Best Liver labs I have ever had

[RJGCEDARS]

I just got back my 3 month lab back after treatment was ended and result was undetected. What really through me for a loop were my AST ALT counts. They  were the lowest they have ever been since I became aware of them 20 years ago. And they were normal. Why is that? Why would being off the interferon bring the enzymes into a normal range..
I am not complaining just curious
rg.

[jmjm530]

first paragraph should read in part:

( you could add size of spleen to the list and palpitation by a good hepatologist)

[jmjm530]

Redvic: If (Bilirubin, Albumin, Platelets, CBC & Prothrombin Time) are within normal limits, no liver biopsy is neccesary if sonogram & CT indicate homogenous liver echotexture.
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if this were true, many here would have been spared what you suggest are unnecessary biopsies. Unfortunately, while the labs and procedures you indicate ( you could add size explained to the list and palpitation by good hepatologist) can be very helpful in terms of diagnosing cirrhosis versus non-cirrhosis, only an actual liver biopsy can be relied on for final diagnosis, and for more exact staging.

This is not to saythat everyone absolutely needs a biopsy in all circumstances. There are instances, given both genotype, age, and projected exposure date ( not to mention geography) where a reasonable person might rely on the markers you suggest instead of biopsy.

But in general, your typical Geno one most probably should get a liver biopsy shortly after diagnosis. Alternatively, one might consider the noninvasive fibroscan test, but unfortunately it's still in trial with furry limited availability. There are also several blood marker tests like Fibrosure but they have limitations.

-- Jim

[mikesimon]

Since I am getting labs anyway they just add the Heptimax to the list. The frequency of my regular labs was originally the transplant's idea and was initiated after I got into trouble when they attempted to wean me off of all anti-rejection meds. Then I developed a bit of distrust due to that episode and the biopsy ordeal which I have never completely come to grips with. I have good veins in one arm and I have them take from my forearm and inside the crux and the back of my hand and all of my veins look really good. And I see what's going on with my blood every two weeks. I could go monthly with just an email but I would like to reduce my A/R dose soon and then I will really want to see lab results - probably weekly. The Heptimax doesn't illicit a whole lot of anxiety anymore but I have been getting them since 2004. It does seem like overkill at this point. I sometimes question whether because of my circumstances - number of treatments and length of treatment, diabetes, 2 or 3 bolus steroid injections for organ rejection and my genotype 1b - the transplant team just cannot believe that I am SVR and they like to see evidence of that frequently. If I weren't a transplant recipient I doubt any insurance company would pay for these tests. I guess in some small way it's nice to see that I am SVR every month but I could live without it easily.
Mike

[redvic56]

ALT & AST indicate only liver lrritation. The true indicators of your liver function are Bilirubin, Albumin, Platelets, CBC & Prothrombin Time. If these are within normal limits, no liver biopsy is neccesary if sonogram & CT indicate homogenous liver echotexture. The threat of exposure is not over in blood products after 1992. The truth is that after a long fight over patent rights, In 2000 the award was given to Drs. Alter & Houghton. In 2004 over 100 patents were held by Dr Chiron in 20 countries and many companies were sued for infringement. The progress is impeded by the pursuit of the almighty dollar.

[roscoe1]

Glad your doing so well. What treatment did you do and what side affects if any? Any advice while on treatment?

[zazza]

I think I might finally understand what concerns you. My last post tx AST/ALT ratio was 2.19. I am not concerned with this since I am SVR. I do not think I have cirrhosis. However if I had had this AST/ALT ratio prior to treatment I would have been concerned.

My AST was 21 and my ALT was 9.6. Couldn't be better in my opinion!

[zazza]

During tx sometimes my AST was higher, sometimes lower than my ALT. Don't think you can really read anything into these readings while we are medicating.

[zazza]

I told you we agreed. You are SVR and your AST is higher than your ALT post treatment. That is exactly what I was talking about. Do you have any liver enzyme readings prior to tx to compare with? Just curious again.

Oh, and MedHelp s c r e w e d up as always.


