Prospective study on anti-hepatitis C virus-positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA.
A significant proportion of patients with detectable antibodies to hepatitis C virus have normal serum alanine transaminase levels. Our aim was to study the outcome of this group. Between 1992 and 1999, 135 consecutive anti-HCV-positive patients with persistently normal ALT were followed for 3.6 +/- 2.3 years (0.5 to 8.5 years), 108 had a liver biopsy at inclusion, and 24 had a second liver biopsy 3.5 +/- 1.0 years later. Serum HCV RNA was detectable with PCR in 94 patients (69%) and not detectable in 41 patients (31%). Patients with and without detectable serum HCV RNA had similar epidemiological characteristics. Serum ALT levels and anti-HCV ratio were lower (P =.001), and histological lesions had lower grade and stage in patients without detectable serum HCV RNA (P =.001). Liver HCV RNA was not detectable with PCR in the 12-serum HCV RNA-negative patients tested. During follow-up, all patients without detectable serum HCV RNA remained HCV RNA-negative and kept normal serum ALT; all patients with detectable serum HCV RNA remained HCV RNA-positive, 20 (21%) had a slight fluctuation of serum ALT above the upper limit of normal. No significant changes were observed in the liver lesions of the 24 patients who underwent a second liver biopsy. In anti-HCV-positive patients with persistently normal serum ALT, histological lesions are significantly lower in HCV RNA-negative than in HCV RNA-positive patients. During follow-up, the HCV RNA status of patients remained unchanged; 21% of the patients with detectable serum HCV RNA had slight increase in serum ALT levels, but histological lesions remained stable.
Martinot-Peignoux
M
M
Unité de Recherche INSERM U481, Centre de Recherche Claude Bernard sur les Hépatites Virales and Service d'Hépatologie, Hôpital Beaujon, Clichy, France. martinot@bichat.inserm.fr
Boyer
N
N
Cazals-Hatem
D
D
Pham
B N
BN
Gervais
A
A
Le Breton
V
V
Levy
S
S
Degott
C
C
Valla
D C
DC
Marcellin
P
P
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001706:Biopsy; D005260:Female; D016174:Hepacivirus / Q000235:genetics*; D018937:Hepatitis C Antibodies / Q000032:analysis*; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood* / Q000378:metabolism; D012016:Reference Values
D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase