AST and ALT ratio

Question

Hello Dr McGovern,

I have a question regarding my recent lab results. I had Acute Hepatitis-B about 4 years ago. I completely recovered and am now Hep-B surf antigen neg and Hep-B antibody positive. I have bloodwork done every 6 months just for routine check ups. On my last test my AST was 14 and my ALT was 8, I was under the inpression that the ALT was always supposed to be higher than the AST and that a higher AST than ALT can signal cirrosis or some other signes of liver disease. I had an ultrasound and an MRI which only showed mild fatty liver. I am pushing for a liver biopsy but my Dr doesnt seem to think it is necessary and seems to think everything is fine. I am considering switching Dr's over this. What is your opinion on this issue? Am I overreacting or is a biopsy a good idea in your opinion?? Thank you for your time!

Mark

Answer

You have much insight into liver disease. AST>ALT can be seen in a few situations: alcohol intake and in advanced liver disease. However, since your liver function tests appear completely normal, I would not be concerned about the ratio. I would only be concerned about AST>ALT when at least the AST is abnormal.

As for the fatty liver on imaging - You will want to ask your doctor as to which risk factors you may have for fatty liver - diabetes, high cholesterol, high triglycerides, obesity, or alcohol use. You will want to address any of these potential risk factors and have further follow-up of your liver function tests. Fatty liver can be benign, but if inflammation (often reflected in abnormal ALT or AST) is playing a contributory role, then something called steatohepatitis can become an issue. I would continue serial liver function tests for now and address any potential risk factor in the meantime.