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Hep C Discussion Forum -> Hep C News -> New (revised) ALT levels
Post Info TOPIC: New (revised) ALT levels
Tig


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New (revised) ALT levels
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I agree SF, it has gone off topic. I ask that posts be left in the appropriate locations to avoid any further additions. I'm going to close this thread to preserve the original content. We don't want to hijack the OP content. Thank you.



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Canuck


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Hey Christina, SF and Jimmy,

Yes good advice is coming forth here, but, we have multiple threads going on here, including this one which was originally about "Hep C News - New ALT levels". Please see more in "On Treatment - How long did it take for you to feel better", and, over in "On Treatment - Bad side effects from epclusa". Maybe we should all converse on one of the "On Treatment" threads?   smile C.



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HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
Shadowfax


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Hi Christina,

 

Jimmy is right. It can be hard to see the light at the end of the tunnel but just know that there is light today and you will get through this and look back at this miraculous period in your life where you finally got rid of this insidious virus.

Water .. Water.. and more Water.  We just cannot emphasis too much how much that will help you. 3 Litres a day at least. Yes, you will be running to the bathroom but you will be running. That alone is improvement.

Visit here often and just read, it has helped us all and will help you. You have friends here that understand and will help as best as we can.

 

Take care

SF

 



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65 yo, GT1A, , Cirrhosis, F-Scan F4 33.5, TX Naive Harvoni 12 wks

SOT 2/9/16 / ALT 187 AST 114 VL 2.3M.    POSTS

EOT 5/2/16  ALT 35/ AST/25  platlets 126 C/B VL UND

EOT +12 7/26/16  ALT 25 /AST 22/ ALP 83  platlets 129 C/B VL UND

EOT + 24 10/18/16 ALT 27/ AST 20/ ALP 71 platlets 153 C UND

 * SVR *
JimmyK


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Hi Christina, welcome to the Family here!

First let me say I am sorry you are feeling so bad while on treatment. Trust me I understand. I had a run in with Riba that left me felling exactly projecting.

First things first.

1) You are half way done and most likely UND right now. Have you done a 4 week RNA Blood Draw?

2) This one is actually the most important. How are you doing with hydration? You need to be drinking a LOT of water every day without fail in order to minimize side effects.

You are going to be alright, in fact you are going to be cured of a very dangerous condition.

We are here for you. We will hold you up when you can't. We are shoulders to cry on and we actually get it. In many cases, we have been there done that and are now cured so we are here to help.

Hang in there and YOU CAN DO IT!

 

JimmyK



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Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

"I go to war with the brothers I trust."
Ineedsleep


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I am on my sixth week ok epclusa treatment.  I am having trouble doing everything in my life.  Anxiety is so bad I am losing almost all my hair. I can't sleep I have insomnia and always feel depressed and dazed like I'm in a cloud.  I'm really scared.  I have anxiety meds and sleeping meds and still can't handle this. Someone help me.



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Christina Tsatsis
Shadowfax


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I noticed on my last blood work a few weeks ago that a number of levels were lowered so before if you fell into the normal range, you may not now.

 



__________________

65 yo, GT1A, , Cirrhosis, F-Scan F4 33.5, TX Naive Harvoni 12 wks

SOT 2/9/16 / ALT 187 AST 114 VL 2.3M.    POSTS

EOT 5/2/16  ALT 35/ AST/25  platlets 126 C/B VL UND

EOT +12 7/26/16  ALT 25 /AST 22/ ALP 83  platlets 129 C/B VL UND

EOT + 24 10/18/16 ALT 27/ AST 20/ ALP 71 platlets 153 C UND

 * SVR *
Canuck


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1.      Healio

GUIDELINES

New ACG guideline on liver chemistries lowers normal ALT level

Kwo PY. Am J Gastroenterol. 2016;doi:10.1038/ajg.2016.517.

December 21, 2016

The American College of Gastroenterology has published the first new guideline in over 10 years on the evaluation of abnormal liver chemistries, which provides a framework for physicians to approach this common problem, and notably sets new lower thresholds defining normal serum alanine aminotransferase levels.

"What is unique about the ACG guideline is that for the first time in a liver test guideline, a normal healthy [alanine aminotransferase (ALT)] level is defined for women and men (19-25 IU/L [for women], 29-33 IU/L [for men]), and levels above this should be assessed by physicians," Paul Y. Kwo, MD, FACG, FAASLD, of the division of gastroenterology/hepatology in the department of medicine at Stanford University School of Medicine, Palo Alto, Calif., told Healio.com/Hepatology. "This decision was based on the emerging data over the past decade demonstrating that ALT levels above our defined thresholds are associated with higher liver related mortality rates across a broad range of populations world-wide including populations from the U.S., Europe, and Asia that is driven in part by the obesity epidemic."

Kwo and his co-authors - Stanley M. Cohen, MD, FACG, FAASLD, of the Digestive Health Institute at University Hospitals Cleveland Medical Center, and the division of gastroenterology and liver disease, department of medicine at Case Western Reserve University School of Medicine in Cleveland, and Joseph K. Lim, MD, FACG, FAASLD, of the Yale Viral Hepatitis Program at Yale University School of Medicine in New Haven, Conn. -  acknowledged that others have argued against lowering ALT thresholds as it would lead to higher health care costs, unnecessary evaluations, mental anguish and anxiety, and a reduced blood donation pool. However, the guideline authors maintained that the emerging data mentioned above warrant educating clinicians about "the adverse long-term outcomes of these historically non-elevated levels," and standardizing ALT levels across populations.

"We recognize that it will take time for clinicians to recognize the newer lower limits of ALT levels that should now be considered normal," Kwo said.

The guideline also provides management algorithms to help clinicians evaluate elevated ALT levels.

"We have devised algorithms that allow a graded approach to those with elevated aminotransferase elevations by categorizing these elevations as minimal, mild, moderate and severe, as well as giving specific guidelines as to when immediate evaluation is required and when a more limited evaluation can be performed with subsequent evaluation if liver chemistries fail to normalize," Kwo said.

Moreover, the guideline authors provide additional algorithms for evaluating abnormal alkaline phosphate levels and bilirubin levels, "to help clinicians efficiently evaluate these abnormalities including suggested serologic and radiologic evaluations as well as when liver biopsy should be considered," Kwo added.

This practice guideline is intended to be flexible and adjusted for individual patients, and the quality of evidence used to develop it was classified using a modified grading of recommendation assessment, development and evaluation workup. - by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.

 

 



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
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