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Author Topic: High ALT Liver enzyme #s and Atripla: a better option?  (Read 5607 times)

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Offline NY2011

  • Member
  • Posts: 173
High ALT Liver enzyme #s and Atripla: a better option?
« on: April 22, 2012, 08:50:04 am »
I'd like to know if anyone has switched from Atripla to another drug because of elevated liver enzymes, and has seen an improvement.

My current AST is 40 to 48, which is normal to slightly out of range.
My current ALT is 100 to 110, which is high.

I switched from the first regimen: Truvada+Norvir+Prezista due to extremely elevated enzymes, so protease inhibitor (or booster) is not an option for me. Within 45 days of taking that drug combination, the AST went as high as 110, and ALT went to 320!  I stuck it out for five more weeks, with weekly blood tests showing that the numbers were trending downward, but not fast enough, so my doctor switched the Prezista+Norvir to Sustiva. 

One week after switching to Atripla, the AST was 40 and and ALT was 98. 

Doctor said it's non-alcoholic fatty liver disease, but I'm still convinced that it's the drugs.  My first blood test, taken 10/27/2011 while I was very sick and was seroconverting, but before starting drugs, showed AST and ALT both at 60. 

Any anecdotal information is appreciated from people who have seen an improvement in their ALT as a result of the switch from Atripla to something else. 

Thanks.

btw, I have tested negative for hep A B and C.  I was immunized years ago for B and just got the first of 2 shots for A.
« Last Edit: April 22, 2012, 03:19:29 pm by NY2011 »
Logged
10/26/2011 - SEROCONVERSION (fever+rash, 104 degrees F)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   (49%)
03/26/2014 - CD4=1,050 VL= ud
11/25/2014 - CD4=1,335 VL= ud
12/01/2015 - CD4=1,115 VL= ud (55%)
11/22/2016 - CD4=1,071 VL= ud (52%)
06/01/2017 - CD4=1,014 VL= ud (53%)
switched to Biktarvy in 2018
04/23/2019 - CD4=1,072 VL= ud (52%)
01/15/2020 - CD4=  925  VL= ud (50%)

Offline newt

  • Member
  • Posts: 3,900
  • the one and original newt
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #1 on: April 22, 2012, 10:57:39 am »
ALT of around 100 isn't really that high.

Your doc can tell if it's non-alcoholic fatty liver disease by doing an ultrasound.

Isentress is the best option for reducing burden on the liver

- matt
Logged
"The object is to be a well patient, not a good patient"

Offline Billy B

  • Member
  • Posts: 392
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #2 on: April 22, 2012, 12:47:13 pm »
Hello NY,
I also have slightly elevated liver numbers but it is because of damage from a genetic disorder that causes iron overload (hemochromatosis). Because of this my ID and Gastro Doctor decided that I&T were the best meds for my liver health. They both said that they did not really get too concerned over enzyme levels until they were 3 or 4 time the normal range. A liver biopsy is really the best way to evaluate your liver health and condition. I have had many over the years and the procedure is so much easier now than it was 20 years ago.
Peace,
Billy
Logged
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13
VL  UD   CD4 450 CD4% 29.8 09/10/13
VL  UD   CD4 430 CD4% 31.0 04/29/14
VL  UD   CD4 520 CD4% 34.8 11/05/15
VL  UD   CD4 440 CD4% 33.5 03/10/15
VL  UD   CD4 450 CD4% 30.5 08/23/16
VL  UD   CD4 510 CD4% 34.0 07/21/20  (Biktarvy)

Offline NY2011

  • Member
  • Posts: 173
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #3 on: April 22, 2012, 01:49:43 pm »
Matt/Billy. Thank you. This is EXCELLENT advice, and I will ask about an ultrasound, and I will inquire about Isentress.  I will pass on the liver biopsy, though I have read that today's procedure is simple and painless. 

« Last Edit: April 22, 2012, 03:21:27 pm by NY2011 »
Logged
10/26/2011 - SEROCONVERSION (fever+rash, 104 degrees F)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   (49%)
03/26/2014 - CD4=1,050 VL= ud
11/25/2014 - CD4=1,335 VL= ud
12/01/2015 - CD4=1,115 VL= ud (55%)
11/22/2016 - CD4=1,071 VL= ud (52%)
06/01/2017 - CD4=1,014 VL= ud (53%)
switched to Biktarvy in 2018
04/23/2019 - CD4=1,072 VL= ud (52%)
01/15/2020 - CD4=  925  VL= ud (50%)

Offline eric48

  • Standard
  • Member
  • Posts: 1,361
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #4 on: April 22, 2012, 05:30:06 pm »
Hi,

Because of my combo I unders surveillance for hepatoxicity.

I was explained that liver disfunction is suspected not when ALT or ASAT or other go out of range, but when they reach 5 times (or more) of the 'normal' range;

Being 10% over the 'range' is nothing, IMHO, in that context

Eric
Logged
NVP/ABC/3TC/... UD ; CD4 > 900; CD4/CD8 ~ 1.5   stock : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: https://clinicaltrials.gov/ct2/show/NCT02157311 ; 2016: use of granted patent US9101633, 3 days ON, 4days OFF; 2017: added TDF, so NVP/TDF/ABC/3TC, once weekly

Offline newt

  • Member
  • Posts: 3,900
  • the one and original newt
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #5 on: April 23, 2012, 09:19:37 am »
Quote
I will pass on the liver biopsy, though I have read that today's procedure is simple and painless. 

