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12. What are the guidelines for evaluating treatment among chronic carriers with elevated ALTs (liver enzyme levels)?

If you come to my office, and your ALT is 80 (normal is 40) then I would proceed to check your hepatitis B virus DNA level. If your ALT is normal I won't even check the DNA level, because this test costs a few hundred dollars. If your DNA is a few million, then this is most likely a sign of active liver damage - if your viral count is high and your ALT is twice above normal, then you can gather that the elevated ALT is being caused by the virus.