Hello Maga, welcome to the forum, and congratulations on starting your 84,000 USD treatment . Looking forward to your 4 weeks test result, there is a very good chance you will be undetected by then, most patients on DAA treatment are, best of luck.

Hi MAGA and welcome to the group. Congrats on getting treatment underway and best of luck going forward!

You should do the test again.

https://www.journal-of-hepatology.eu/article/S0168-8278(16)00010-6/fulltext

Whatever the cause, the problem of hepatic decompensation during antiviral therapy calls for heightened awareness and careful monitoring of patients with cirrhosis who receive antiviral therapy for hepatitis C. The first appearance of features of decompensation should lead to rapid initiation of appropriate supportive care and early discontinuation of antiviral treatment. For the research community, an important priority is to establish objective criteria for hepatic decompensation to use in describing results and to standardize reporting rates across clinical trials. The episodes of acute decompensation also need to be better described clinically, particularly in the context of other adverse events, timing of viral clearance, serum enzyme changes and serial bilirubin, albumin, ammonia and lactate levels. These studies are of great priority because treatment of patients with advanced hepatitis C cannot be withheld because of concern for this complication.

What is your HCV genotype?
Do you have cirrhosis? What F-score do you have for your liver?

This is an emergency at least to take another urgent test and schedule an emergent consultation with a hepatologist to see if another test for hepatic decompensation or liver damage is available.

It’s fibrosis score – F0 – healthy liver, F4 – advanced fibrosis.

Done with liver ultrasound or Fibroscan in like one hour.

You may actually need to know it now.

On the one hand, it could be a mistake or another reason for massive liver damage:

https://www.ueg.eu/education/latest-news/article/article/mistakes-in-liver-function-test-abnormalities-and-how-to-avoid-them/

The significance of aminotransferase levels in the diagnosis and prognosis of acute liver failure is often misunderstood. Excessive aminotransferase levels occur in acute viral, toxic or ischaemic liver injury. Although impressive, these levels merely reflect acute hepatocellular damage rather than loss of liver function. Consequently, marked aminotransferase elevations in the absence of jaundice, coagulopathy and encephalopathy should not lead to a diagnosis of acute liver failure.

EASL recommendation:

Patients with decompensated (Child-Pugh B or C) cirrhosis
should be treated in experienced centres with easy
access to liver transplantation and close monitoring during
therapy is required, with the possibility of stopping
therapy with evidence of worsening decompensation
during treatment (A1).

http://www.easl.eu/medias/cpg/2018/EASL%20Recommendations%20on%20Treatment%20of%20Hepatitis%20C%202018/English-report.pdf

Nothing else to see here, except for the need for expert monitoring.

Sof/vel is recommended for the decompensated cirrhosis but it can cause effects of decompensation (liver damage) on-treatment, when treatment should be cancelled and emergent measures should be taken.

It is actually important to know your liver fibrosis state now.

Read this.
https://livertox.nih.gov/Sofosbuvir.htm

Find out if you have or have had Hepatitis B or cirrhosis. If you do, it could be a serious life-threatening condition.
If you don’t then probably it is a test mistake.

You may want to schedule other blood and liver tests corresponding to the findings of the sofosbuvir Drug Record (to confirm or exclude Hep B reactivation or hepatic decompensation).

You may even need expert monitoring to assess a need for emergent liver transplantation and to see what other tests including blood tests, liver tests should be done. Or to urgently assess other test values to confirm it was a mistake.

I am not a doctor at all, just would like to say that it’s not okay and you should act quickly. Call ambulance, see a doctor to consult with. Do more tests.

Only FDA-documented reasons related to sof+vel are Hepatitis B reactivation and cirhosis decompensation in people with cirrhosis.

https://www.webmd.com/a-to-z-guides/aspartate_aminotransferse-test#2
Apart from the documented treatment complications, it could be additionally for one of these generic reasons or just a false positive.

If you had cirrhosis or Hepatitis B, a decision to stop or continue treatment would have to be urgently made by a hepatologist in a hostipal treating people with decompensated cirrhosis.

If if it is something serious, it must be fixed very soon. Or it’s just a mistake/something else.

But it’s not okay. No such increase of AST/ALT was documented in the sof+vel FDA sheet, except for the mentioned reasons.