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AST, ALT High, LFT Normal, Hepatitis B Carrier, Last Test Negative, Soreness Muscle

Posted on Thu, 24 May 2012

Question: AST/ALT high, other LFT are very normal
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Dear Doctor,

Would appreciate if you can comment on my latest LFT result. Does it indicate liver damage or something else? Has been posting in multiple forums. Want to get a second opinion.

Protein, Total : 73
Albumin: 46
Globulin: 27
Bilirubin, Total : 3 (it is indicated low, as I normally get 7-10)
Alkaline Phosphatase, Total: 67
Alanine Aminotransferase : 114 (high)
Aspartate Aminotransferase : 207 (high)
Gamma-glutamyltransferase : 28

I am Hep B carrier under lamivudine treatment. Last HBVDNA test was last year Aug and negative. HBeAg changed from positive to negative after 3 years of lamivudine treatment and has kept as negative so far. However, my doctor want me to continue take lamivudine after sero-conversion. Moreover, happened to test ALT (part of yearly body check) 4 days ago before above test, and the value is 42. So far, I am feeling great, eating and sleeping normal (apart from anxiety). Moreover, I have LFTs test every 4 months and all normal so far.

I am not drinking or taking any medicine, except herbs. (Taken some Valerian root before testing) I have searched Internet lately, and found that AST elevated faster than ALT, may due to muscle sore. I had weight training 2 days before the test, and some muscles are pretty sored during the blood taking.

Answered by Dr. Poorna Chandra K.S (2 days later)

Hi ,

Thanks for the query

There are certain points of uncertainity in your query
HBV carrier state is not normally treated and one initiates therapy only if there are elevated SGOT & SGPT along with a raised HBV DNA levels. Bilirubin is always normal in a carrier where as it is eleveted in your case.
Muscle related raise in SGOT is usually not associated with significant raise in SGPT and any elevation in bilirubin
Lamivudine if used for more than 6months has a high likehood of leading to development of resistant virus and subsequently a flare of hepatitis. Hence in your case one cannot rule out a viral brakthrough and a hepatitis flare.
HBV hepatitis is of two types of disease - HBeAg +ve HBV hepatitis and HBeAg -ve HBV hepatitis. Hence it is better to test HBV DNA rather than looking at HBe Ag
Hence I would suggest you to consult your GI and get these issues clarified
Regards
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Poorna Chandra K.S (8 days later)

Hi doctor, I think my Bilirubin is lower than normal but not elevated.

Answered by Dr. Poorna Chandra K.S (26 hours later)

Hello again,

Thanks for writing back.

Normal value of total Bilirubin is 0.1 to 1.2. Your total Bilirubin level is 3 which is high.

Hope I have cleared your doubt.

Wishing you good health.

Regards,

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Above answer was peer-reviewed by : Dr. Radhika