Background/Aims: There is a lack of consensus about the currently accepted range of normal values for serum alanine aminotransferase (ALT) levels because some investigators have claimed that the true values are significantly lower than those listed by kit manufacturers. Methods: A total of 255 chronic hepatitis-B-virus (HBV)-infected patients with traditional, normal levels of ALT (<= 42 U/l) were divided into 2 groups: (1) low normal ALT (men: <= 30 U/l; women: <= 19 U/l) and (2) high normal ALT (men: 31-42 U/l; women: 20-42 U/l). The extent of hepatic inflammation and fibrosis was evaluated in these patients by examining liver biopsy specimens. Results: The levels of HBV DNA were >10,000 copies/ml in 58.4, 52.9 and 61.2% of the patients with traditional normal ALT, low normal ALT and high normal ALT values, respectively (p > 0.05). Also, the moderate degrees of hepatic necroinflammation [histological activity index (HAI)-NI score of >= 9] and severe hepatic fibrosis (HAI-F score of >= 3) were similar among the 3 groups of patients (p > 0.05). Conclusion: The newly defined low normal cutoff values for ALT did not exhibit any added clinical benefit for assessing the extent of liver damage in patients with chronic HBV infection in Bangladesh. Copyright (C) 2010 S. Karger AG, Basel