Some patients with HIV disease will experience an ALT (alanine aminotransferase) "flare". This can often be traced to one or more underlying conditions.
The definition of an ALT elevation flare varies:
(1) There should be an increase in serum ALT, with previous values normal or else much lower.
(2) The elevation in the serum ALT may be above the upper limit of the normal reference range OR above an absolute concentration (> 200 IU/L).
(3) The increase in serum ALT activity may be a single episode but usually it is confirmed by repeat testing several days or weeks apart (Bansi et al use > 14 days).
Conditions associated with an ALT flare:
(1) low CD4 count
(2) high HIV viral loads
(3) history of clinical AIDS
(4) antiretroviral medications (nevirapine, ritonavir, prolonged stavudine, prolonged zidovudine)
(5) viral hepatitis (C, B)
(6) severe alcohol abuse
(7) obesity (BMI >= 30 kg per square meter)
