New here - Enzymes elevated 8 weeks on Epclusa

[Ella]

Hi there,

I've been lurking on this forum since I was diagnosed with HCV in May 2017. I started Epclusa September 1st. Some basics:

Pretreatment:
Genotype 3A
Fibrosure F1-F2 (on the cusp of F1)
VL 2.8M
ALT 93
AST 76

After 4 weeks on meds (Oct 2):
VL Not done
ALT 29
AST 20
All else normal.

After 8 weeks:
VL <15 IU/ml DETECTED
ALT 58 (6-29)
AST 36 (10-35)
All else normal.

I freaked out when I got these results and assumed I was failing treatment, but then I came here and read about dragonslayer's and Lucinda's experiences with viral load among others, and that reassured me that during treatment viral load means little. So I feel better about that.

I am concerned about my enzymes being up, though, and I haven't seen any discussions here about that. I assumed I'd hear from my doctor's office (they are impossible to get a hold of), but haven't after a week.

I've taken the position that if they were concerned, I would have heard from them, and maybe the elevated enzymes are no big deal. I was prescribed Zofran for nausea (I've had a rough ride), and took ibuprofen for a week due to severe body pain (a preexisting, recurring issue).

I haven't seen much discussion about enzymes being elevated, except that it is uncommon, but I did see monitoring guidelines suggesting that if the enzyme elevations were less than 10 fold and asymptomatic, discontinuation is not required. That does suggest it sometimes happens. All my other lab tests were normal, and I feel fine. In fact, the side effects have finally gone away except for exhaustion, and I had that pretreatment.

What do you think? Have you had other forum posters with elevated enzymes?

Also, thank you all so much for your kind attention to this great forum! It's such a comfort to have you here!

[gnatcatcher]

Welcome, Ella. The enzymes are lower than before treatment, and temporary elevations can be caused by many things, including pain medicines. I don't know what the normal range is at your lab, but the current AST is probably within its range and the ALT just a tad over its range. Your VL is much lower than before treatment and is almost undetectable. Chances are, there's no problem. Presumably, you'll be tested again after 12 weeks. If the AST and ALT aren't the same as or lower than now, it might help your doctor to know exactly when you took the ibuprofen and if you had irritable bowels around the time of the elevation. (Those were two temporary liver enzyme elevators mentioned by the Mayo Clinic.)

Best wishes with the rest of your treatment,

Gnatty

[Ella]

Thank you, Gnatty. I went back and edited my original post to add the lab ranges.

The range for ALT is 6-29, and the range for AST is 10-35.

I didn't know about the irritable bowel being a potential cause for elevated enzymes.  I got terrible constipation from the Zofran and had a hard time getting that settled. D: I went off the Zofran, but I've had gas ever since. Maybe I'll get some Activia. When I first started treatment, I got diarrhea, and Activia fixed that so....

I don't have labs scheduled for end of treatment, but I do have an office visit then, so I'll talk to the nurse about getting another CMP. They aren't planning to do another viral load until 12 weeks after end of treatment, and that is fine with me.

Thanks again!

[gnatcatcher]

Ella, even with those normal ranges (which are much lower than at the labs I go to), the AST is near-normal and the ALT is only double, plus in your case the rises have a plausible explanation. Have a great weekend.

[Ella]

Hi Gnatty,

So I got an EOT (+ 5 days) Viral Load and Fibrosure test.

Fibrosure F0-F1 (down from F1-F2)
VL NOT DETECTED
ALT 32 (6-29)

Whee! Now I just need it to stick!

~Ella

[gnatcatcher]

Yay, Ella! That's great not only about the undetected but that your F score has gone down already. As for the ALT, when classical musicians tune up, at some point they say, "Close enough for jazz." You're on track for having a totally normal life.

Gnatty

[Ella]

"Close enough for jazz." Ha! I'm totes stealing that!

[singinasong]

Congratulations!!! Yay!!! You did it!

[Ella]

Hey Gnatty,

I had some bloodwork done for my PCP, and I just wanted to report that ALT is now 17 (6-29) and AST is 16 (10-35). I won't have my EOT + 12 weeks viral test until Feb 16th, but it's looking good for now! Dr. Freeman at FixHepC said most people relapse in the first month after treatment, and I'm holding him to that! 

[gnatcatcher]

Terrific, Ella -- you made my day! Thanks for letting me know.

[abacomike]

I also was on Epclusa from April to November, 2017 (24 weeks) and my enzymes were a bit high , but they are always a bit high.  I contracted liver cancer in 2016 and had a liver resection to remove three malignant tumors.  I still had Hep C at the time which caused the liver cancer.

