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Jun 30, 2003

What is the cause of elevated ALTs? Why do HEP+ people with lower ALTs sometimes have a more difficult time clearing virus? If ALT has no direct relationship to hepatic damage, why is "normalization" of ALT seen as a good thing in therapy?

Response from Dr. Dieterich

Good question! ALT and AST are enzymes that are contained in liver cells. When those cells die, they release the enzymes into the blood and they are measured in a test. When more cells are dying there is usually a better immunne response to the virus resulting in more cell killing of infected cells. So people who have higher AST and ALT have better immune responses to the viruses. If the virus goes away then the enzymes will normalize because there will be nothing for the immune system to attack. However ALT has no relation to fibrosis or scarring in the liver which can lead to cirrhosis. Scar formation is unrelated to inflammation and is caused by other cells call stellate cells that can't be measured in the blood. If you understand this, you are way ahead of most doctors! DTD

Wife tested positive.

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