Oh, while we are on this subject.

In the 3000 odd patients there have been a handful who have had neurological things during/after treatment.

Facial pain, arm and leg pain. We also see tinnitus (ringing ears) and changes in taste (usually returning and deemed better, but sometimes deemed odd) happen reasonably commonly – low single digit %.

The good news is that my observation is that these issues do seem to resolve over about 6 months.

I had one chap with “all over body tingling” at the beginning of treatment. (There is no medical condition all over body tingling so he falls into the NFI class and you wonder if it’s all in his head). Anyway, the really fascinating thing was how it got better. First in his chest, then down his arms, elbows, wrist, knuckles, fingers until finally the last bit of tingling in his fingertips and toes went away. The significance of that is that it seemed like the nerves were getting better from the cell body (in the spinal cord) down the axons to the terminal sensors.

So Hep C is known to infect nerve cells and we do see nerve-related changes during treatment.

Hang in there. I expect it will settle down given a bit of therapeutic time…

Hello SHarmon,

You are a bit unusual at baseline with the AST > ALT in the context of a fibroscan of 5.6 kPa

You are also correct that for a low fibrosis patient we usually see a more rapid fall in these values at the 4 week test.

I think the key here is your weight 238 -> 208. Assuming you’re a not basketballer height I would expect the weight of 238 probably represented quite a bit of extra fat and that some of this has been in your liver (fatty liver) and that while part of the enzyme fall has been due to the Hep C treatment part of it has also been due to a reduction in fatty liver with the 30 lbs weight loss you’ve had.

When the dust settles, and you are at SVR we do expect somebody with a 5.6 kPa to have totally normal, usually ~20 (say 15-25) AST and ALT values. If your AST continues to be elevated then it should be looked at. Many of the usual suspects have been ruled out but here is the full list of causes:

https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/definition/sym-20050830

Hello Mikey87,

It’s certainly unusual but does sound neuropathic.

Your observation that vitamin B12 helped should probably be followed up with “try that again”. You don’t need injections, just a reasonable oral dose. All the B vitamins are water soluble so it’s next to impossible to overdose so either get a good multi-B or just B12 and have at least 1 a day.

Magnesium decreases nervous excitability so 2-3 magnesium tablets an hour before you lie down would be cheap to try and not carry any significant risks.

Hello Chrisine,

That’s a perfectly reasonable response for ALT and AST – they are now 1/3 of what they were. You AST is lower than your ALT which is always a good rule of thumb sign. In most countries and ALT < 40 or 50 would be normal. Your lab probably says <35 and for all intents and purposes that's where you are now. Platelets are sensitive to how blood is drawn. If the draw is slow they stick together and you get lower levels, but they are not worrying.

Platelets of 199 are good, they are normal, not low, not worrying.

Yes the AST and ALT fall on treatment (and so does the APRI). This is why APRI is only applicable to people PRE treatment – when they were looking at the numbers and the correlation with liver biopsy it was all in untreated patients…

I think you are overthinking things a bit. Your liver is in the state it is in and we know, because you’re posting, it’s good enough to keep you ticking over. We also know, that in the context of ongoing Hep C infection, it’s likely to get worse rather than better as time passes.

The question of cirrhosis (or not) relates only to odds of success, treatment duration, +/- ribavirin and the need for long-term HCC follow up.

The realm of the possible is treat, cure, and allow recovery. The earlier we do this the better. The only 100% specific way to assess fibrosis is liver biopsy and that has a whole lot of issues best avoided and why we have all the other ways of making an informed guess.

If you look at all the various tests that exist we see the best we can get is 80-90% so it’s really a matter of coming to terms with that degree of uncertainty.

Hello Christine,

To have an APRI of 0.61 with an AST of 83 your platelets must be about 330. Nobody I know with cirrhosis has platelets anywhere near that high – they are all <140 and typically <100.

The ONLY clinical significance (given we are treating now, can't treat you last year, etc) is would we like to use either longer treatment or Ribavirin. With GT1b being in the easy to treat category, you being a female, an no real indication of cirrhosis 12 weeks Rx will be just fine.

Hello Christine123,

A level of 352 is a bit high, but, as your doctor suggests, probably just needs watching.

It needs to be considered with iron levels, and total iron binding capacity.

Ferritin is an acute phase protein which means the levels we measure are elevated for a variety of reasons – most of them quite harmless.

The significance of high ferritin (as a disease marker) relates to the iron overload disease Haemochromatosis. There is a simple genetic test for this which rules this out.

The treatment for patients with haemochromatosis is simple – we just take a little bit of blood from time to time forcing the body to use up the extra iron to make new red cells.

This is only your full blood count but it is remarkably unremarkable and quite normal.