An important consideration when evaluating the risk of hepatic fibrosis is that both AST and ALT can be normal even in the setting of cirrhosis, and the utility of the AST:ALT ratio in adults persists even if both values are within the normal reference interval.39 While it is hard to justify the routine analysis of both AST and ALT together on every liver blood test request, a strategy not supported by the data from the BALLETS study, subsequent testing of AST (or ALT depending which one is undertaken first) to calculate the AST:ALT ratio is clearly desirable. The gene discussed is GPT; the disease is Hepatic fibrosis.