Laboratory reference ranges for ALT often run to 40 U/L or higher. Hepatitis B guidelines use lower upper limits, roughly 30 to 35 U/L for men and 19 to 25 U/L for women depending on the guideline, because liver inflammation can be present below the laboratory limit.
In today's RADICAL data, ALT above 30 U/L within the 'normal' range tripled the chance of becoming immune-active.
- Interpret ALT in hepatitis B against guideline thresholds, not the laboratory reference range.
- Repeat ALT and HBV DNA every 3 to 6 months in untreated patients.
- Assess fibrosis with elastography where available when ALT is high-normal.
- Refer when ALT is persistently above guideline thresholds with HBV DNA above 2,000 IU/mL.
Why it matters
Relying on the laboratory range can hide active hepatitis B for years.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free