Fluctuations in Liver Enzymes During Hepatitis B Treatment

After taking Baraclude for hepatitis B carrier status, the liver enzyme levels fluctuate?

Dear Dr.
Chen,
I am a carrier of hepatitis B and started treatment with Baraclude on April 14th of this year due to elevated liver enzymes.
I have been taking the medication for about three weeks now.
The changes in my liver enzyme levels during this period are as follows:
Before medication:
- April 12: AST: 122, ALT: 309
- April 14: AST: 119, ALT: 295
After starting medication:
- April 25: AST: 136, ALT: 267
- May 2: AST: 167, ALT: 338
Although there seems to be a downward trend in liver enzymes after starting the medication, I noticed an increase in liver enzyme levels on May 2.
This is my first time taking medication for hepatitis B, and I take the medication on an empty stomach before bed every day, so I should not be developing drug resistance.

Is it normal for liver enzyme levels to fluctuate during the early stages of treatment? Thank you.

Mr. Lin, 20~29 year old female. Ask Date: 2017/05/06

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
Belatacept rarely develops resistance, and the onset of resistance does not occur within the first few months, so there is no need to worry.
Changes in liver function need to be evaluated to rule out other causes and should be monitored further, including a comprehensive assessment of viral load fluctuations.
Changhua Hospital cares about your health.
Chen Shih-Tien.

Reply Date: 2017/05/06

More Info

Dear Patient,
Thank you for your inquiry regarding the fluctuations in liver enzymes during your Hepatitis B treatment. It’s understandable to be concerned about the variations in your liver function tests, especially when you are undergoing treatment for Hepatitis B.
Firstly, it is important to recognize that fluctuations in liver enzyme levels, such as GOT (AST) and GPT (ALT), can occur during the initial phases of antiviral therapy for Hepatitis B. This is not uncommon and can be attributed to several factors. When starting antiviral treatment, the body may undergo a series of changes as it responds to the medication and as the virus is being suppressed.
In your case, you mentioned that your liver enzymes showed a downward trend initially but then spiked again. This could be due to a few reasons:
1. Viral Replication and Immune Response: The initial decrease in liver enzymes may indicate that the antiviral medication is effectively suppressing the virus. However, the subsequent increase could suggest a rebound in viral activity or an immune-mediated response as your body begins to fight the infection. This is sometimes referred to as a "flare," where the immune system becomes more active, leading to increased inflammation and, consequently, higher liver enzyme levels.

2. Medication Efficacy: While you are taking the medication as prescribed, it is possible that the specific strain of the virus you are dealing with may have varying levels of susceptibility to the drug. In some cases, the virus may develop resistance, although this is less likely in the early stages of treatment if taken correctly.
3. Liver Health and Other Factors: Other underlying health issues, lifestyle factors (such as diet, alcohol consumption, or co-existing conditions), and even laboratory variability can influence liver enzyme levels. It’s essential to consider these factors when interpreting your results.

4. Monitoring and Adjustment: Regular monitoring of liver enzymes is crucial during treatment. Your healthcare provider may adjust your treatment plan based on these fluctuations. If the liver enzymes continue to rise or do not show improvement over time, further investigation may be warranted to assess for potential resistance or other complications.

In conclusion, while fluctuations in liver enzymes during the initial phase of Hepatitis B treatment can be concerning, they are not uncommon. It is essential to maintain open communication with your healthcare provider, who can provide personalized guidance based on your specific situation. They may recommend additional tests or adjustments to your treatment plan if necessary.

Lastly, it is crucial to adhere to your prescribed treatment regimen and attend follow-up appointments for ongoing monitoring. This will help ensure that any potential issues are addressed promptly and that your liver health is managed effectively.

Thank you for your question, and I wish you the best in your treatment journey.

Best regards,
Doctor Q&A Teams

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