Bili alt ast have been elevated on off for a yr confirmed mild diffuse fatty infiltration. hep viruses and autoimmune disease ruled out. cirrhosis?

Depends on biopsy: Cirrhosis can only be truly proven by a liver biopsy. Certain lab tests, such as bilirubin, INR, albumin, and platelets are often used as surrogate markers of liver function, and are an indirect estimator/predictor of cirrhosis. Additionally, imaging such as ultrasound or CT can suggest cirrhosis. But again, a biopsy is technically needed to prove the diagnosis of cirrhosis.

Possible: Cirrhosis is advanced liver disease and can be the eventual outcome of long-standing liver inflammation. The only way to detect early signs of cirrhosis would be liver biopsy. Imaging studies and endoscopy only find advanced disease. You should be seeing a specialist who can advise you on cause, risks and treatments.