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15. Do you recommend treating patients with a high-viral load and normal ALTs (liver enzyme levels)?

We will probably end up recommending treatment for people with high viral loads and so-called normal ALTs, because the normal ALT level is not accurately reflecting what is happening to the liver. Also, what do you call normal? Normal is probably 16-18 - to me even the upper limits of what some people call normal (such as a level of 40) is abnormal, because normal should really be about 20 or less. Because looking at ALT levels alone is not enough, we will probably wind up like HIV - looking at the viral load.