Concerning the non-HBV causes of higher ALT elevations among the 75 triple negative patients, ischemic liver injury, drug-induced liver injury, autoimmune hepatitis, obstructive jaundice, post hepatectomy, alcoholic cirrhosis, Epstein–Barr virus (EBV) hepatitis, cytomegalovirus (CMV) hepatitis, idiopathic thrombocytopenic purpura, hepatitis C, hepatitis A, traumatic liver injury and hemophagocytic syndrome were the causes in 24 (32.0%), 22 (29.3%), 6 (8.0%), 4 (5.3%), 4 (5.3%), 5 (6.7%), 3 (4.0%), 2 (2.7%), 1 (1.3%), 1 (1.3%), 1 (1.3%), 1 (1.3%) and 1 patient (1.3%), respectively (Table 5). This evidence concerns the gene GPT and hepatitis A virus infection.