Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests

Table 3 Criteria of a positive reexposure test in herb induced liver injury cases

Test result	ALTb	ALTr
Positive	< 5 N	≥ 2 ALTb
Negative	< 5 N	< 2 ALTb
Negative	≥ 5 N	≥ 2 ALTb
Negative	≥ 5 N	< 2 ALTb
Negative	≥ 5 N	N/A
Uninterpretable	< 5 N	N/A
Uninterpretable	N/A	N/A

Details and criteria for a positive reexposure test are based on the conclusions of International Consensus Meetings. Accordingly, required data are the alanine aminotransferase (ALT) levels just before reexposure, designated as baseline ALT or ALTb, and the ALT levels during reexposure, designated as ALTr. Response to reexposure is positive, if both criteria are met: first, ALTb is < 5 N with N as the upper limit of normal, and second ALTr ≥ 2 ALTb. Other variations lead to negative or uninterpretable results. Criteria are based on ALT values and thereby applicable to the hepatocellular type of liver injury. N/A: Not available.