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.

[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!
------------------------------
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