Chronic hepatitis C with normal or abnormal aminotransferase levels: is it the same entity?
OBJECTIVE
The features of hepatitis C virus (HCV) infection with persistently normal serum alanine aminotransferase (ALT) activity levels are not well defined. This study evaluated the characteristics of HCV infection according to the presence or absence of elevated ALT.


METHODS
Demographic data, liver histology and HCV genotype were studied in a group of 80 HCV-RNA-positive subjects with persistently normal ALT (PNALT) (group 1), and compared with a second group of 455 HCV-RNA-positive patients with elevated ALT (group 2). The annual progression of liver fibrosis was also calculated.


RESULTS
A higher proportion of women was found in group 1:64% vs 42% in group 2 (P< 0.0002). The HCV genotype 1 was less frequent in group 1:49% vs 60% in group 2 and genotype 2 was more frequent: 16% in group 1 vs 4% in group 2 (P< 0.002). Cirrhosis was less frequent in group 1 (4% vs 13% in group 2 (P< 0.0001)). Normal liver was more frequent in group 1:9% vs 1% in group 2 (P< 0.0001). The Knodell score was significantly different between the two groups: 3.2 +/- 0.27 vs 7.15 +/- 0.22 (P< 0.0001). The progression of liver fibrosis was lower in group 1: 0.053 +/- 0.14 units/year vs 0.13 +/- 0.24 in group 2 (P < 0.007).


CONCLUSIONS
HCV infection with PNALT is associated with less severe histological liver disease and a lower fibrosis progression rate. This suggests that the natural history of HCV infection in these patients is different from that in patients with abnormal ALT.
Hervé
S
S
Digestive Tract Research Group, Rouen University Hospital, France. sophko@hotmail.com
Savoye
G
G
Riachi
G
G
Hellot
M F
MF
Goria
O
O
Lerebours
E
E
Colin
R
R
Ducrotte
P
P
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000201:enzymology* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D017678:Sex Distribution
D000410:Alanine Transaminase