Good day all,
Just wanted to get your opinion about something.
I recently went for my 6 monthly blood test and ultrascan. Everything on the ultrascan was fine, although about a year ago the ultrascan consultant noticed 2 polyps which have been monitored with no further size increase and smaller than the recommended stance if having them removed.
My bloods, however, came back with a slight elevation on my ALT - 40 (range 0-35) and my AFP - 3 (range 0-10).
Usually my average ALT hovers around the 30 mark (so below the range threshold) and my AFP has been 2 for countless years.
I’m a 40yr old Asian male who’s been on Tenovofir disoproxil Mylan (245 mg) for the past 5+ years and my HBV virus has been UNDETECTED for in as many years.
The liver specialist advised they wanted me to take my next set of blood tests in 3 months as opposed to 6 (so June time).
Should I be worried that 1). My ALT has gone up and is now above the normal range? 2). My AFP has gone up to 3 when it’s been 2 for many years - although still very much in the 0-10 range.
Would a slight increase in ALT or AFP indicate something?
TIA.
Pete A
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Hi Pete, thanks for your message and good questions. Glad to hear that you’ve been on tenofovir for the past 5 years with undetectable viral load. That’s really good news! As far as your slightly elevated ALT levels, there can be variations at any given time due to different factors. Since you mentioned being 40 years old, you could be putting on weight due to a slowing metabolism, which happens as we get older. Additional weight adds extra stress to the liver. Your AFP is still well within the normal range so it could be a variation in the moment, but not a worrisome finding. I’m really glad that your doctor wants to see you in 3 months to follow-up on these test results. I’m sure others will weigh in with their thoughts, but I wanted to provide some reassurance that there will be variations over time as we get older. Thanks again and keep us posted! Always, Joan
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Dear @peteshine_7,
I would agree with @Joan_Block’s assessment. Such small variations shouldn’t be anything to worry about, but good that you’re getting extra monitoring to see if this is an ongoing trend (which is more important to know).
Cheers
Thomas
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Yes I agree too.
It is likely nothing to be concerned about, but it is important to monitor closely in case it is the start of an upward trend.
It sounds like your liver specialist is doing all the right things so you should follow their advice.
Best wishes
Mark (Infectious Diseases specialist)
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Many thanks for the advice and reassurance. I will let you all know the outcome when my next blood tests come in. Stay safe and blessings to you all.
Pete
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Hi everyone.
My lft result from 30/10/21 was AST-40 ALT-39
My result from 2/12/21 was AST-165 ALT-162, elevated in such a big no. Within a month makes me little worrying and arises many questions in my mind. Just wondering what could be the reason for this much of elevate with my lft,could this be my activity or the food intake before the blood test. Or does this somehow indicates the changes of phase from immune tolerant phase to the next phase. HBeAg was positive in September,viral load from October was in a million and my lft test was in a normal range. Base on my understanding I was in immune tolerant phase)
For a better assessment iam 29 years old,horizontal transmission in 2019/2020 i guess, I feel healthy for now,I dont have any problem. I have started taking meds TDF 300mg for the first time from last month. Coming to my food habit I sometimes eat meat and foods cook with oil but no alcohol for the last 2 months.
Please help me understanding with my elevated ALT&AST
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It potentially does represent a change in phases, but you would have to get the tests (e.g, hbeag, hbeab) to confirm. These phase changes can occur over weeks to months, so it could be a longer term process of monitoring.
TT
I agree with Thomas, but also want to emphasize that your food intake is not responsible for your ALT increase. It could also be a result of your starting TDF last month? But most importantly, you should contact your doctor to see if you can be retested again in a few months to make sure that your ALT level doesn’t continue to increase. Your doctor needs to keep a close watch on this blood test! Always, Joan
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Hi Colleagues,
My AFP is 12. AFP was 9 a year ago and became 15 Six months later and now 12.
I am concerned with this elevated AFP.
