Just got the blood and ultrasound report and I’m a bit worried.
My background: Asian female 46 yo. Very likely I was born with HepB.
Started treatment since the end of 2022 when ALT and AST went out of range (ALT 44 AST 35) and viral DNA always lingering between 1000~10000.
I have been on Entecavir for about 2 years. It works on me and makes viral DNA undetected till now. I got blood and ultrasound checks every 6 month and fibroscan every two years. It was all good till the most recent check.
A few items in the reports make me worried:
Ultrasound report: “it is of mildly increased echogenicity with a coarse echotexture” “Nonspecific heterogeneous appearance of the liver”
My specialist seems don’t think it is an issue, and didn’t mention it when she reviewed the report with me. When I brought it up, she said I don’t have to worry about it. She said with my fibroscan report (which was done two years ago), it is fine.
I’m still a bit worried, since I’m not over-weighted (my BMI is 19.6), and I’m on healthy diet. No alcohol, no smoke.
ALT and AST elevated: ALT 35 and AST 34 (AST has been under 30 and ALT has been under 25 for the past two years after I started treatment), but now they start to increase
AFP: my AFP level is always a bit out of the high end (has been on 13 mark for more than 10 years (ranging between 11 to 14). but this time it gets to 15. My specialist said I don’t have to worry, but she asked me to do another AFP check in 3 months time, to be cautious
Seems neither my GP or my specialist is concerned much, but I can’t stop worrying. Could anyone please share your thoughts on it? Thanks!
Hi @ abcde
From your questions and worries about blood test and ultrasound
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If your ultrasound results are accurate and no bias , I consult with radiologist (my wife), this is the non specific features and may be caused by fatty liver or hepatitis etc. The most common cause of hyperechogenicity of liver is fatty liver and in your case , I think that you may have mild fatty liver , this can be found in normal BMI person which we call lean NAFLD. You should work up about lipid profile and assess about anthropometry eg. waist circumference to height ratio , blood pressure to rule out metabolic syndrome which is treatable and reversible.The other causes such as some drugs like hormones and herbal supplements should be ruled out.
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Your AST and ALT are slightly elevated from base line level and I think it may be explained fron NASH which result from lipotoxicity and injury to liver cells
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your AFP level is not high and the result is in normal range(< 20 ) which it may be slightly variable from time and it is not specific to HCC , it may be elevated by other causes eg. hepatitis, germ cell tumor . If you worried about this , you can check the subtype of AFP called AFP - L3 which is specific for HCC if your laboratory tests are available. .You should consult with your doctor and I hope this may help you understand about your issues and not to worry about it.
Hi @abcde,
I agree with @chul_chan interpretation and recommendation. I just want to add that your ALT and AST of 35 and 34 are within the normal range (40 and 44/45 respectively). I will not worry so much about this. These fluctuations can happen from time to time, so don’t be too surprised to see this happen. Different labs in different countries will use different standards. Your values in the US are considered within the normal range. Also, remember that a lean person can develop a fatty liver or have a higher cholesterol. Being lean does not play any role here.
Consult with your doctor for further evaluations to understand the cause of your fatty liver. It seems all HBV patients develop mild fatty liver at some point. Best, Bansah1
Thanks @chul_chan@Bansah1 for your reply!
I have been very careful with my diet and doing regular workout. The findings are discouraging and I’m not sure what else I can do to help myself.
Will do a fibroscan in six-month time. Maybe we can have a better idea then.
Great to hear from you again, and hope you’re well. That’s fantastic that you are eating healthy and exercising. These are things that work over many years, and what you are doing is likely helping, don’t give up! While you may be disappointed that it is not completely cleared of fatty liver, think about how much you have prevented and what it could have been like if you continued with poor diet and no exercise!