ALT/AST ratio - FixHepC

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31 March 2016 at 7:07 pm #14695
Johnboy
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- Guardian Angel
@johnboy
I have a friend who is about to get treated for his G3 HCV. At the moment he has no information about his liver condition, except that he does not have cirrhosis. He hasn’t had a fibroscan but had an ultrasound. The doctor has not told him the stage of his fibrosis from the ultrasound and I’m trying to get an idea for him……. out of interest only, at this stage. I’ve looked at his latest liver function test and am surprised to see his ALT is only 37. He is alcoholic (recently in rehab and not drinking ATM) and I was thinking, because of his alcoholism and HCV, that he would be close to cirrhosis. However the ALT figure has got me thinking he is not as bad as I though. His AST is 73 and his GGT is high (from alcohol, I assume)…. 174. He has probably had HCV for ten years but has been alcoholic for longer than that.

I am concerned that his doctor may recommend Sofdac for twelve weeks and that twelve weeks may be too short. I’m trying to get him to use GP2U and Dr Freeman so as to make sure the treatment time is suitable for his condition.

Can anyone tell me what the ALT/AST ratio suggests? Obviously he will be getting further tests and a proper diagnosis but I’m interested in finding out what his figures suggest as far as fibrosis score is concerned.

Thanks in advance for any commentary. I do realise that a proper diagnosis is needed.

G1 58yo F1 54,000 viral load Relapser 2003/4 Sof/Dac started 21/9/2015
31 March 2016 at 11:28 pm #14696
Gaj
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@gaj
His AST/ALT ratio of nearly 2 suggests alcohol and/or some level of damage (maybe even quite high) but based on only one result and lack of other indicators could be misleading. Do you know his platelet count? If so put that and his AST into the APRI calculator at the top of the Decision Support Tool http://fixhepc.com/hcv to get what should be a more accurate idea.
As a G3 myself I believe he should have a consultation with someone with experience of HCV treatment with DAAs. Your suggestion as to where is in the right direction.

G3a since ’78 – Dx ’12 – F4 (2xHCC)
24wk Tx – PEG/Riba/Dac 2013 relapsed
24wk Tx – Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx – 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 – 22/06/17 UND
SRV12 – 27/07/17 UND
SVR24 – 26/10/17 UND
1 April 2016 at 5:57 am #14715
Johnboy
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@johnboy
Strangely his full blood test doesn’t have a platelet count or I would have used the tool. The tool suggests twelve weeks but I’m sceptical about that length. Yes, he is going to see JF for sure, I’m just trying to get the background info organised as he has communication difficulties. Going to get another test including platelets and chase up his Qld doc for older info.

He also had some serious damage from a fall (split pancreas, bruised liver and detached bowel). That’s a story in itself. How about this for luck………he fell from a seventh floor balcony (like the cartoons, hands slowly slipping away), but was found a day later on the sixth floor balcony!!!

Thanks for the reply.

G1 58yo F1 54,000 viral load Relapser 2003/4 Sof/Dac started 21/9/2015
1 April 2016 at 6:35 am #14718
Dr James
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@fixhepc
Can anyone tell me what the ALT/AST ratio suggests?

Normally the AST is less than the ALT.

When the AST is higher than the ALT it suggests (but does not prove) advanced fibrosis/cirrhosis. It is not a good sign.

It is calculated as AST/ALT so is > 1 (bad) when AST > ALT

The APRI score is better than the AST/ALT ratio. It is calculated from AST and Platelets. You can use the APRI calculator in our decision support tool at http://fixhepc.com/hcv (this also does AST/ALT)

If his platelets are anything less than 200 he will have an APRI of > 1 which suggests advanced fibrosis.

YMMV
1 April 2016 at 6:39 am #14721
Dr James
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@fixhepc
Strangely his full blood test doesn’t have a platelet count or I would have used the tool.

Are you sure it’s not buried in there somewhere. I’ve seen Hb only but never seen a Full Blood Count without Platelets, that would be like the “Glass 1/2 Full Blood Count” or worse still if you drink a bit “The Claytons Full Blood Count”

YMMV
1 April 2016 at 7:02 am #14722
Johnboy
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@johnboy
Thanks for your reply and time.
I will re-check the paperwork later tonight….. Is it possibly called something else?

