Liver Function is high. Doc says I have a "fatty" liver?

[HowYouDoin]

I been on meds since Jan 2007 and since my first labs my liver function have been in the high 100's reaching close to 200 after a year on meds. My firest regimen was Kaletra/Truvada and I was on it for  3 years and a half and switched to Isentress/Truvada a week ago.

My latest Liver function is 102 which dropped from 187. My doctor told me it isn't suppose to be more than 38 points, so i more than triple that number at the moment.  For more than three years I've been asking him Why I have this problem and he tells me I don't have alot to worry about since I tested negative for all the Hepatitis or and probably shouldn't worry about it unless it reaches 200 or above. He thinks the Liver function is due to me not exercising and having a fatty liver.

It's kinna true that I am a couch potato but I didn't have this problem until i started medication (kaletra/tuvada now on isentress). I am hoping that with Isentress this problem will change and I am also eating healthier and walking alot more hoping my "fatty" liver will get skinny. Anyone else have this issue? Could it just be that Kaletra (which by the way raised by Tryglicerides ALOT) be the cause of the rise in liver function? I get my new lab in a month or so and I am considering switching doctors if my labs don't improve and he continues to blame it on my poor diet. I am not obese so I don't think it's cause I am a fatty.

Your input is highly appreciated.

AL

[Billy B]

I been on meds since Jan 2007 and since my first labs my liver function have been in the high 100's reaching close to 200 after a year on meds. My firest regimen was Kaletra/Truvada and I was on it for  3 years and a half and switched to Isentress/Truvada a week ago.

My latest Liver function is 102 which dropped from 187. My doctor told me it isn't suppose to be more than 38 points, so i more than triple that number at the moment.  For more than three years I've been asking him Why I have this problem and he tells me I don't have alot to worry about since I tested negative for all the Hepatitis or and probably shouldn't worry about it unless it reaches 200 or above. He thinks the Liver function is due to me not exercising and having a fatty liver.

It's kinna true that I am a couch potato but I didn't have this problem until i started medication (kaletra/tuvada now on isentress). I am hoping that with Isentress this problem will change and I am also eating healthier and walking alot more hoping my "fatty" liver will get skinny. Anyone else have this issue? Could it just be that Kaletra (which by the way raised by Tryglicerides ALOT) be the cause of the rise in liver function? I get my new lab in a month or so and I am considering switching doctors if my labs don't improve and he continues to blame it on my poor diet. I am not obese so I don't think it's cause I am a fatty.

Your input is highly appreciated.

AL

HowYouDoin today Al?
I have some liver damage from to many years of D&D and the combo we are taking is the most liver friendly according to my my IDS. My ASTis 87 & my ALTis 113. While they are a little higher than high normal, my Dr. said he has patients with 10 times higher numbers than mine.
My doctor uses a noninvasive test called a FibroSpect assay that rates liver damaged using the Metavir score. This test is preformend using blood. Before I started HIV Meds my score had an index of 60 and a Metavir rating of F2-F4 which indicates mild to moderate fibrosis. My last FibroSpect assay had an index of 30 and a Metavir rating of F0-F1 which indicates no fibrosis. My IDS is completely clueless as to why this happened.
Peace,
Billy

[HowYouDoin]

Hey Billy

Thanks for your input. I will wait for my next labs and I am almost certain it was the former meds that were messing with my poor liver. Isentress sounds to be less toxic so I have faith. Will keep ya'll posted.

AL

[Dsd09]

I have exactly this - an ongoing high liver reading (not sure which one though).
When I first started on meds it was up in the several hundreds, and they had blood off me every couple of days to see what it did. But then I did turn into a beetroot the first couple of weeks on sustiva.

I now don't have any noticeable side effects other than this one high reading, which the doctor said he was reasonably happy with but would keep an eye on it anyway.

He said he had shown it to the liver specialist at the hospital, and this guy said the liver is really sensitive and the slightest thing could make it elevate.

He told me that if there was nothing else obviously wrong and it wasn't causing problems, then it would probably be nothing to worry about going forward.

Hope this helps 

[justpozman]

There are other causes of fatty liver also known as NASH.  Non Alcoholic Steatohepatitis  and is a growing problem in the US even with those without hiv. 

I have had problems with high alt/ast and many meds have caused my counts to rise.  I finally found out I had to switch my diet.  It took me a year, but I have switched to using non-processed foods. 

It means cutting out HFCS (High Fructose Corn Syrup) & Hydrogenated Oils.  Good fats come from coconut oil, olive oil, avocado oil, ie plant based oils. 

