title: Clinical features of hepatitis C-infected patients with persistently normal alanine transaminase levels in the Southwestern United States.
abstract: Approximately one third of patients with chronic hepatitis C virus (HCV) infection have normal alanine transaminase (ALT) levels. We studied the clinical, biochemical, virological, and histological features in patients with persistently normal ALT. A case-control study was conducted on 275 patients with chronic HCV infection, including 75 patients with persistently normal ALT and 200 patients with abnormal ALT. Persistently normal ALT was defined as 4 consecutive ALT values in each patient within a period of 12 months. The average age of the patients was 44 years (range 18 to 69 years). More non-Hispanic whites had persistently normal ALT. The mean serum ferritin level was significantly lower in patients with persistently normal ALT as compared with abnormal ALT (128 +/- 92 ng/mL and 224 +/- 128 ng/mL), respectively (P =.017). The mean HCV-RNA level was significantly lower in patients with persistently normal ALT as compared with abnormal ALT (12 x 10(5) +/- 2.8 x 10(6) copies/mL and 33 x 10(5) +/- 8.0 x 10(6)), respectively (P =.02). Histologically, patients with persistently normal ALT had less severe portal inflammation (P <.05), lobular inflammation (P =.003), piecemeal necrosis (P =.002), fibrosis (P <.05), lower prevalence of cirrhosis (P =.007), as well as a slower fibrosis progression rate (P <.001). Chronic hepatitis C patients with persistently normal ALT have low-activity grade and stage on liver biopsy. In these patients the hepatitis C RNA level was lower compared with abnormal ALT patients, which may explain the slower fibrosis progression rate.
authors.affiliation: Division of Gastroenterology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131-5271, USA. mmjamal@salud.unm.edu
authors.forename: M M
authors.initials: MM
authors.lastname: Jamal
authors.forename: A
authors.initials: A
authors.lastname: Soni
authors.forename: P G
authors.initials: PG
authors.lastname: Quinn
authors.forename: D E
authors.initials: DE
authors.lastname: Wheeler
authors.forename: S
authors.initials: S
authors.lastname: Arora
authors.forename: D E
authors.initials: DE
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000201:enzymology / Q000473:pathology*; D006801:Humans; D007249:Inflammation; D007501:Iron / Q000097:blood; D008099:Liver / Q000473:pathology; D008297:Male; D012367:RNA, Viral / Q000097:blood; D044469:Racial Groups; D012016:Reference Values; D012709:Serum Albumin / Q000032:analysis; D012727:Sex Characteristics; D015206:Southwestern United States
chemical_list: D012367:RNA, Viral; D012709:Serum Albumin; D005293:Ferritins; D007501:Iron; D000410:Alanine Transaminase; D001663:Bilirubin