Not under any medication. HBV DNA PCR quantitative is undetectable for the last 3 years. Hbsag is >1000. Hbeag is negative. Mild liver fibrosis of 5.72 KPA. Fatigue and body itching is routine beside pain under the right rib cage. Doctor would not let me start treatment. I understand this just information sharing platform and not a substitute for Dr advice etc so I request if there is anyone with the same situation. Would starting treatment better the quality of my current life. For example getting rid off fatigue, itching and pain under the rib cages. Just in case you happen to experience the same.
Please advice.
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Hi @Wadani1, please know that I am not a physician so (most of us on the forum are not physicians unless they identify they are) anything I say should be checked with a practicing doctor. With that said, yes, your AFP levels are above normal but not extremely elevated, and these results seem to fluctuate downwards, which is good. However, you definitely want to talk to your doctor about this and make sure they are keeping a close eye on your AFP levels. You seem in otherwise good condition with undetectable viral DNA – and not even on treatment, which is wonderful --and low level surface antigen. Any of us with chronic hep is going to have mild inflammation as a result of the virus within us. You don’t mention your ALT test results? I assume they’re below 30, which in the US is considered the upper limits of normal in men (this number was adjusted upwards in the US because there are differences in the diagnostic testing labs here). Finally, as everyone on this forum knows, I always raise the question about whether there is any family history of liver cancer or serious liver disease since that trumps any blood test values in terms of deciding whether to start treatment or not.
In regards to you itching, fatigue and pain under your right rib cage, those are common complaints of many of us living with hep b. Although I only had fatigue, I know that once I started treatment at 45 years, I did experience a notable decrease in fatigue which was a great benefit. Of course now that I’m almost 63 years, I get tired more easily than in the past so I attribute that to age and also the fact that despite being on treatment, the sneaky hep b virus continues to attack my liver on a daily basis. Oh well.
It would be very interesting to hear from others whether treatment helped with itching and the pain under the right rib cage? Thanks again for posting and raising a good question. Always, Joan
Hi Wadani,
I agree with everything in Joan’s post. I think some others have talked about itching in other threads, so it may be worth searching the forums (using the magnifying glass up on the top right hand side) to see how others may have dealt with it. It’s difficult to know whether it is anything to do with the HBV or if it’s a separate issue. Not all Hep B patients have itching though.
Hope this helps,
Thomas
Thank you very Thomas Tu and the team.
Very helpful indeed.
I recently developed tingling and numbness under the feet’s at night when lying down. Wondering if this is related to HBV. Anyone experienced the same. I am still NOT under treatment with HBV DNA <20 IU ML and HBsag >1000 IU/ML with Liver Fibrosis of 5.72KPA and AFP 12 (high) still Doctor would not let me start treatment.ALT and AST normal range . Any experience on the above.
Hi @Wadani1, I haven’t personally heard of tingling and numbness of feet with hep b, but there could be some possibility. It’s something to talk to about with your doctor in case he or she wants to check for any other possible causes. Thanks for posting! Always, Joan
Hi @Wadani,
Under current guidelines, you would not be recommended treatment because your liver health is still good (little to no fibrosis from the fibroscan) and your viral load is already suppressed (lower than 20), so the medications would probably not affect anything.
Regarding the tingling and numbness in your feet, someone else reported this in a previous thread (Titling feet and pain on the righ shoulder blade). If I remember correctly, it ended up being a posture issue and things improved a lot when they got a new office chair. Perhaps you can consider some other causes that might be causing you this.
Hope this helps,
Thomas
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Thank you very much. Very helpful indeed. I know non of us here is medical specialist and advises should not be a substitute to seeing doctors. However, from your experience, I am getting very tired and feel pain under the feet and fingers lately. My viral load has always been <20ML/IU without treatment. This keeps on decreasing. My worry was the AFP which is 12 (dropped from 15). Hbeag negative and Fibroscan of 5.72KPA. With this there is a suspicious that I have gastritis and infection (H pylori). From experience, which is the best anti biotic for someone like my situation. Antibiotics with less or no liver damage please.a local Doctor says ceftriaxone injection. But a bit worried…Please share your experience .
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Hi Wadani1,
From my initial reading, it looks like ceftriaxone is safe, even in patients who are cirrhotic.
Thomas