liver enzymes up with treatment
Apr 13, 2003
dear doctors....i have been on tenofovir, 3tc and a norivir boosted amprenavir regiman for 5 months. it has been very tolerable and i was very compliant. the only disturbing problem is that my AST values have been rising steadily each month. i do have chronic Hep B, so my baseline AST has always been about double...approx. 80-90 u/l. the first month it went to 109, then 168, then 199, then 229 and most recently 350. my doctor doesn't seem to freaked out, but i am seriously worried about the damage to my liver. we will be discussing it. anyways, what is your take on these drugs..do they have a history causing liver abnormalities...will my liver explode if i continue with them (i might add that they work well with a healthy increase in T cells and non-detectable VL) thanks for your help. D
Response from Dr. Henry
Potent antiretroviral therapy not infrequently can cause an elevation in liver enzymes. Ritonavir containing regimens (particularly higher dose ritonavir) are particularly likely to cause that (though the actual health consequences are less clear). I assume that you have no evidence for hepatitis A or C and that alcohol use is minimal. If your hepatitis B is doing well on the 3TC/tenofovir then I often carefully observe the liver status if the regimen otherwise is well tolerated and effective. Liver irritation often doesn't result in serious health problems and may settle down with more time. If your liver enzymes continue to rise then a careful clinical/lab evaluation and consideration of a lvier biopsy would be indicated. KH
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