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Re: Fatty Liver Diagnosis
Feb 17, 2004

You stated in a response last year that a diagnosis of fatty liver by ultrasound is always suspect. My doctor did an ultrasound after a slightly high alk. phos. number(140)and slightly high alt.(37). (I have never had Hep C and have resistence to Hep B.) Ultrasound showed "enlarged liver" upon which he did additional blood work (not sure what all it entailed, but did have an ANA). He said all that blood work was "normal" and didn't seem overly concerned about the fatty liver, saying it could be hereditary or from the meds (currently on Sustiva, Tenofovir, and Epivir 1X a day...my CD4s are over 600, average 45, and VL<75). He said it would be ok for moderate alcohol consumption, about 4-5 drinks a week. Incidentally, is 4-5 drinks per week considered moderate or light drinking--so hard to get a straight answer on number of drinks vs. level of consumption.

I see my doctor again next week and based on your comment re: diagnosis of fatty liver, I'd like to know what I should ask him as far as a follow-up to the diagnosis, i.e., do I truly have "fatty liver", particular tests taken as part of the diagnosis, etc? You state that a true diagnosis of fatty liver requires a biopsy, something he did not request. I gather that based on the "additional blood work" he felt a biopsy was not necessary. Are there certain tests I should ask him to give me?

Also, what is your opinion on alcohol? Would a limited amount be all right given my circumstance? Is the fatty liver alcohol related? I also gather fatty liver can easily go undiagnosed if liver functions are not checked often as they are for people on HAART and since I had no pain or other symptoms. Does it sound like I have either steatosis or steatohepatitus (NASH)? I have never been an extremely heavy alcohol user, though I felt before I was diagnosed in the acute phase and started immed. on HAART I drank more than I would have liked to. One of the true benefits of going on HAART has been that I have cut my drinking way, way back in the 18 or so months I have been on meds. Though my cutting way down on alcohol was initially because of my diagnosis and being on medication, I have found so many great reason for being a moderate to light drinker. I find now that I can go a number of days without desiring a drink and when I do have one I can easily stop at one drink and make it a point not to have more than two on any given day. I am concerned about continuing to limit my drinking and obviously do not want to develop cirrhosis. If I indeed have fatty liver, should I give up drinking entirely? What is considered ok for most individuals doing well on HAART in terms of drinking? I appreciate the changes I've made in limiting my alcohol and still find pleasure in an occasional glass of red wine or cocktail.

Your comments are much appreciated.

Response from Dr. Dieterich

It sounds like your liver is OK. The best test for fatty liver is insulin level, fasting and a glucose at the same time. You are not taking any drugs that can likely cause it. It could also be completely genetic and not HIV related. 4-5 drinks per week is OK as long as they are all not on Saturday night! DTD



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