Oct 3, 2001
dear doctor. I began a new combo of viramune, epivir and videx. last two blood tests ggt was 350 and 430 which is about five times the upper normal limit. all other liver enzymes were nornal. I have no side effects. if ggt go up do I risk liver damage? at what level of ggt do I have to change my drugs? can you also elaborate of what exactly ggt is? is it realy less important than other liver enzymes? can i use any nutritions to reduce ggt? thank you very much for your input.
Response from Dr. Young
Thanks for your question.
Elevations in ggt are suggestive of liver injury. Levels as high as you describe are very concerning and in our office would certainly prompt discussions about treatment interventions.
You have not described what your other liver function tests are doing, but one would be concerned about the likelihood that other tests (AST, ALT, bilirubin) might be abnormal too. Liver injury can be the result of many insults, including medications, excessive tylenol or alcohol consumption. While you might be able to continue to monitor you clinical and laboratory situation, I would be led to conclude that nevirapine (Viramune) is likely to be the culprit (the time line is very characteristic of nevirapine-induced liver function abnormalities). If this were the case, one could entertain switching from nevirapine to another NNRTI, such as efavirenz.
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