He is seeing a local doctor today and apparently the Qld paperwork is going to be there. I want to get him organised before he sees you. His brain is pretty fried and he is on too many pills so it’s a nightmare getting info. Will make appointment when we know a bit more.

G1 58yo F1 54,000 viral load Relapser 2003/4 Sof/Dac started 21/9/2015
1 April 2016 at 11:27 am #14729
LondonGirl
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@londongirl
Here in the UK, I have sometimes had FBs without platelets. Usually when the test is from the GP rather than the hospital. GP doesn’t do AST either unless consultant specifically requests it.

Sounds like your friend has a very good mate in you, well done you it isn’t easy when alcohol dependency is involved.

GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 ‘In the slow lane’
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
9 April 2016 at 7:25 am #15124
Johnboy
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@johnboy
My mate has had another LFT and yes, they didn’t do AST either. They did do his platelets this time and they are 291.

The abdomen scan only suggests an enlarged liver, no further info on the liver. However the scan has found two kidney cysts and and a prostate on the upper limit of enlargement. He is treatment naive but has a long history of alcohol abuse.

The SVR calculator asks for an F score, which he does not have and I’m guessing he is at least F3 …… a doctor has said recently he doesn’t have cirrhosis. I’m thinking he must be close. When I put his figures in, it says twelve weeks and I’m convinced he will require more. Of course I’m a lay person.

So…ALT 37
AST 73 tested a month ago.
291 platelets gives an APRI score of 0.627

The calculator will only go to 24 weeks if I put in treatment failure and/or F4.

I will be getting him an appointment as soon as his viral load and genotype confirmation come back in a week.

I suppose I’m wondering if these figure suggest that Dr Freeman or his offsider Dr Devsham will give him 24 weeks or at least more than 12. I’ve heard of too many relapsers on twelve weeks and I’m sure my mates liver is pretty stuffed. A fibroscan will take far too long to get done and we want him treated ASAP.

Perhaps James can tell me when he will return and be available or maybe he can ease my concern by suggesting which treatment length he would give. I don’t want to make an appointment without having the ducks lined up. He is G3.

G1 58yo F1 54,000 viral load Relapser 2003/4 Sof/Dac started 21/9/2015
10 April 2016 at 3:29 am #15154
Dr James
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@fixhepc
If I was G3 I would do at least 16-18 weeks and 24 weeks if rules/finances permitted.

With G3 having either past treatment failure or F4 == 24 weeks.

YMMV
10 April 2016 at 5:18 am #15161
CJ
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@cj
Hi Johnboy,

I had an alcoholic friend whom I helped through tx, also tried desperately tried to help her get off the grog, so I feel for you.

It’s difficult to organise them, as their brains are kind of scrambled.

I think what your doing is wonderful.

Do you think you can get him detoxed before tx, as it would be a good start to getting him clean & better chance of getting virus free.
I know it’s hard, but him going into a clinic for detox is best.

It’s heart breaking seeing how alcohol destroys some, just takes over their lives.
It takes a lot of pushing, a lot of patients and a lot of love to get them through .
Maybe the thought of the HCV will knock him into to trying to get clean.

Thank goodness my friend is finally hep free AND alcohol free now
Hopefully your friend will also get this way.

Good luck & hugs from me

Love Cindi x

J the young dragon slayer is:
HepC 1a since birth
Male aged 15
VL 2000000
Started Twinvir/ 10-11-15-then Sof/led.
NO sides so far !
after one week VL : 37
after 4 wks VL : UND !
EOT 2/2/16 UND.!
4 wks. post tx results….pending….
7/3/16 VL result : 4 week post tx: SVR !
12 weeks SVR !
24 wks SVR yeeaa!!
10 April 2016 at 10:59 am #15176
Johnboy
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- Guardian Angel
@johnboy
Thankyou.

Crossed fingers…… He is living with us and grog free ATM. Hopefully he stays off it. My other mate has changed his life and been off everything eight years. We have least shown him it can be done and it worth it. We will see.

Thanks James for your your comment too, hopefully he will see you when you return from Spain. It will be PBS drugs so it will be up to you how long he gets treated for.

G1 58yo F1 54,000 viral load Relapser 2003/4 Sof/Dac started 21/9/2015
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