Rapid increase in ALT and AST (I am in panic, please help)

[SafiSifa]

Dear Friends,

I am on Entecavir treatment for 5 months.

5 months ago
ALT: 86
HBV DNA: 557 000 000

2 months ago
ALT: 90
HBV DNA: 55 000

This Week
ALT 347
HBV DNA: not resulted yet.

As you see my ALT increased rapidly in the last 2 months. My doctor says It may be because of (1) mutation or (2) sport+eating protein. They want me to wait HBV DNA result.

Dear Stef and other friends. Please share your comments. I am in panic.

Regards.

[andrey19]

Here is an article to give you a clue of your ALT flare level:

Hepatology. 2001 Nov;34(5):1021-6.
Serum alanine aminotransferase flares during interferon treatment of chronic hepatitis B: is sustained clearance of HBV DNA dependent on levels of pretreatment viremia?
Nair S1, Perrillo RP.
Author information
Abstract
During interferon treatment of chronic hepatitis B, an alanine aminotransferase (ALT) flare may herald a sustained loss of viral replication, but the relationship between virologic response, the extent of a flare, and pretreatment hepatitis B virus (HBV) DNA level has not been defined. We retrospectively examined the impact of an ALT flare on sustained virologic response in 121 interferon-treated patients and 42 untreated controls with either low-level ( or =100 pg/mL) viremia. The degree of ALT flare was classified as mild (increase in ALT of 86-171 IU/L above baseline), moderate (increase of 172 to 343 IU/L above baseline), and severe (increase of > or =344 IU/L above baseline). Undetectable serum HBV DNA and hepatitis B e antigen (HBeAg) loss were significantly more likely at the end of follow-up in patients having a flare (P =.0001 and.001, respectively). In the high viremia group, a proportionate increase in virologic response was observed as the degree of flare increased. By multivariate analysis, high baseline HBV DNA, high pretreatment ALT, and both moderate and severe ALT flare were independently predictive of a virologic response with severe flare being the most powerful predictor for a sustained loss of serum HBV DNA (odds ratio, 5.3; P =.004). Severe flare was predictive of a virologic response in the high but not low viremia group. We conclude that a virologic response in patients with high-level viremia is dependent on the degree of ALT flare. Induction of a robust flare may enhance virologic response when high-level viremia is detected.

[SafiSifa]

Very clear description. Thank you stef

[stef2011]

the standard would be to have:
hbsag quant iu/ml
hbeag quant pei units or s/co
hbvdna iu/ml

if alt goes up and hbsag/hbvdna goes down, you are clearing

if alt goes up, hbsag and hbvdna goes up, the virus is reinfecting many cells and immuen system is trying to manage the situation but fails because both hbsag and hbvdna goes up

using hbvdna only is not extremely precise to tell but it should be more than enough on entecavir or antivirals in general (hbsag plus hbvdna is more useful on peg)

[SafiSifa]

What is your current situation?

[SafiSifa]

Dear mustthinkpositive and stef2011

It is good to see you.

I have two doctors, one is a famous professor of virology in my country, the other one is assoc. professor of virology. Both of them are from different hospitals. Believe in me that, they are not knowledgeable as much as stef2011. The assoc professor is not even be aware  of fibroscan and quantity test of hbsag.

Anyway. What I should understand from the ALT flare;

1. It is very low percentage of resistance in 5 months

2. My HBV DNA is too low to flare ALT

3. If my HBV DNA keeps the decrease, my ALT flare is good, right?


So, if my HBV DNA increase, what can the bad sign be?

Thanks a lot