Simple FactSheet: ALT, a Liver Test

ALT, A liver Test
a Simple FactSheet from the AIDS Treatment Data Network

||||| What is ALT?

ALT is a protein. It is made by liver cells. The ALT test is measured by taking a blood sample. If there is an increased level of ALT above that which is normal, something is going on which is causing ALT to increase in your blood. ALT should mainly be in your liver where it acts as an enzyme (a working tool) to assist in building proteins. Your liver is where everything gets broken down and proteins are made. It is also where bile to digest food is made.
If ALT increases in your blood (sometimes called plasma), it usually means that something is causing it to get out of the liver. ALT may be seeping into the blood because the liver is damaged or some chemical or virus is overloading your liver.
An increased ALT level in your blood can be a sign of a lot of different things, so it's a good overall test to check your liver out. Even a slight elevation or an increase from a previous test means you should get it checked out more completely. In some serious liver problems, your ALT may only go up a little or seem normal.
You should have an ALT test at least once a year. It is very easy to have done. In most cases an ALT test will be done as part of a Liver Panel, a group of liver tests that helps determine a bigger view of the ALT elevation. If it is suspected that you may have been exposed to toxic chemicals, or a virus like hepatitis or HIV, or prescriptions drugs that are stressing your liver, a complete liver panel and other tests will be done. If a health care provider believes that you just don't fit the profile of someone who might have been exposed to a virus like hepatitis, you may have to ask for an ALT and other liver tests to be done.
The earlier you find out what is going on, the better the chances of treatments for many liver conditions to be treated. If liver disease is taking place and you don't find that out until it is serious, your treatment choices could be limited. For very seriously damaged livers sometimes your only option is a liver transplant. You really want to avoid that being your only option if you can, and finding out early about your liver might just keep you from getting there.
||||| What an ALT test Tells You:
Sometimes an ALT can suggest that you have been infected with a hepatitis virus. It might indicate that any prescription drugs, alcohol, alternative treatments or supplements, or exposure to harsh chemicals is not going over well with your liver. Some risks can be avoided, and others can be stopped to prevent serious damage, so it's better to know your ALT as soon as possible. Your ALT may be above normal for years without you having any symptoms of liver disease of any kind. Once you do develop symptoms, it usually means you waited too long and there is probably some damage to your liver.
Your liver is responsible for at least 5,000 crucial functions. It makes hormones, including sex associated ones, and builds protein. It processes everything that goes into your body, from food to medications to dangerous toxins in your environment. It can store fat as well if what you eat is not really what you should be eating. This condition, known as NAFLD or non-alcohol related fatty liver disease leads to diabetes, heart disease, and often a serious increase in fibrosis (scar tissue) in the liver. Getting an ALT test for an organ like the liver is a very important thing to do. Having a Liver Panel done with tests for hepatitis or HIV can be done at the same time if that is possible. You may have to request that, but it provides more very useful information.

||||| Silent Damage:

Treating liver disease even if it has progressed to an advanced stage could save billions of dollars every year in the United States alone. It could also save a lot of lives and prevent unnecessary morbidity - all those conditions and symptoms that need treatment. HCV may be a silent disease in many people, but even while no obvious symptoms are present, all kinds of processes are going on in your body that could effect every organism in your body, including your liver.
The number of children in the United States who develop cirrhosis, a very serious form of fibrosis which can lead to the need for a liver transplant, is growing rapidly in this country. The number of people who die each year because they can not get a liver transplant because there just aren't enough of them is also growing. But if you have ignored the underlying damage taking place in your liver for many years, you might develop a condition (such as heart disease or alcohol abuse related mental illness) you are probably not going to be approved for a liver transplant.
If you are co-infected with another disease, such as HIV/AIDS, treating the hepatitis C and HIV at the same time can be very difficult. And although researchers are studying liver transplants in people who have both HIV and Hep C, like in many cases of people who are chronically infected with hepatitis (including hepatitis B), the hepatitis is likely to come roaring back and need treatment. In some cases the miraculous regeneration of liver cells and the nodules that get created lead to fibrosis all over again. The earlier you know about exactly what is going on in your liver, and the more you do to protect it and keep it healthy, the better off you will be regardless of your age.
||||| Your Response to the ALT testing:
If you test positive for chronic hepatitis or HIV or even if you have a high ALT it does not mean you have been formally diagnosed with AIDS or that you are going to die from liver disease if you don't start treatment right away. You may have no idea how you could have been exposed to any of these viruses because many people don't. You may have your suspicions. But the point is that however you might have become infected or however liver disease is occuring, you need to stop further damage and assess your risks.
Now is the time to follow-up and sort out exactly what is going on. That means having more tests done to determine if you actually have chronic hepatitis or HIV or anything going on with your liver. It is the time to ask for counseling and have follow up tests done. The whole process may shock you or make you feel like running away from it all, but that is the worst thing you can do for yourself and others in your life.
A health care provider or a case manager can counsel you on your next steps. There are national and sometimes local organizations and agencies that can help you if you feel you need to talk things out before going any further. This is important because paying for additional tests and health care can be expensive. How you are going to pay for what might be needed, including treatment if it turns out you need that, should take place during this counseling. For many people it will be the first time they had to focus on exactly what their insurance or any state or federal programs they might need actually cover. A case manager can help you throughout this process. The Network can also provide you with information on what treatments and services are covered by your insurance, Medicaid or Medicare, and state programs, or available for free or a small fee. Contact The Network at 212-260-8868 in New York City or 800-734-7104.

