I had hepatitis B about five years ago. I recently had blood work done for insurance. My results came back abnormal. The results stated that my AST, ALT and GGTP were abnormally high. Is this normal for someone who has had hepatitis B, or should I see my doctor? What else could cause this?

J.T.

Hepatitis B virus (HBV) is a virus that infects the liver and is spread by sex and contact with blood. In most cases, when a person is infected with HBV, acute hepatitis (liver inflammation) occurs. The patient may have fever, right upper abdominal pain and jaundice (yellowing of the skin and eyes). In 90 percent of cases or more, the patient fully recovers without further complications. Some people may have signs that virus is still present in the body (detected by a test called the polymerase chain reaction, or PCR) but show no evidence of liver disease. In some cases, chronic (persistent) infection results. While some of these people remain carriers, with no ongoing damage to the liver, others develop chronic active hepatitis, leading to end-stage liver disease and death.

You say that you had hepatitis B. I will assume that you had symptoms of acute disease. Just playing the odds, there is more than a 90 percent chance that you were cured of your infection. A simple blood test can determine whether you are free of the virus. If your hepatitis surface antigen test (which indicates the actual presence of HBV) is negative, and the surface antibody test (indicating that your body developed proteins called antibodies to fight HBV) is positive, then you do not have chronic hepatitis B. If the reverse is true, then you do have chronic hepatitis B. Acute hepatitis B does not cause persistent liver test abnormalities unless it is followed by chronic infection.

What else could you have? If you were infected with HBV, then you also are considered at risk for hepatitis C virus (HCV) infection, an illness that leads to chronic infection in the majority of people infected. Whatever factors that exposed you to HBV could have led to HCV infection, possibly at the same time. Another possibility, if your liver tests show only mildly elevated levels, is a condition called fatty infiltration of the liver. This is usually a non-progressive problem often seen in obese people and people with diabetes.

Abnormal liver tests also might be a sign that you are experiencing a reaction to a medication. Antibiotics, cholesterol-lowering medications and drugs for epilepsy are common culprits. Several genetic abnormalities, including hemochromatosis, which causes accumulation of iron in the body, can result in abnormal liver tests. Yet another possibility is alcohol abuse, which can lead to liver damage and is one of the most common causes of abnormal liver tests in the United States. In addition to what I have already mentioned, there are dozens of other causes of liver test abnormalities. I would urge you to see your doctor for a work-up. Many causes of your problem are treatable -- even hepatitis B.