Increased ALT/AST: Work-up & Management

Identify potential cause of increased liver enzymes, using the following steps:

See Clinical Management and Treatment of HBV Co-infection and HCV Co-infection in PLWH
See Liver Cirrhosis: Classification and Surveillance 
See Liver Cirrhosis: Management

  1. Non-Alcoholic SteatoHepatitis, see NAFLD
  2. APRI, AST to Platelet Ratio Index = (AST in IU/L) / (AST Upper Limit of Normal in IU/L)/ (Platelets in 109/L)
  3. FIB-4 = Age ([years] x AST [U/L])/([platelet [109/L]) x ALT [U/L]). For NAFLD aetiology FIB4 cut offs are as follows: < 1.30 (low risk), >2.67 high risk. FIB4 cut off < 2.0 should be considered in persons aged > 65 years
  4. [14]