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. > 20 g in women, > 30 g in men
  2. Non-Alcoholic Steatohepatitis, see NAFLD
  3. APRI, AST to Platelet Ratio Index = (AST in IU/L) / (AST Upper Limit of Normal in IU/L)/ (Platelets in 109/L)
  4. FIB-4 = Age ([years] x AST [U/L])/([platelet [109/L]) x ALT [U/L]). For NAFLD aetiology FIB-4 cut offs are as follows: < 1.30 (low risk), > 2.67 high risk.
    FIB-4 cut off < 2.0 (instead of < 1.30) should be considered in persons aged > 65 years