the better the responce to peg, maybe for hbv too

i had 3 days of fever 39.5 i had to use a lot of paracetamol, then it lessened to only 37-37.5 few times after injection.

the fever  goes away after the first few weeks for almost all patients

[Raj185]

hi Stef

I have started my pegintf 2alpha +entacavir treatment from today.

I'm experiencing high fever.  is it normal to experience this

Thanks

[stef2011]

yes it is normal that it goes up and down, it is best to test every 24 weeks like for pegintf to have a clear picture

it is not vit d because it requires months to get stable.results, good or bad, from vit d can be seen after levels are stable with intact pth 10-20pg/ml (when normal range of the lab is 10-80pg/ml) for at least 6 months.i dont indicate vitd25oh because it is different person to person to make pth that low

if pth does not reach that low there is vit d deficiency whatever the vitd25oh results are

[Raj185]

Hi Stef,

I recently got the Hbsag Quantitative test done.

HBsAg Quantitative(CMIA)
26/12/14 - 34268 IU/ml
20/02/15 - 16066 IU/ml
03/03/15 -  27602 IU/ml

I see lot of variation in the results, is it normal. I get the tests done from the same lab and only thing that changed between 2nd and 3rd report is that I started taking Vit D tablets.

Let me you what you feel about this. HBV DNA was undetected recently.

[stef2011]

vit k 2 mk7 at least 90mcg

[stef2011]

vit d must be taken daily, weekly not studied and monthly only worsening health