Question
Why is my ALT elevated?
9 June 2022. Related: All topics, Living with HIV long-term, Side effects.
My liver ALT enzyme has slightly gone high and I drink alcohol in moderation. I am on dolutegravir and tenofovir. Since I got diagnosed my ALT was always slightly higher anyway. Is anyone in the same situation and how do you decrease your ALT?
Answer
Hi, how are you doing?
Is your ALT high but within a normal range, or is it high and outside of the range?
ALT is a test that is used to determine how healthy the liver is. If this is increased it means the liver has been/is being damaged.
Tenofovir is only known to cause liver damage if given with other drugs. These include: stavudine, didanosine and zidovudine. As you have not mentioned any of these drugs, it suggests tenofovir is not a cause.
Dolutegravir can cause liver damage. How this happens is unknown but it is a common side effect. In these cases a rise in ALT is expected and different hospitals will have different cut-offs for intervention. ALT can rise a lot before there is a cause for concern, as an example some may not intervene until ALT is 5 times the normal value.
When this happens, doctors would consider switching from dolutegravir or starting treatment breaks. Have you noticed any other symptoms suggestive of your liver being damaged? These include: jaundice (yellowing of the skin), prolonged bleeding, and increased weight.
Reducing ALT depends on the damage and the cause. You have mentioned you drink and this can cause liver damage. Reducing or stopping this can help reduce your ALT. This can also be improved by following a healthier lifestyle with a balanced diet and exercise.
Josh.
Hi Az, your doctor is right to say that is okay to remain on your current treatment – as long as you continue to be monitored. As mentioned, a rise in ALT is not always significant/warranting intervention.
While you only drink a couple glasses of wine, cutting down may help to improve/prevent further damage to your liver. As your ALT was higher before starting treatment, this is suggestive that something else is the case – your medication may just have an extra effect.
Switching to a single tablet will only have a benefit in this context if you are switching the drugs. A combined pill will have the same dose of each medication as when they are split.
Hello Josh
I believe the ALT is high as the normal range should be from 10-50 however my ALT two months ago was 86 and previously it was 76.
However before starting the treatment it was 62.
The docter believes it’s still fine however I am concerned that it keeps going high.
I don’t have any other symptoms and as I said I drink less then 14 units of alcohol per week such as couple of glasses of wine.
I am also changing to a single tablet a day and was wondering if this would lessen my changes or liver and kidney damage in the future.