How To: Monitor Liver Function

Question

Hello All,
I have a basic question if a person is diagnosed with Mild/Moderate (F2) fibrosis of liver and has ALT levels that are normal (30) and AST (20) and he is not on any medication then how does one monitor the liver function? Assuming here Liver biopsy is already done once and now how to monitor Liver functions (is it thru blood test i.e. ALT/AST levels and if it is normal should someone still start medication?)

thanks

stef2011 · Accepted Answer

in your case is not necessary a real liver function test since the damage is little and blood tests will never detect it so early
a real measure is most useful for advanced/cirrhosis stage but all blood tests are not sensitive enough to measure liver function and when they are abnormal the damage is too advanced

during advanced fibrosis stage alt/ast can be perfectly normal despite very low function, in cirrhosis they are surprisingly normal despite hbvdna quantitity low to moderate, high liver damage and very low liver function.
the most sensitive tests used now are platlets, PT, bilirubin,ggt, albumin and some other but i stress this again during cirrhosis they can all be normal but liver function is not really normal

the most sensitive are still on trial and the most sensitive is brethtest, the same as the one for helictobacter and the same machine.
it is on trial with a high number of patients to set all the values according to the liver damage and liver function but i read at conferences that some values are set already

ono8ono · Answer

interferon lambda? Is this gonna be availalble in US or in Europe after the trial? Thank you.

stef2011 · Answer

http://www.medpagetoday.com/MeetingCoverage/AASLD/16856

as you see from the stady death by liver failure happens with normal alt, alt can be useful if monitored for a long time because if always normal for years you might suppose that liver damage or previous liver damage has recovered

it will be very interesting when they will study the other levels of liver function not only the ones close to death

stef2011 · Answer

if you have hbsag quantification available by abbott architet you might check that because if it is decreasng it means that you are clearing most of infected cells from hbv

hbvdna/alt flactuates on cronic hbv from active disease to inactive and it is very poor test to see if you are clearing or just normal cronic hbv.

the best is to wait for the new drugs and just monitor hbvdna/alt to stay low/moderate

bhagwankabanda · Answer

Hi Stefano,
Thank you so much for gr8 information, I had done my blood test in Aug 2010 and following were the results:

HEPATITIS B VIRUS DNA, PCR 
HEPATITIS B VIRUS DNA                          281412 H (REF: <29 IU/ml) 
HEPATITIS B VIRUS DNA                       1,637,818 H (REF: 169 copies/ml) 

AST                                                  29               (REF: 10-40U/L) 
ALT                                                  50                (REF: 9-60U/L) 
ALKALINE Phosphate                        34  L            (REF: 40-115 U/L) 

And then I did a test on Oct 22nd (3 months later): 

HEPATITIS B VIRUS DNA, PCR 
HEPATITIS B VIRUS DNA                          Pending 
HEPATITIS B VIRUS DNA                       Pending 

AST                                                  19               (REF: 10-40U/L) 
ALT                                                  31                (REF: 9-60U/L) 
ALKALINE Phosphate                        34  L            (REF: 40-115 U/L) 

My ALT levels have gone down from 50 (Aug 01st), then 65 (Sept 20th) and now on Oct 22nd it is 31, can someone help me with the results (I will share the DNA HepB count later when I have it).  Also during these last 3 months I have lost 10 pounds (with some excersize, etc.) Is this ALT level change more from my wieght loss?

stef2011 · Answer

if your hbvdna is not very very high you'd better wait because there are many drugs available soon that act on hbv and not only on hbvdna replication

interferon lambda which has no sides so that responders can use it for years until hbsag negative, baracludex (which blocks viral entrance)

cajim · Answer

how does one monitor the liver function?

--Blood test of ALT/AST.

 if it is normal should someone still start medication?

--Depends on who you ask.

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