liver enzymes going higher on treatment

[GOLF]

I am 53 years old and contracted Hep C 1b 35 years ago. Stage 2 fibrosis as of December 2003. I am on shot 15 of my treatment. Viral load fell from 1,700,000 to 645 as of week 10. Qualitative test on week 13 still reads positive. My problem is that my Liver enzymes have steadily risen: ALT/191,196,220,241. AST/59,63,92,109,110. GGT/237,235,239,267,409. I am negative for Autoammune Hepatitis. Has anyone heard of my rising enzyme problem during therapy, even as the viral load is dropping so much? My doctor wants to have a liver biopsy done. My platelet count is 95. I have heard that Radioligist like to have min. 100 on platelets. Does anyone feel that it is dangerous to have the biopsy? Thank you for your imput and support.

[josiejo]

I hear ya!!! I too am having the same problem.I'm at week 42. My viral load is negative and yet my AST is 77, ALT is 64, and GGT is 120. I am puzzled by this. I have good eating habits but do take sleeping pills at night. I have searched the internet regarding this subject to no avail. If anyone could shed some light I would be interested.
Joanne

[GoofyDad]

My guess is he wants to make sure they're doing more good than harm with tx. A question I would want answered. As far as safety of the procedure - I guess anything can go wrong - but no one should know better than Gish as to whether it's safe. I'd be inclined to go for it. Are they talking about supporting platelets with Neumega first? Just curious - never actually heard of anyone taking Nuemega.

[friole]

Welcome.  You are about at the same place I am - I am at shot #17.  I am a 1a, 57yof, beginning vl 1.52 million IU/ml and still positive at week 12. I have heard that the treatment itself can raise liver enzymes and that it is normal and they will come down after tx.  WHat is the purpose of the bx - to determine whether you should continue since you were still detectable at 13 weeks?  I say, keep going for it.  There are a few of us here in the same boat.  I got a 16 week PCR and am waiting for the results.  My suggestion is to keep getting PCR's until you clear so you know exactly when that is.

I do hope your question will raise up a discussion about biopsy during tx.  Healed24 is looking at the same issue right now since they determined they mixed up her pretreatment biopsy.  I have seen forum members very adamantly say that you cannot bx during tx, but I have never seen the reason.

Anybody got links?

friole

[GOLF]

I think the reason the Dr. wants the biopsy has to do with my liver enzymes going up. By the way, my doctor is Dr. Gish.

[mikesimon]

I think a biopsy is a good move. Your enzymes are troubling. You can get a biopsy while on TX. I had at least 2 of them and maybe 3 while taking interferon and ribavirin and my platelets were lower than yours are. I'd trust the doctor for now and let him check you out thoroughly. It's a positive sign that your VL is dropping but the enzymes need attention. Good luck to you. Mike

[jmjm530]

Gish has an excellent reputation as an agressive/individualized treater. I guess then that the combination of not being clear and rising enzymes is giving him pause. I agree with the Mike that as far as platelets alone are concerned, there should be no problem with a biopsy. Kalio has an interesting point on comparing pre/post tx biopsies to in-tx biopsies, but maybe Gish is looking for something else. Good luck and let us know how things work out.

-- Jim

[jmjm530]

Not sure about *rising* enzymes, but yes, I've heard of elevated enzymes during treatment with negative viral load tests.

I'd have a sit-down with your doctor and ask the reasoning behind a mid-treatment biopsy. Very unusual. A second medical opinion on this from a liver specialist (hepatologist) would be appropriate.

Please keep us updated with what you find out.

-- Jim

[GOLF]

No one has mentioned any medication for low platelets. Doctor Gish has no problem with the platelet count. The radioligist that would preform the treatment has to be willing. I was told by Dr. Gish's Nurse Practitioner that some Doctor's won't do a biopsy with platelets <100, that's what got me concerned.

[jmjm530]

Some bedtime reading on low platelets courtesy of the Cleaveland Clinc. http://www.clevelandclinicmeded.com/ccjm/april04/george.htm

[Pirategold]

What is the significance of GGT levels of "GGT/237,235,239,267,409?"  Do most people who are treating have GGT levels in this range?

I'm still so new at this, that I don't understand what the various blood results actually mean?

Pirate

[Snookmiester]

I am trying to find the article about elevation of enzymes during tx. I belive it was in projects of knowledge, but I cannot locate it on my computer. As soon as I find it, I will post.
In the article, it states elevations such as the numbers you posted above, to possibly be DRUG toxicity. The interferon itself, MAY be causing more damage. It also states causes, one being anti-viral therapy. Other possibilities are AIH, fatty diet, and recent medications. Also, household chemicals can cause elevations as well as Excercise. But those elevations would tend to be lower than the numbers you are stating.

But just so you know, my liver enzymes NEVER obtained "normal" range throuout the entirity of tx. I started at 62, and by week 2, was 128. From then on, they slowly declined, and then spiked again at week 36. I had PCR's done many, many times to confirm undetectable statis, and continued tx. By week 48, they dropped ALT 51, AST 30..
I searched the web, and racked EVERY medical board and Medical mind that would listen. Two of the greatest Hepatologist in the world, Dr Schiff, and Dr Cecil, BOTH stated that interferon, SPECIFICALLY Pegasys, CAN elevate liver enzymes. And that the elevation will not decrease, until tx is stop. 15-20% of patients who undergo combination therapy, will not obtain normal ALT levels until the discontinuation of treatment.

But listen to Dr Gish... I've read A LOT of his articles and HCV approaches to treatment. Be confident that he KNOWS, or WILL find out the cause.

[craigie]

My problem is that my Liver enzymes have steadily risen: ALT/191,196,220,241. AST/59,63,92,109,110. GGT/237,235,239,267,409. I am negative for Autoammune Hepatitis. Has anyone heard of my rising enzyme problem during therapy>>

This happened to me...I had a massive autoimmune reaction. They thought it was AIH and then they were looking at Primary Biliary Cirrhosis. The GGT is a marker for that disease and Primary Sclerosing liver disease. I also had a positive ANA and AMA.I got off the IFN and was put on Prednisone and Imuran for a year and a half. My hepatologist told me NEVER to try IFN again. That's why I am waiting for protease inhibitors. This may not be the case for you though.

[mistybean]

I have heard about this but don't know much about it.  Sounds strange and I would maybe do the bio as you don't want the treatment to hurt you.