As you read ingredients, you will catch on to processed foods that contain the above items.  Learn the other names for them because companies are learning they must change the name in order to keep people buying the product.  Hence, another reason to eat only non processed foods.  If you cannot afford this, switch to dry beans and learn how to cook them. 

Fresh fruit and steamed vegetables, no canned foods.  The lining in canned food is thought to now be a problem with health.  Since we have hiv, we must be on guard with this.

Remember everything you take down into your stomach, the liver processes.  EVERYTHING!  It does not matter if you are thin to obese. 

Watch out for high sugar products.  100% juice although without HFCS, still has many of sugar.  Better to eat fresh fruit.

Try eating a mixture of fresh fruit every morning.  Buy melons, mango, kiwi, bananas, pineapple and cut these up, dividing them into containers (mixed up) enough to store for 4 or 5 days.  Eat this in the morning on an empty stomach along with your coffee or tea if you drink that.  (btw, non dairy creamer has the oils that should not be consumed).  Do not eat anything else for 30 minutes.  This helps your body and ads the liver.

Whole beets and the greens are good for the liver.  You can keep them in the crisper until you want to steam them.  Add a little bit of cinnamon and steam for 35 minutes or so. 

An egg a day will help the liver since the sulfur is said to be good for the liver.  If you like boiled eggs, eat one of them daily.

Watch out for your bread.  Most has the oil you should not eat.  Watch out for genetically modified grains.     If you eat bread, be sure it is organic and if it is, is should be gm free. 

Check out the carbs and keep the serving carb rate at 15 or below with fiber, since some prepared items will have carbs in the 20s, 30s or 40s and no fiber.  Eat as little as possible anything that lists sugar as the #1, #2 or #3 item.

Cut out eating ice cream.  Or have it once a year.

It takes about a year for the body to adjust. 

The meds are hard enough on the body.  Modern life is hard too.  Processed foods add to the stress. 

[HowYouDoin]

Wow Justpozmen,

Thanks for the advice, it was very helpful and will take your advice into consideration. I eat dry beans and cook them on a regular basis and rarely eat any processed food. I eat tortillas alot since that is part of my culture's everyday eating diet and have been cutting down on it lately because Diabetes runs in my family. I have also cut down on bread. Do you think drinking alcohol and doing recreational drugs once in a blue affects the liver?

AL

[Ann]

Do you think drinking alcohol and doing recreational drugs once in a blue affects the liver?

Once in a blue moon isn't going to do any harm.

Heavy drinking will, especially if you're also on heavy-duty meds like ARVs. I'm a light to moderate drinker - also used to be hep C poz, but got the cure - and my liver's fine.

As I'm fond of saying, all things in moderation, including moderation.

[justpozman]

What is moderation?  Answer:  It depends on the person.

Do you know that a serving of alcohol is 4 ozs.? Measure it out sometime.  It isn't much.  For someone without liver problems, the rule is 2 drinks a day for men and 1 drink for women. 

What is moderation for street drugs?  Is it one bowl a day of pot, or only on the weekend?  Is it meth or blow and how much is it for moderation?  One may say, once a month, another every weekend and another a hit per day. 

The real question, is for the individual:  What can my liver handle at this time and for the foreseeable future?

It's good we live at a time, you can track this with your bloodwork and I hope you are keeping copies of all of your blood work so you can see for yourself.  Along with this, you need to take note of the changes you have done to relate it to the blood work.

As for your cooking beans, the tortillas you are using, look at the  ingredients and you may find it contains, some form of hydrogenated oils.  If so, find one that doesn't have it.  Google other names for hydrogenated oils.  The rule of thumb is, if you cannot pronounce it, then don't buy it. 

Did you know, that for 8 ozs of soda, it contains 14 teaspoons of HFCS?  Most sodas today had 16 ozs or 20 ozs.  Yes, HFCS may be okay in moderation, but 14 teaspoons is not moderation and I would think it is not moderation in anyone's mind.

There is HFCS in ketchup, in relish, in bread and it is not only a teaspoon.  It is in cakes because it makes them soft and moist.  Yes, a piece of cake is okay once a month, but that is if HFCS is being contained to that one piece of cake per month or only that one 8 oz glass of soda and not the big gulp. 

We have pesticide sprayed modified grain fed & hormone shot meat & dairy, hydrogenated fries, genetically modified buns & BPA plastics (which now they say do not microwave anything in plastic even if it says it is ok on the container). 

