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Elevated ALT Levels
Nov 10, 2013

Hello Dr. Taylor,

I recently had a blood test done at work and everything came back normal except my ALT. Specifically, it was 52. My billirubin total was 0.4, my albumin was 4.4, my AST was 25, and my alkaline phosphatase was 51.

Through my research, I learned that the acceptable upper limit for ALT was dropped from 55 to 45. Should I be concerned about my elevated ALT given that everything else is normal? I am a sexually active gay male and have received unprotected oral sex on a handful of occasions. Should I be tested for any form of hepatitis specifically?

Response from Dr. Taylor

First, all gay men and other men who have sex with men, should be checked for hepatitis B with a blood test for hepatitis B surface antigen, and vaccinated against hepatitis B if not infected. This should occur no matter what the ALT level. The same goes for hepatitis A.

There are many, many reasons that the ALT may be elevated. The list includes infections, such as viral hepatitis C and B, as well as syphilis; toxins/medications such as 'statins' taken to lower cholesterol and alcohol; and other forms of liver disease (genetic, metabolic for example fatty liver disease, and others).

HIV and hepatitis B may be spread via unprotected oral sex.

I suggest getting tested for HIV, hepatitis A and B, and syphilis to start.

There remains controversy about the 'cutoff' for what constitutes and elevated ALT. If after getting these tests you do not have the answer and your ALT remains negative, a careful history and physical exam can help your doctor with further evaluation to get you an answer.



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