Week 17 = Elevated Enzyme Levels

Question

My husband is on Week 17 of triple tx with INC.  He's done very well, minimal sides in the grand scheme of things.  BUT, we just got his labs back today and his enzyme levels have increased.  They haven't been in normal range the entire time on tx and had actually skyrocketed due to an allergic reaction to Allegra.  They were definitely heading int the right direction, though, and on 2/3/12 were AST 42, ALT 67.  His most recent labs, however, are now AST 69, ALT 96.  All his other numbers are excellent almost within normal on many if not most:

WBC  4.1
RBC  4.12
Hgb 13.4
Hct  382
AbN  1.6
Biluribin 0.6

Of course we'll ask our doctor about his when we see him on Friday, or before, but wanted the group's opinion about this.  Why are the enzymes coming down?

LookingForward12 · Accepted Answer

My AST/alt levels were in the normal range when I started treatment. By the third week they had increased enough to make me sit up and take notice. They have fluctuated weekly since beginning treatment and have basically stayed high with numbers similar to what you are reporting. My doctor told me that this was normal (of course, to him it seems that everything is normal and to be expected from treatment). I thinkit is the onslaught of poisons in our systems.

2mlbb · Answer

Congrats on that for sure...Good news...

can-do-man · Answer

Pop Pop, Fizz Fizz - Oh What a Relief it is....:)

Glad to hear, common here but has never been a problem... Good luck to you both.

willbb · Answer

Thats great news stormy.. Don't worry the enzymes,however he may possibly want to stop the  herbs as I mentioned .
Good luck to you both...
Will

stormy456 · Answer

Update: Doctor pushed through the PCR so got results back in 2 days, (this is why I love our doctor)  and husband is still UND!  Still not sure why enzymes are elevated, but beyond relieved that it's not the virus.   Thanks for feedback and support.

stormy456 · Answer

I think maybe he needs to stop the Marrow Plus and see how the enzymes resolve.  Of course I'll be on pins and needles awaiting the VL results.  Thanks for the reassurance everyone.

LookingForward12 · Answer

I don't think I would be nervous over your doctor's reply. It sounds as though he is really on top of things (they should all be as responsive). Note that he mentioned the supplements first. Sometimes it is not the supplement as much as it is the ingredients used to bind them, i.e. to make them into tablets.  I think I agree with willibb that if anything is suspect, it may be the marrow supplement. Do you think his hemoglobin can maintain its current course if he just forgoes that one supplement? Only seven weeks to go now for him.

Ironpony · Answer

I would suspect the tx and all the herbs before a breakthrough. My doctor really did not want me on anything else at all because he wanted less complications, if any.
          PCR will tell all...if there is enough virus to raise alt/ast then the test will certainly be able to pick it up. I'll be thinking of u two...don't upset yourself too much if you don't have too, okay? He has been doing great this whole tx and I feel like after being UND for THIS LONG it would be a very small chance that it is due to breakthrough. Hang in there..
Laura

willbb · Answer

Actually I take all these myself with my Hepa's recommendation 
----------------------------------

I don't take the "marrow plus"

willbb · Answer

Hopefully the elevated and somewhat rising enzymes is nothing to be concerned with(as is most often the case when treating) and the PCR will tell the tell definitively.

The above I would imagine has all been approved by his treating physician and for the most part these are vitamins with ALA that can help uptake glutathione. 
Actually I take all these myself with my Hepa's recommendation to  assist in possibly keeping enzymes low. Whether they are helping achieve this or not I have no prove of that ,however  still  with HCVHCV my enzymes are only slightly above normal ref. range.

But the one thing I am wondering about is this "marrow plus".

From what I understand this is full of "Chinese herbs"   and I know there are a number of herbs that can actually be injurious to the liver.(i don't know the ingredients of this)

Again..if he is taking this with the blessing of his doctor then it may be alright.

Just a thought  on a possible cause of elevated enzymes..

Will

stormy456 · Answer

vitamin D, vitamin E, vitamin b-12, he's taking Marrow Plus for the red blood cells, alpa lipoic acid, glutathione.

willbb · Answer

What supplements is he taking?

Will

stormy456 · Answer

Here is our doctor's response -now I'm nervous:

"This is concerning. I'm not sure why they remain elevated but I don't like it. Some of it may be the interferon and something called immune reconstitution. Basically the immune system rebuilding itself as it heals. Some may be his supplements as I have said before. I did another viral load to make sure that this isn't the virus talking (which should NOT be the case but I just want to be sure)."

Bali05 · Answer

If the PCR is UND and your husband has elevated enzymes it tells you
that tx is working and that the elevated enzymes are caused by something
other than the virus.There are many things that can elevate those like
meds incl. tx meds also autoimune Hepatitis. I would discuss this with your
Dr. and keep closely monitoring everything he takes.
Congratulations on having minimal sides that makes things a lot easier.

b

BoceprevirGal · Answer

What week was he undetectable? I read that these medicines are hard on the liver, and that is why the enzymes go up, during treatment....so maybe there is a build up of toxin? My ALT/AST levels were at 400 & 500 when I started treatment, then at 2 weeks, they were way down, to the 40's, and at week 4, when my virus (genotype 1) when undetected, my enzymes went down to normal. I'm only on (almost) week 7 of tx with Victrelis, and my biopsy was at a Stage 2. My platelets were low before I treated (120_ then went down to 90, ant 2 wks, and then back up to 127 at 4 weeks. So you see, there is alot of # fluctuation, with lab work~

can-do-man · Answer

Hi stormy, while i've seen this many times here while on treatment i have never seen it being a problem. Post treatment yes, but even then they are some what higher... I guess we tend to watch numbers so close these things bother us, i know i did.

If this is anything like in the past you have nothing to worry about, my goodness his HGB numbers are great for someone treating... Hang in there all is well, best to you both.