I'm sorry I sound pessimistic, but my point is to say, we are giving our liver an onslaught of things to fight against.  The liver is really good at doing this and has been for centuries.  However, we live in an age that has changed the way we handle food and our environment.  So, we have to be extra careful, plus we have to add the hiv and anything else that may be fighting our bodies.  Is it doable?  YES!!!!

My father use to drink a gallon of whiskey on the weekend and during the week he drank beer.  With each shot of whiskey, he drank a glass of water.  When he died, all of us thought his liver had to be shot to hell.  His liver was fine, not a problem with it.  His lungs, not so good, I saw that man suck gas out of cars along with the fact he smoked, so I'm not surprised. 

With me, my liver counts were up before I became infected, always by 20 points.  After getting infected with hiv and getting on the meds, they still stayed about the same.  Then I went off of all meds and I was infected with hepb.  Suddenly, my alt/ast shot up faster than a rocket to the space station.  So, I had to find ways of adjusting and I found going fresh fruit, steam veggies, no HFCS, no bad oils.  Then my liver count fell to 1 point about normal.  I've never seen that ever in my adult life as far back as I can recall with those counts.  If I had known then, I'd have at least a few more nickels.

You may find in looking at the food you are consuming, you missed some vital health side effects ingredients.  Check everything!  Even Wholefoods sells things with HFCS and bad oils, yet I have friends who thought it never did.  Don't assume what you are buying is ok, check it out. 

Most fruit that you peel is okay to eat because the outside has been treated and sprayed.  Fruit that is normally not peeled, even after washing, still contains pesticides.  Those fruits, you should buy organically.  Grapes grown in the US are considered safe, strawberries, you need to buy organic.  Apples organic.

Most root vegetables are safe, greens are not, unless organic.  Lettuces, should be organic.  If in doubt, ask questions or don't buy it.  Buy local to where you live as much as possible.  The transport time is less and thus normally has less pesticides.   

Slowly convert over so you have less risk of failing. 

Remember, the Taco Bell item you consume, will have HFCS and a higher chance of bad oils, unless otherwise stated.  McDonalds and the like, same thing. 

This is long and again, sorry about that. 

Change doesn't happen overnight, it takes 1 to 3 years maybe 5.  But the liver will start to respond usually within 3 months and most by one year. 

Peace 2u.

[tednlou2]

I've always been concerned about liver function even though my numbers have always been good except for a couple times when the AST was just slightly above normal.  Since my back surgery, I've taken Tylenol and then Tylenol in prescription pain meds.  I've always made sure I took less than the 4,000mg a day allowance.  Well, right after the surgery, I'm sure I took more than that.

I've had red splotches on my palms for several years now.  When I googled it, it talked about liver issues or syphilis.  I tested neg for that.  Whenever I've mentioned the palms to docs, they've always said they are nothing.  Still, I've heard some say they found out they had liver problems even though their numbers said all was fine.  I suppose AST and ALT usually give ya a good idea of liver function?   

[justpozman]

Did you ever have syphilis?  If so and it was considered 2nd stage, did they ever do a lumbar puncture to verify you do not have it in your spinal fluid?  That would be where it would hide.

Otherwise, it could be an effect of one of your meds, so check out the side effects for them.

I cannot take Tylenol because it causes my ast/alt to skyrocket.  I deal with the pain.  It is not easy some days, but it's better then dealing with another medicine.

Have you seen an allergist & a dermatologist for this?  Both of them should be ones who treat hiv patients.

[hotpuppy]

Heya Howyoudoing,
  I'm sorry to hear you are having some liver issues.  It can be scary and frustrating.  I know, I've been there.  I had to stop meds and the study I was in in December because my liver numbers were too high.

here's what I've learned since then:
- Fatty Liver affects many people with and without HIV.
- It's thought to be linked to metabolic changes caused by Protease Inhibitors... which I would guess is related to lipo type issues.

- The diagnostic process is to send you for an ultra-sound.  This is similar to what a pregnant woman has done... same machine actually.  The fat is very brigth on the ultra-sound.  They can also do this with an MRI, but an ultra-sound is less expensive.

- Beyond that the "cure" is to gradually lose weight, eat healthy, and avoid liver stressors like the plague.

Things that stress your liver:
- Tylenol and derived drugs.
- Alcohol.
- Recreational drugs
- Too many vitamins (certain types)
 

[older-wiser]

Your elevated liver function test readings are actually very low and should be of only modest concern.  I've had this same "problem" for about two years and have done nothing about it.  My infectious disease MD has been much more concerned than I.  I was eventually referred to a hepatologist (with a secondary interest in liver transplantation) who really found nothing else unusual (OK, maybe a minimally chubby liver).  Interestingly I subsequently passed a gall stone and was persuaded to have an endoscopic gall bladder removal in January. Surprise! my liver enzymes have returned to normal. I still have a slightly fatty liver, I'm told.