Excerpt from table 3 "Clues in the Evaluation of Mildly Elevated Liver Transaminase Levels":

"CLINICAL CLUE --- SUGGESTED DIAGNOSIS

Longstanding alcohol abuse --- Cirrhosis

Intravenous drug use, history of blood product transfusions, nonsterile needle exposure, AST/ALT ratio less than 1.0 --- Hepatitis B or C

Obesity, diabetes, hyperlipidemia, AST/ALT ratio less than 1.0 --- Steatosis/steatohepatitis

AST/ALT ratio greater than 2.0 --- Alcoholic liver disease, Wilson's disease"

[Trinity4]

My AST 22   ALT  18  as of  12/18
ALT is always lower too

[jmjm530]

meant" ALT is always lower"

[jmjm530]

My ALT is 14 and AST is 24. Like yourself, my ALT is always a bit higher post tx  which my doc said doesn't mean a thing given the actual numbers and my SVR status. BTW how do you handle those monthly tests? I'd be on xanax. LOL. Maybe try every two months or quarterly :) Have a happy Holidays.

Zazza, Happy Holidays to you as well!

[mikesimon]

My AST is 19 and my ALT is 14 and I know that I'm SVR because I got this month's Heptimax results yesterday. My AST is always higher than my ALT - always close to the values I posted..
So Jim, yours are the opposite - you ALT is higher?

Mike

[zazza]

Sorry for the sarcastic tone, but it is not like I am saying that the original poster is not SVR if he has an AST/ALT ratio less than 1, I just asked. Maybe I expressed myself carelessly in my first post, but I have tried to explain in a better way what I meant in my following posts. I cannot see that I have stated anything incorrect.

[zazza]

"But for the last time, you cannot draw any assumptions from the alt/ast ratio in an SVR patient with normal liver enzymes."

Oops, I guess maybe I am not SVR then after all.

[zazza]

"...but if not, just ask your doctor the signficance of the AST/ALT ratio in SVRs with normal enzymes. But again, the ALT/AST ratio is irrelevant in SVRs with normal liver enzymes. It's nada, nilche, nunca :)"

Note, that my liver enzymes were always within normal range, so I had to find other indications than just having normal liver enzymes to tell me whether I had SVR'ed or not. So since I could not get a PCR until 3 months post, it was very nice to see at 6 weeks post that my AST/ALT ratio was now greater than 1 for the first time since contracting hepatitis C. It was my first indication that I had SVR'ed. So for me not knowing I was an "SVR with normal liver enzymes", it was everything but "nada, nilche, nunca".

[jmjm530]

Jm: I only mentioned "fibrosis" because some believe you can draw assumptions there.
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Reference was to the non SVR patient with elevated enzymes.

[jmjm530]

Zazza: Considering the clinical clues I posted above, I would be happy if you would stop saying I am incorrect when you are discussing fibrosis and I am discussing clinical clues to diagnosis. We are not even discussing the same thing.
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Yes we are. I'm saying you are incorrect when discussing "clinical clues" per what the original poster stated. But for the last time, you cannot draw any assumptions from the alt/ast ratio in an SVR patient with normal liver enzymes. I only mentioned "fibrosis" because some believe you can draw assumptions there. Hopefully, anyone interested in the subject will carefully re-read both the original post, your response(s), my response(s), and come to their own conclusions. They might also ask their doctor should they have a good liver specialist.

-- Jim

[zazza]

The reason I find the AST/ALT ratio interesting is because I am curious to if it can help us unfortunate souls who have to wait for a PCR post tx, but do have the opportunity to get liver enzyme readings, to in some way get an indication of relapse or SVR. By asking someone who is SVR, I am trying to find out if in his case what was true for me, was true for him, i e as a hep C patient my AST was always lower than my ALT prior to tx but after tx my AST was higher than my ALT.

Considering the clinical clues I posted above, I would be happy if you would stop saying I am incorrect when you are discussing fibrosis and I am discussing clinical clues to diagnosis. We are not even discussing the same thing.

[zazza]

Found this to back up my statements:

"The ratio of AST to ALT has some clinical utility, but has important limitations. In many forms of acute and chronic liver injury or steatosis (fatty infiltration of the liver), the ratio is less than or equal to 1. This is particularly true in patients with hepatitis C. However, an AST/ALT ratio greater than 2 characteristically is present in alcoholic hepatitis. ...  While these ratios are suggestive of certain conditions, there is too much overlap between groups to rely on them exclusively when making a diagnosis."