Fibroscan, a special ultrasound for the liver, is non-invasive. Liver biopsy is invasive and carries quite a high risk of complications even if it is indeed simple and painless these days.

- matt
Logged
"The object is to be a well patient, not a good patient"

Offline Billy B

  • Member
  • Posts: 392
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #6 on: April 23, 2012, 11:58:25 am »
Newt,
Not to contradict you but:


Imaging techniques such as ultrasound-based transient elastography (TE) and magnetic
 resonance elastography (MRE) are available at the Mayo Clinics here in the US. It is a good non invasive test but the closest clinic with this equipment is 12 hours from where I live. I was in the trials for use and evaluation of the noninvasive screening with serum markers (Fibrotest) verses having a biopsy and the Fibrotest only gives a % or estimate of damage.
Below is the link to the full explanation of all the procedures.


http://www.aidsmeds.com/articles/hepatitis_biopsy_fibrotest_1667_20603.shtml
Peace
Billy
« Last Edit: April 23, 2012, 12:12:18 pm by Billy B »
Logged
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13
VL  UD   CD4 450 CD4% 29.8 09/10/13
VL  UD   CD4 430 CD4% 31.0 04/29/14
VL  UD   CD4 520 CD4% 34.8 11/05/15
VL  UD   CD4 440 CD4% 33.5 03/10/15
VL  UD   CD4 450 CD4% 30.5 08/23/16
VL  UD   CD4 510 CD4% 34.0 07/21/20  (Biktarvy)

Offline NY2011

  • Member
  • Posts: 173
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #7 on: April 23, 2012, 07:59:51 pm »
Quick update: The good news:
the latest blood results show AST = 28 and ALT = 54. Something worked within a month.  Also, t-cell count went up to 1,221 from 750 four months ago.  Medicines have come a long way, huh.

The bad news:
Viral load went from undetectable to 140.  Could be a "blip" as my doctor put it. 
Cholesterol is 276, and triglycerides is 194, tho I was not fasting.
TSH (thyroid) is 9.89, when it should be around 4.5, even on synthroid .075mcg.
« Last Edit: April 24, 2012, 10:42:31 pm by NY2011 »
Logged
10/26/2011 - SEROCONVERSION (fever+rash, 104 degrees F)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   (49%)
03/26/2014 - CD4=1,050 VL= ud
11/25/2014 - CD4=1,335 VL= ud
12/01/2015 - CD4=1,115 VL= ud (55%)
11/22/2016 - CD4=1,071 VL= ud (52%)
06/01/2017 - CD4=1,014 VL= ud (53%)
switched to Biktarvy in 2018
04/23/2019 - CD4=1,072 VL= ud (52%)
01/15/2020 - CD4=  925  VL= ud (50%)

Offline NY2011

  • Member
  • Posts: 173
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #8 on: April 26, 2012, 06:35:37 am »
Newt, I found a doctor in NYC that uses FibroScan: Dr. Dieterich @ Mt. Sinai Hospital.  As per my latest results, I will not need the scan, however, it is good to know if it's ever needed in the future, or if others in the NY area are dealing with this.  Very informative.  Thank you.
Logged
10/26/2011 - SEROCONVERSION (fever+rash, 104 degrees F)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   (49%)
03/26/2014 - CD4=1,050 VL= ud
11/25/2014 - CD4=1,335 VL= ud
12/01/2015 - CD4=1,115 VL= ud (55%)
11/22/2016 - CD4=1,071 VL= ud (52%)
06/01/2017 - CD4=1,014 VL= ud (53%)
switched to Biktarvy in 2018
04/23/2019 - CD4=1,072 VL= ud (52%)
01/15/2020 - CD4=  925  VL= ud (50%)

Offline Billy B

  • Member
  • Posts: 392
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #9 on: April 26, 2012, 11:36:57 am »
Newt,
My apologies to you. The FibroScan procedure appears to be very similar to magnetic
resonance elastography (MRE) that is available at the Mayo Clinics.  I looked up the  procedure and found it to be European / Canadian based. I guess that each major top tier medical organization will soon have scans with their own copywritten name.
I had thought about going to Florida and having a MRE preformed instead of having my last biopsy and my insurance company actually approved the procedure
because it was cheaper to preform.
Peace
Billy
Logged
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13
VL  UD   CD4 450 CD4% 29.8 09/10/13
VL  UD   CD4 430 CD4% 31.0 04/29/14
VL  UD   CD4 520 CD4% 34.8 11/05/15
VL  UD   CD4 440 CD4% 33.5 03/10/15
VL  UD   CD4 450 CD4% 30.5 08/23/16
VL  UD   CD4 510 CD4% 34.0 07/21/20  (Biktarvy)

Offline NY2011

  • Member
  • Posts: 173
Re: High ALT Liver enzyme #s and Atripla: a better option?
« Reply #10 on: April 26, 2012, 10:00:28 pm »
Good to hear, Billy...that it was approved, and thanks for your info.
Logged
10/26/2011 - SEROCONVERSION (fever+rash, 104 degrees F)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   (49%)
03/26/2014 - CD4=1,050 VL= ud
11/25/2014 - CD4=1,335 VL= ud
12/01/2015 - CD4=1,115 VL= ud (55%)
11/22/2016 - CD4=1,071 VL= ud (52%)
06/01/2017 - CD4=1,014 VL= ud (53%)
switched to Biktarvy in 2018
04/23/2019 - CD4=1,072 VL= ud (52%)
01/15/2020 - CD4=  925  VL= ud (50%)
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