I was treated with interferon and Ribavarin in 2006 - did not reduce my viral load sufficiently to continue the treatment.  Tried Harvoni for 12 weeks, but failed to rid my body of the virus.

On Nov. 1st of 2017, had my blood tested to determine if Epclusa was successful after 4 weeks post treatment - no virus detected.  Had a blood test on January 1st - no virus detected.  So far so good.  Next test is in June.  My hopes are high that I finally got rid of the Hep c virus.

Keep fighting - I did and after 37years, I have s good chance to be cured.  Good luck.

[Lynn K]

Hi abacomike

Wow I thought I had a hard fight! Congrats on making it to SVR 12! From all I have read your odds of relapse at this point are extremely remote. I also tested at 6 months post and at one year just to be sure since I was a 3 time interferon based null responder and had relapsed after taking Sovaldi with Olysio for 12 weeks. I next treated with Harvoni and ribavirin for 24 weeks and that did the trick.

Were you also diagnosed with cirrhosis? From what I understand having cirrhosis is the risk factor for liver cancer. So hep c causes cirrhosis which in turn causes liver cancer is how I understand it.

I was diagnosed with cirrhosis ten years ago but so far I have been lucky but still having my ultrasounds and blood testing done at 6 month intervals and an annual visit to my liver specialist at UW liver center.

Congrats again I think you got it this time!

[abacomike]

Lynn, thanks for the info.  In answer to your question about cirrhosis of the liver (whether or not I was diagnosed with it), the answer is no - to the best of my knowledge.  The only comment(s) my doctors have stated had to do with a "fatty" liver - but no cirrhosis.

After failing Harvoni after 12 weeks, my doctor put me on Epclusa 6 months after my liver resection.

I stopped Epclusa (last does after 24 weeks) the 2nd week of October and had a blood test on November 3rd to check for Viral Load.  The result was no virus detected.  I had my second Post Treatment blood test for viral load 3 weeks ago (3 months post treatment) and again no virus was detected.  So, finally, things are beginning to look up for me.  I have another test scheduled for 6 months post treatment and then another 12 months post treatment.

My last blood test showed slightly elevated liver enzymes, but they are always borderline since first being diagnosed with Hep C in 1996.

The CT-Scan I had done 3 weeks ago showed no evidence of recurring tumors, but did show a hematoma in the right quadrant of my abdomen - not very large - which was first indicated immediately after surgery for the resection.  It has reduced in size over the past year and a half.  They did find a small hernia to the right of my navel - probably due to the significant muscle wall invasion my the surgeon.  I get pain every so often, but no way am I going back into surgery unless my life is on the line.

My only concern (and the concerns of my doctors) is the recurrence of carcinoma of the liver.  Unfortunately, there is no very much available for this type of cancer in the form of chemo-therapy.  Any recurrence would mean they would burn it out with microwaves.  But I am already 73 and have hopes of living several more years.

I've been through the ringer, so to speak, and if anyone has any questions about side effects of Epclusa or Harvoni or liver resections, would be more than happy to answer them.

Thanks again, Lynn.

[gnatcatcher]

abacomike, glad to read you are officially cured (no virus detected 12 weeks after the end of treatment). At our stage of life, if it's not one pain, it's another. At least the hematoma is reabsorbing, however slowly. Now that you are cured of HCV, the risk of HCC is lower -- fingers crossed! I'm sure you'll be making the most of every moment.

[dragonslayer]

Hey Gnatty,

I had some bloodwork done for my PCP, and I just wanted to report that ALT is now 17 (6-29) and AST is 16 (10-35). I won't have my EOT + 12 weeks viral test until Feb 16th, but it's looking good for now! Dr. Freeman at FixHepC said most people relapse in the first month after treatment, and I'm holding him to that! 

Actually, most people dont relapse!   

[Lynn K]

Hi congrats again on your results.

I had my gall bladder removed because of gall stones and attacks likely due to hep c and cirrhosis.

I also developed an incisional superaumbical hernia after my procedure even though it was done laparoscopically.

I really am surprised about the primary liver cancer in the absence of cirrhosis first I had heard about but I am far from being a medical expert. Glad they were able to help you.

About the 4 weeks post results if someone was going to relapse it would be more likely to have happened by then but if you have made it to SVR4 your odds of staying that way I have read are about 98.5%

As dragonsslayer said most people do not relapse most people are cured!

[Ella]

Thanks, dragonslayer and Lynn, that's what I meant! Most relapsers relapse in first four weeks. And that would NOT be me! 

Cheers!