AST/ALT Indicative of SVR at EOT+8 weeks?

[mike716]

Hi, all.

I hope everyone is being treated with the new DAAs and getting cured. It's a new world out there.

I finished 12 weeks of Tx with Sovaldi + Olysio at the end of January. I'm slated for a VL at the end of April (EOT+12), but I am a nervous wreck from waiting. Also, I have to go back to Buenos Aires for the VL at my hospital there as the test is prohibitively expensive in New York if, like me, you don't have U.S. insurance. And if I'm not cured I'll have to turn right around and come back to New York again. Kind of a catch-22 situation.

But I can get a blood test including hepatic enzymes quite inexpensively here in NYC and I was thinking that maybe the results would tell me if I'm cured. Surely if I've relapsed the AST & ALT would be back up again, no? (They were around 100 before Tx and then down to 21 and 10, respectively, at week 8 on the meds.)

Anybody here have experience with this? Help will be much appreciated.

Cheers.

Mike

[mike716]

Hi, frijole bean, and thanks for your good wishes.

I was extremely lucky indeed that the DAAs came around when they did, because I couldn't have held out any longer. A year ago my AST/ALT shot way up and my platelets dropped to 80k, and a Fibrotest gave a readout of F4 (cirrhosis). I would finally have had to treat with INF/RBV if the DAAs hand't been approved. I got lucky.

Now, as you say, I'll have to see what the price is for waiting and letting the fibrosis advance. If I end up with liver cancer or portal hypertension and varices, it won't have been worth it. For now, though, my liver seems to be working okay.

Cheers.

Mike

[frijole]

Well, I had to show my face just to say, Holy Cr*p - MIke finally treated!!!!!

I don't know how many years you held out while the rest of us tried and failed and tried again, but you were always poking your head in, checking on the various treatments and fibroscans and the like.  So, I thought this was another one of those posts,  but I was all smiles when I saw that you had finally done it.

And, in the long run, I think you were right to wait as long as you did for these current meds.  As one who treated on traditional and then triple (with Victrelis) I didn't wish those side effects on anyone.

I found, like Can-do and Hector that an elevated AST and ALT after treatment was an indicator of relapse.  Mine spiked up 10 weeks post, but that was the first test I had run.

So my hearty congrats, as you seem to have succeeded.  I hope your liver was not damaged too much to recover.  With enzymes in the 100s, it would seem that there was significant damage.  Good luck to you going forward.

My best
frjiole (bean)
and a big HI to Hector and Can Do

[mike716]

Hi, Kim.

The blood test kit arrived today, so I'll do the draw on Monday and UPS it in. Pretty nervous about it, but it's better to know the truth ASAP.

M.

[mike716]

Good luck with that transplant, Hector. 15 months in, sounds like it's gonna work for you.

[Livelife777]

Hi Mike.   I'm going to approach it from a different angle which should also give you some thoughts to ponder.
I was one of the first participants  to start Sovaldi  (other then the clinical trial group) once it hit the shelves.   Because of that my Bloodwork was closely watched once the treatment was started.  Two weeks after starting Sovaldi my AST/ALT dropped 40-50 points right outta the gate.  With that correlation in mind along with the post #s it would appear that these 2 liver functions would surely be indicative of a relapse.  Therefore as mentioned even further verification that a low # would be cause for celebration.
I go along with the pack.   Ease your stress and get those values.
Personally, I think you've got it in the bag!
......Kim

[HectorSF]

Your doctor makes a good point and if you don't have health insurance, periodic viral load tests during treatment tell little. Viral test are not as important as they used to be. Which is why the hepatitis C guidelines only recommends VL testing before treatment, then at week 4 and only at week 6 or 8 if still undetectable. These tests are used to test for patient compliance they tell nothing about the odds of SVR. SVR rates are based on a patient's profile BEFORE treatment and the treatment prescribed - genotype and subtype for some, treatment experienced or not, cirrhosis or not these are the biggest factor for success. What happens with the viral load is irrelevant unless you are not taking the treatment meds consistently.

All people who treat with a DAA based treatment become undetectable on treatment and stay that way as long as they remain treating. No non-responders, viral breakthroughs, etc. like in the good "old days". All people that fail treatment do so by relapsing after finishing/stopping the treatment meds. By the way it doesn't matter when you become undetectable, week 1 or week 8 SRV rates are the same.

By now if you relapsed by week 4 I would imagine your ALT and AST would be going higher assuming you had raised levels prior to treating as can-do pointed out.

ALT and AST lab tests is a cheap way to have peace of mind. If they are still low the odds are huge you will be cured. Of course you must be prepared for bad news if by some small chance you have relapsed. But even then, why wait around for weeks not knowing? I personally would rather know one way or another. I know everyone may not.

I am okay. Cured of hep C but still dealing with post liver transplantation issues now 15 months since my transplant. I am the co-Community Leader for the Cirrhosis forum so that is where I am on MedHelp pretty much.

Take care.
Hector