EOT blood work, elevated enzymes, does this mean relapse?

[mrlhudson]

Hello All-

New to the forum and looking for some insight. Feeling just awful at the moment, just received bad news.

My husband had 12 week harvoni treatment, he is genotype 1a, treatment naive. Before treatment he had a viral load under a million and normal ast, alt. During Harvoni treatment he was  at 0 virus detected. 

He had his 12 week end of treatment blood panel. So far his enzymes are elevated.

An RN in the office said if she were a betting type of person she would bet he relapsed.

Is this a good bet?  Anyone with similar results?

(And believe I am appalled with her blase choice of words when talking about my husband's health. It's no game for us.)

Hoping for hope but would like to be prepared for the truth,
Michele

[beto]

mrl,

You will get a lot of good posts on this from the informed gang here.  The nurse who commented is off the charts insensitive.  Were the enzymes elevated to the pretreatment levels?  Or only slightly.  Also, where ALT/AST were pretreatment is good info.  Please be aware that many things can blast up the enzymes and on this very forum, there have been folks who had elevations EOT that turned out to be from other things.  If I was a betting person I'd expect that something else is the culprit because of the extremely high cure rate of these meds.  Anyway all moot until the VL comes back which unfortunately you have to wait for.  If, god forbid it is bad news, there are other drug down the pike and available now that have dramatic results for those few that did not clear the virus the 1st time.  Hang in there and let this forum support you.

[dragonslayer]

Now, we have nurses betting on a bloodtest result?   Unbelievable.. Did his test not include a viral load?

[mrlhudson]

Beto and Dragonslayer thank you for your kind words and reply. Not many understand that awful feeling while waiting for test results.

My H's AST/ALT numbers have been mostly in the 40s, sometimes mid 50s. He has had Hep C most likely since the 80s.

Jan 2010 AST 41 ALT 52

April 2016 AST 37 ALT 56

May ALT 66 ALT 42

TREATMENT June

End of first month on treatment= ALT 37 AST 30
Viral Load Undetected

Today, 1 month post treatment
AST 45 ALT 47
Waiting for viral load. Waiting. Tomorrow, Friday or Monday.


Your kind words (and a little meditation) are making this easier.

Thank you,
MRL

[dragonslayer]

>>End of first month on treatment= ALT 37 AST 30
Viral Load Undetected

Today, 1 month post treatment
AST 45 ALT 47<<

MRL,  Im not a doctor, however that doesnt seem like a huge increase.
  AST and ALT values fluctuate.   From what you say, he never had very high numbers.  Try and remain calm til the viral load numbers come in in a few days, and report back here when they do.  My guess is youll be able to approach that nurse and ask to collect!

[mrlhudson]

Yep, you are right. Compartmentalizing this is the only way through-- with grace and the kindness of strangers, we'll wait.  Thank you for your reply, it is so kind to do so.

[beto]

So...I'm not a Dr. either of course.  Over exercising alone can raise enzymes.  High iron or, high ferritin can raise them.  Other tissues in the body like heart and kidney can produce higher levels under some circumstances. Alcohol of course but also, diet. Environmental toxins etc...the list goes on.  Get the viral load and if it were me, I would let the presumptuous nurse know that he/she can take the bets to the races  .  Good luck.  Pulling for you.

[dragonslayerinprogress]

I just got my lab results in pot treatment 8 weeks.
My ALT is up at 38 and AST is 50. Both have risen 6-8 points since my 4 week test. Platelets dropped to 49 (insert huge sigh here)
Viral load is still undetected so, that is good news and betting your husband's will be the same.

[KimInTheForest]

My AST/ALT were elevated above normal shortly after treatment even though they had dropped to normal while on treatment. And I was still cured. Just had my SVR 1-year last month. As others before me have said, many things can cause liver enzymes to rise in blood - not just Hep C. I think it is quite unlikely that your husband has relapsed. That nurse is unbelievable making a comment like that.

kim

[Lynn K]

When I was treated with Sovaldi and olysio for 12 weeks my alt and ast were in normal range for the first time in decades and my viral load was not detected at EOT. ALT 78 AST 54 before any treatment. Twelve weeks after I finished treatment I got my alt and ast back before my viral load. Unfortunately my alt had risen to above normal range ALT 56 and when I got my viral load back a few days later it did show I had relapsed.

I treated again with Harvoni for 24 weeks along with ribavirin for 15 weeks.  ALT 20 AST  22 on treatment. When I finished treatment my alt and ast did go up a little ALT 29 AST 27 but were still in normal range. This time I was still not detected and I was still not detected at 24 weeks and 44 weeks.

As was said there are many things that can raise ALT and AST and that nurse wins for most insensitive nurse of the year award.

As your husband was treatment naïve and had a low viral load 12 weeks of treatment of treatment has a very high success rate I would be very surprised he relapsed.
 
We are all pulling for you and your husband that he is still not detected. You should know in a few more days.

Even if he did relapse there are other treatments out there please no matter what don't give up and don't give in keep fighting.my best to you both.

[mrlhudson]

Before any further results come in, please know my husband and I thank you-- for your kindness, for giving us peace.

[Baxter]

I would report that nurse. She has no business working with the public.

[mrlhudson]

My husband's Viral Load test came back UNDETECTED.

Thank you, thank you. This forum was the only place where people understood just how tense an experience. October 31 is the 12 week test! I have such hope! Thank you.

This goes to show don't listen to people, healthcare workers or otherwise, who make off hand comments without true analysis of the data available (for a professional that's called malpractice). Good grief the despair that nurse caused.

 Thank you again for your comments - to know that others had elevated enzymes post treatment or had heard of it before was a relief.

MRL

[Lynn K]

Thanks so much for letting us know and CONGRATS!!!!!!!

Yay hooray whoopie!!!!!!!

Jumping up and down for you both

[beto]

You might want to tell the nurse to "not" buy a lottery ticket and stay the heck away from Vegas...tehe 

[Mila]

mrlhudson~

My AST & ALT went up slightly too. I've been off for almost 3 weeks.
Unless his blood work comes back with a viral count, not detected is not detected. I don't think it would be abnormal for those numbers to fluctuate after what our bodies have been through pre, during and post Harvoni. Sometimes the body needs time to re-regulate itself. Plus in my experience those numbers fluctuate on people who have never been infected.

Not an expert, but lived through the 12 weeks & the 30 years prior.

I notice some peoples AST/ALT numbers went way down and I wondered why mine did not. They went down and are in a good range and I have no viral count so undetected is undetected.

I hope your hubbies number come in at 0.
~Mila