Most of the advice in these posts has merit.  I particularly like "moderation in your moderation".  Abstain from alcohol if you can and watch your total intake of tylenol (acetominophen---it's in damn near every over-the counter medication).  Be aware that most of your HIV medications themselves can cause modestly elevated liver enzymes.  I wouldn't go crazy over any special diet; I, myself, am addicted to Haagen-Dazs vanilla ice cream.

[hotpuppy]

Heck life without pleasure is pretty miserable.

When I looked at my diet I decided that it made more sense to cut out coca-cola and caffeine then to make drastic changes to what I ate.  So I gave up caffeinated sodas..  I still have a sprite or root beer every once in a while, but I refuse to buy the stuff at the store and won't keep it in the house.  I drink kool-aid instead (don't laugh) and allow myself something to snack on mid-afternoon and/or at bedtime.

My current favorite is an ice cream cone.... the drumstick ones with nuts on top (boy do I like nuts.... lol) and chocolate topping.  It's tasty, a good portion, and most importantly I'm not likely to eat half a gallon of it as "lunch".   lol.

Anyhow, the salient point here is that weight loss should be gradual.  I'm losing about 3 pounds per month now and that's a good slow rate of weight loss. 

[Jeffreyj]

I have been accused of the "fatty Liver" thingy. As they say:"this too shall pass" in time. This is not worth the worry. Like Jan says, limit the hooch and you should be fine. Walk a few miles a Day if nothing else. Best of luck Howie.

[hotpuppy]

Yea, my personal reaction was like.... Um excuse me... do you mean to tell me I abstained from being a drunken lush all these years and still wound up with the same liver problem?  Hmmm, I'd like my wild 20's back please!

[bagavat]

I think you have to take an active interest in your health by actually getting off the couch and exercising and eating right as the other people have said.  You cant just rely on docs and meds to make you healthy.  I go to the gym a couple of times a week for a modest workout and swim and sauna.  Not only is it good for my body but also for my mental health.  It really gives me a boost to get out and see and talk to other people, esp in the sauna I have found people like to talk.  I even got cruised yesterday by a couple of guys I thought might be gay.  It was in the locker room and I was naked going from the showers to my locker since someone had walked off with my towel when I was in the pool.  That was a nice boost for my fragile ego since I am ancient (61) by gay standards.  But I am fit and look fairly good in my decrepitude. 

Anyway, I go to the local Korean market and get really nice fresh and very cheap veggies and especially fresh fruit by the bag full.  Then when it is ripe I put it in my juicer (it has a stick in the top to push around the stuff as it grinds up).  I used to go to Jamba Juice after my workouts but at about $4 its a little pricey.  So now that fruit is plentiful I grind up everything I can get my hands on.  And dont forget ice cubes to give it that crunchy mouth feel.  Just like the big boys. 

My favorites are kiwi, strawberry, banana, peaches, mangoes, blueberries (frozen), oranges, and some protein powder.  It is sweet and delicious and full of good things and gets those 4-5 servings of fruit we are supposed to have every day.  In winter and if you dont want the hassle of cutting up all the fruit, etc you can just get some Odwalla juices, etc and put them in with some banana and protein powder and ice cubes.  Its very easy and still very good for you.

[hotpuppy]

I think you have to take an active interest in your health by actually getting off the couch and exercising and eating right as the other people have said. 

Um, you know.... some of us didn't sit on the couch and ask to have our metabolism screwed up by HIV drugs.  Lipo issues are well known and not very well understood.  It's not that you get fat, its that your fat reserves move into your liver and crowd the cells there....

The cure isn't "going to the gym" or "going on a diet".  In fact there is no cure.  The only counter-action is to slowly lose weight by modifying your diet and hope that your liver enzymes come down.

Anyhow, so before you jump on the "go to the gym fatass" bandwagon, please at least understand the problem and it's cause. 

[BusyDame]

Did you ever have syphilis?  If so and it was considered 2nd stage, did they ever do a lumbar puncture to verify you do not have it in your spinal fluid?  That would be where it would hide.

Is there a remedy for things lurking in the spinal fluids? How about just treaating 2nd stage infections, I must confess I have little understanding of them.

Speaking of allergies,  I do know of someone whose baby boy developed bright and painful full body coverage sloptches each time she ate chillies while she was breast feeding. This was only discovered by retracing.

All the best