AIDS Treatment Data Network • The Access Project
Last modified: 12/29/2008
The Network

\|\|\|\|\| What is ALT?
ALT is a protein. It is made by liver cells. The ALT test is measured by taking a blood sample. If there is an increased level of ALT above that which is normal, something is going on which is causing ALT to increase in your blood. ALT should mainly be in your liver where it acts as an enzyme (a working tool) to assist in building proteins. Your liver is where everything gets broken down and proteins are made. It is also where bile to digest food is made. If ALT increases in your blood (sometimes called plasma), it usually means that something is causing it to get out of the liver. ALT may be seeping into the blood because the liver is damaged or some chemical or virus is overloading your liver. An increased ALT level in your blood can be a sign of a lot of different things, so it's a good overall test to check your liver out. Even a slight elevation or an increase from a previous test means you should get it checked out more completely. In some serious liver problems, your ALT may only go up a little or seem normal. You should have an ALT test at least once a year. It is very easy to have done. In most cases an ALT test will be done as part of a Liver Panel, a group of liver tests that helps determine a bigger view of the ALT elevation. If it is suspected that you may have been exposed to toxic chemicals, or a virus like hepatitis or HIV, or prescriptions drugs that are stressing your liver, a complete liver panel and other tests will be done. If a health care provider believes that you just don't fit the profile of someone who might have been exposed to a virus like hepatitis, you may have to ask for an ALT and other liver tests to be done. The earlier you find out what is going on, the better the chances of treatments for many liver conditions to be treated. If liver disease is taking place and you don't find that out until it is serious, your treatment choices could be limited. For very seriously damaged livers sometimes your only option is a liver transplant. You really want to avoid that being your only option if you can, and finding out early about your liver might just keep you from getting there.
\|\|\|\|\| What an ALT test Tells You:
Sometimes an ALT can suggest that you have been infected with a hepatitis virus. It might indicate that any prescription drugs, alcohol, alternative treatments or supplements, or exposure to harsh chemicals is not going over well with your liver. Some risks can be avoided, and others can be stopped to prevent serious damage, so it's better to know your ALT as soon as possible. Your ALT may be above normal for years without you having any symptoms of liver disease of any kind. Once you do develop symptoms, it usually means you waited too long and there is probably some damage to your liver. Your liver is responsible for at least 5,000 crucial functions. It makes hormones, including sex associated ones, and builds protein. It processes everything that goes into your body, from food to medications to dangerous toxins in your environment. It can store fat as well if what you eat is not really what you should be eating. This condition, known as NAFLD or non-alcohol related fatty liver disease leads to diabetes, heart disease, and often a serious increase in fibrosis (scar tissue) in the liver. Getting an ALT test for an organ like the liver is a very important thing to do. Having a Liver Panel done with tests for hepatitis or HIV can be done at the same time if that is possible. You may have to request that, but it provides more very useful information.
\|\|\|\|\| Silent Damage:
Treating liver disease even if it has progressed to an advanced stage could save billions of dollars every year in the United States alone. It could also save a lot of lives and prevent unnecessary morbidity - all those conditions and symptoms that need treatment. HCV may be a silent disease in many people, but even while no obvious symptoms are present, all kinds of processes are going on in your body that could effect every organism in your body, including your liver. The number of children in the United States who develop cirrhosis, a very serious form of fibrosis which can lead to the need for a liver transplant, is growing rapidly in this country. The number of people who die each year because they can not get a liver transplant because there just aren't enough of them is also growing. But if you have ignored the underlying damage taking place in your liver for many years, you might develop a condition (such as heart disease or alcohol abuse related mental illness) you are probably not going to be approved for a liver transplant. If you are co-infected with another disease, such as HIV/AIDS, treating the hepatitis C and HIV at the same time can be very difficult. And although researchers are studying liver transplants in people who have both HIV and Hep C, like in many cases of people who are chronically infected with hepatitis (including hepatitis B), the hepatitis is likely to come roaring back and need treatment. In some cases the miraculous regeneration of liver cells and the nodules that get created lead to fibrosis all over again. The earlier you know about exactly what is going on in your liver, and the more you do to protect it and keep it healthy, the better off you will be regardless of your age.
\|\|\|\|\| Your Response to the ALT testing:
If you test positive for chronic hepatitis or HIV or even if you have a high ALT it does not mean you have been formally diagnosed with AIDS or that you are going to die from liver disease if you don't start treatment right away. You may have no idea how you could have been exposed to any of these viruses because many people don't. You may have your suspicions. But the point is that however you might have become infected or however liver disease is occuring, you need to stop further damage and assess your risks. Now is the time to follow-up and sort out exactly what is going on. That means having more tests done to determine if you actually have chronic hepatitis or HIV or anything going on with your liver. It is the time to ask for counseling and have follow up tests done. The whole process may shock you or make you feel like running away from it all, but that is the worst thing you can do for yourself and others in your life. A health care provider or a case manager can counsel you on your next steps. There are national and sometimes local organizations and agencies that can help you if you feel you need to talk things out before going any further. This is important because paying for additional tests and health care can be expensive. How you are going to pay for what might be needed, including treatment if it turns out you need that, should take place during this counseling. For many people it will be the first time they had to focus on exactly what their insurance or any state or federal programs they might need actually cover. A case manager can help you throughout this process. The Network can also provide you with information on what treatments and services are covered by your insurance, Medicaid or Medicare, and state programs, or available for free or a small fee. Contact The Network at 212-260-8868 in New York City or 800-734-7104.