Excerpt from table 3 "Clues in the Evaluation of Mildly Elevated Liver Transaminase Levels":

"CLINICAL CLUE --- SUGGESTED DIAGNOSIS

Longstanding alcohol abuse --- Cirrhosis

Intravenous drug use, history of blood product transfusions, nonsterile needle exposure, AST/ALT ratio < 1.0 --- Hepatitis B or C

Obesity, diabetes, hyperlipidemia, AST/ALT ratio  2.0 --- Alcoholic liver disease, Wilson's disease"

http://www.aafp.org/afp/20050315/1105.html

[jmjm530]

The poster was SVR.

You said to the poster, " bet your ALT is lower than your AST, right? Higher ALT than AST shows that you have an infection, for example hepatitis C, going on. And you don't any more!"

This is simply incorrect for reasons stated and nothing to "agree to disagree on". I believe Dieterich answered the same question in the Expert Forum, but if not, just ask your doctor the signficance of the AST/ALT ratio in SVRs with normal enzymes. But again, the ALT/AST ratio is irrelevant in SVRs with normal liver enzymes. It's nada, nilche, nunca :) I know what my liver specialist would say because I asked him point blank when my SVRd ALT was a bit higher than my SVRd AST.

What some believe the ratio is useful for is as an indication of liver damage (fibrosis) in those with HCV and elevated liver enzymes. That said, only a liver biopsy can be fully relied on.

[zazza]

Let's agree to disagree on this one. On some points I even think we agree. This is how I understand it. Remember I am only a layman.

If your AST/ALT ratio is less than 1 (ie your ALT is higher than your AST) and you have elevated liver enzymes, that indicates non-alcoholic liver disease, for example hepatitis C. (Realize that even with liver enzymes within normal range, they may be elevated for a hep C patient compared to his/her healthy liver enzyme readings before contracting hep C.) You will most likely see greater ALT elevations than AST elevations for the hep C patient without cirrhosis.

In chronic liver disease, for example hepatitis C, ALT is likely to be greater than AST.
In chronic liver disease, once cirrhosis is established, AST is likely to be greater than ALT.

An AST/ALT ratio greater than 2 in a patient without viral hepatitis indicates alcohol induced liver disease. The higher the ratio the greater probability that the cause is alcohol induced liver disease.

Once SVR, the AST/ALT ratio in the non-cirrhotic patient is most likely to be greater than 1 (ie AST is higher than ALT) but less than 2. But as long as one is UND, this really does not matter. I was just curious if this theory held true in RJGCedar's case.

I remember reading the study you posted to back up your statements last time this was up for discussion. I could not see anything in it that was contradictive to my thoughts. Maybe we are just talking past each other. I will see if I can find it again and get back to you.

[Kristina538]

Congrats on the UND and the LFT's will be really worthy of celebration - you must feel like a NEW person lol!!!!

For the record, I always understood ALT/AST ratio was fibrosis related, and as cirrhosis progressed AST would flip higher.    

My non-txg ALT has always been higher than AST, but both times during tx the AST went higher;  however, as Jmjm says, at low (normal) levels it makes no difference.

[jmjm530]

RJ: Enzymes tend to normalize with SVR or even with UND while on treatment.

ZAZZA: I bet your ALT is lower than your AST, right? Higher ALT than AST shows that you have an infection, for example hepatitis C, going on. And you don't any more!
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Not correct and somewhat the opposite although not that either since the ratio has nothing to do with "infection" but fibrosis.

We've had this same discussion before and what I think you're talking about is the AST/ALT ratio and where  some studies suggest it's connected with  fibrosis/cirrhosis. It has nothing to do with  "infection" as stated, and in fact it's a lower AST  that is associated with non-cirrhotics. So in that connection, higher ALT is better, not worse as you suggest.

Further, this connection -- an elevated AST/ALT ratio connected with cirrhosis -- is only meaningful *prior* to treatment when the virus is active. In post treatment SVRs, it doesn't make any differfence whether your AST is higher or lower than your ALT as long as you are UND with normal enzymes.

[geterdone]

Congrats! on the 3 month post.

jasper