Natural history of hepatitis C virus carriers with persistently normal aminotransferase levels.
OBJECTIVE
Some patients with serum hepatitis C virus (HCV) have persistently normal aminotransferase (ALT) levels and are affected by cirrhosis. This study prospectively evaluated progression of the disease in a group of anti-HCV-positive patients with persistently normal ALT levels.


METHODS
Thirty-seven subjects were studied. Each subject underwent liver biopsy at baseline and after 5 years of follow-up. At baseline, serum samples were tested for genotypes and HCV RNA load. ALT levels and serum HCV RNA were tested every other month and every 6 months, respectively. Patients with increased ALT were discharged from the study and treated with IFN. Five years after the end of IFN therapy, a liver biopsy was performed.


RESULTS
Liver biopsy at baseline showed chronic hepatitis in 34 patients and normal histology in 3 patients, 2 of whom were negative for HCV RNA and 1 positive. HCV genotypes were distributed as follows: 2a, 56%; 1b, 41%; and 1a, 3%. At the end of 7-year follow-up, 73% of the patients still had normal ALT values. Liver histology after 5 years was comparable to that observed at entry to study.


CONCLUSIONS
Most patients with persistently normal ALT serum levels have very mild chronic hepatitis. However, healthy anti-HCV-positive subjects exist. In patients with HCV-related chronic hepatitis associated with persistently normal ALT levels, the grade of disease activity does not increase over years and progression to cirrhosis is slow or absent.
Persico
M
M
Internal Medicine and Hepatology Unit, II University of Naples, Naples, Italy. marcpers@tin.it
Persico
E
E
Suozzo
R
R
Conte
S
S
De Seta
M
M
Coppola
L
L
Palmentieri
B
B
Sasso
F C
FC
Torella
R
R
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001706:Biopsy; D002353:Carrier State / Q000097:blood / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012016:Reference Values
D012367:RNA, Viral; D000410:Alanine Transaminase