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What does elevated ALT mean during treatment

Hello all,

My partners ALT levels came back elevated last week, he is currently on 1200 ribivirin and 150 pegatron/interferon, the doctor does not seem to concerned says it could be related to the dose of interferon being to high and they will just keep an eye on it.  He is on week 8 of treatment and undected at week 2 - gneotype 3
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96938 tn?1189799858
ALT / AST can be misleading indicators while on treatment, don't put any significance on  them  - only viral loads.  He has only to focus on two things while on treatment; taking the meds on time and showing up for labs.  
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Avatar universal
Thanksss F1guy that is reasurring I am easily panicked and neurotic about these test results
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96938 tn?1189799858
Mine were elevated, above normal range, during both treatments.  Second treatment worked (Geno 3 also)
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Avatar universal
RIght now the labs to watch are the viral load and CBC numbers.  As FlGuy said, ALT/AST can be misleading during tx.  They can fluctuate quite a bit.  After treatment those levels will be important to watch.  For now try to relax, he's UND and that's great!

Week 8 already - wow, he's 1/3 of the way there.  Soon this will be just a disappearing blip in your rear-view mirror.  Best of luck.

jd
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548668 tn?1394187222
Mine dipped on week 2 and 4 then started rising and didn't dip again until EOT.   The doc thought it was related either to the interferon or, he said, my thyroid which was being monitored because it was slightly hyper.    I managed SVR too (but spent a lot of time on this site looking into others who had reported elevated ALT during tx).   Well done on 8 weeks - when you look back it doesn't seem as long as looking forward :-).
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Avatar universal
I thought that aminotransferase levels were supposed to return to "normal" when the virus got knocked down during treatment?
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Avatar universal
ALT/AST often do go down during treatment and are good markers but not perfect markers as other things can influence these numbers and cause them to rise, not just liver damage from HCV.  My ALT/AST actually got higher than it had been before treatment due to going hyperthryoid during treatment and was one of the early tipoffs that I had some other issues going on.  Later in treatment they went higher again due to the introduction of antibiotics when my white counts dropped.  However I remained UND throughout and went on to SVR - even though my ALT/AST took a jump post treatment.

It's the viral load that matters most during treatment as a marker of how well the drugs are working.
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626749 tn?1256515702
While all the above comments are correct, it also depends on the amount the alt increases. Smaller increases are very normal on tx.
You don’t mention any exact numbers.

My alt was 400 before tx. After 2 weeks it was almost at normal levels. 4 weeks into tx was und with normal alt. After tx my 'normal levels' even went down more into the teens.

There was some concern for me of auto immune hep because of high smooth muscle and high ANA blood work. My Hepatologist went on to say if your alt goes up we might be going in the wrong direction.
If your alt is 2,3,4 or more times over normal levels before tx,  and on tx doubles up or goes up considerably, then it might be time for an autoimmune hep test from a bx.

What I am saying is, if your alt is something like 400 before tx and on tx goes up to 600 or more, then its time to look for a problem.

jmo
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Avatar universal
Agreed and good point.  When I saw my ALT/AST going up, that was my concern, AIH - autoimmune hepatitis.  Turned out to be hyperthyroid instead but since that is an autoimmune disease, kept watching from that point forward keeping AIH in mind as one increases the risk of additional.

Excellent point.
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