Chronic hepatitis C with normal aminotransferase levels: a clinical histologic study.
OBJECTIVE
To define chronic hepatitis C virus (HCV) infection among patients with persistently normal aminotransferase levels (PNAL).


METHODS
Retrospective chart review of all patients encountered during 1-yr with positive hepatitis C antibody (anti-C100-3 ELISA), no alternative cause for their liver disease and PNAL for 6 or more consecutive months prebiopsy. Blinded review of liver histology.


METHODS
Outpatient hepatology clinics of two academic centers.


METHODS
Fifty patients with PNAL among 303 with hepatitis C.


METHODS
Epidemiologic profiles, reasons for seroscreening and confirmatory analyses were tabulated. Histology was reviewed and grading of inflammatory activity and stage of fibrosis was determined by protocol.


RESULTS
Among 50 patients with PNAL, 35 (70%) were female, 34 (68%) had parenterally acquired HCV, 44 (88%) abstained (> 2 yr) from ethanol, all were HIV-negative and none pharmacologically immunosuppressed. HCV infection was uniformly confirmed by RIBA II or HCV-RNA assay. The mean level of HCV-RNA by quantitative PCR was 3.79 x 10(5) copies/ml (range, 500 to 1.8 x 10(6) copies/ ml) and by B-DNA, 53 x 10(5) copies/ml (range, 3.5-230 x 10(5) copies/ml). Traditional histoevaluation yielded chronic hepatitis ("active", n = 15; "persistent", n = 25), cirrhosis (n = 7), and normal histology (n = 3). Blinded protocol review of histology (inflammatory grade/fibrotic stage) revealed 0/0 (n = 4), 1/0 (n = 6), 2/0 (n = 17), 2/1 (n = 3), 2/4 (n = 1), 3/0 (n = 2), 3/1 (n = 6), 3/2 (n = 2), and 3/3 (n = 9).


CONCLUSIONS
In chronic HCV infection, active inflammation, fibrosis, and variable circulating HCV-RNA levels may coexist with PNAL, particularly among female nondrinkers. Asymptomatic carriers with normal histology comprise 6 to 8% of chronic hepatitis C with PNAL. Management guidelines for this group of patients need to be developed.
Gholson
C F
CF
Department of Medicine & Pathology, Louisiana State University School of Medicine, Shreveport, USA.
Morgan
K
K
Catinis
G
G
Favrot
D
D
Taylor
B
B
Gonzalez
E
E
Balart
L
L
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001707:Biopsy, Needle; D004796:Clinical Enzyme Tests; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
D000410:Alanine Transaminase