title: Prospective study on anti-hepatitis C virus-positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA.
abstract: 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.
authors.affiliation: 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
authors.forename: M
authors.initials: M
authors.lastname: Martinot-Peignoux
authors.forename: N
authors.initials: N
authors.lastname: Boyer
authors.forename: D
authors.initials: D
authors.lastname: Cazals-Hatem
authors.forename: B N
authors.initials: BN
authors.lastname: Pham
authors.forename: A
authors.initials: A
authors.lastname: Gervais
authors.forename: V
authors.initials: V
authors.lastname: Le Breton
authors.forename: S
authors.initials: S
authors.lastname: Levy
authors.forename: C
authors.initials: C
authors.lastname: Degott
authors.forename: D C
authors.initials: DC
authors.lastname: Valla
authors.forename: P
authors.initials: P
authors.lastname: Marcellin
mesh_terms: 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
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase