Jul 19, 2010
Hi, I am HIV positive since May 2008. My first CD4 count was 650 and they keep fluctuating. I am now back to 700. My viral load is 134. I am not taking any medication, as my doctor insists that the longer we delay the treatment , the better it will be for my future health. My last test shows very high levels od AST (169) and ALT (98) as well as Albumin (52). I was vaccinated against Hepatitis A and B 10 years ago and have created antibodies.As for Hepatitis C, I haven't had any sexual relations for the last 2 years, which makes it very difficult to have gotten it. 5 months ago these levels were in the 20's. As for my lifestyle: I do not drink, I don't smoke, I follow a healthy balanced diet and I exercise regularly.I am 40 years old, by the way. What do you reccomend I do? WHat can this high levels mean??? Thanks a lot and congratualtions on this great site. Tony form Spain
Response from Dr. McGovern
I would get tested for HCV antibodies and HCV RNA regardless of whether you think you are at risk. I am concerned about the elevations of AST and ALT which are significant.
When I see this pattern of ALT elevation (eg, AST greater than ALT) I usually consider alcohol injury. However, your lifestyle does NOT suggest this....
I would also ask for testing for diabetes, insulin resistance, and triglycerides and cholesterol, which are risk factors for fatty liver disease.
I would also pursue evaluation for other kinds of liver disease such as hemochromatosis. You may need an evaluation for chronic liver disease by a hepatologist if no diagnosis can be obtained by laboratory evaluation and your liver tests remain elevated. You need a careful history and examination and you may need a liver biopsy in the future.
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