title: HIV/hepatitis C virus-coinfected patients with normal alanine aminotransferase levels.
abstract: OBJECTIVE
  The significance of normal alanine aminotransferase (ALT) levels in patients with HIV/hepatitis C virus (HCV) coinfection is not well understood.
  
  
  METHODS
  We performed a cross-sectional retrospective analysis on consecutive HIV/HCV-coinfected patients (n = 89) who underwent a liver biopsy during a 2-year period. Similar data were also collected on HCV-monoinfected patients (n = 117).
  
  
  RESULTS
  Mean ALT levels and the percentage of patients with normal ALT (< or =40 U/L) levels were similar in HIV/HCV-coinfected (mean +/- SD, 81.7 +/- 56.1 U/L; 21%) and HCV-monoinfected patients (97.3 +/- 100.7 U/L; 18%; P = 0.19 and 0.54, respectively). Coinfected patients, however, had significantly advanced necroinflammation (P= 0.001) and fibrosis (P = 0.02) compared with monoinfected patients. The percentage of patients with advanced necroinflammation (grades 3 or 4) was lower in HCV-monoinfected patients with normal ALT levels compared with those with elevated ALT (5% vs 20%, respectively). In contrast, the percentage of coinfected patients with advanced necroinflammation was similar whether the patient had normal or elevated ALT levels (32% vs 37%, respectively).
  
  
  CONCLUSIONS
  In coinfected patients, normal ALT levels are not an indicator of mild necroinflammation and may not portend a more benign disease course.
authors.affiliation: Center for the Study of Hepatitis C and Division of Gastroenterology and Hepatology, Department of Medicine, Weill Medical College of Columbia University, 525 East 68th Street, New York, NY 10021, USA.
authors.forename: Stevan A
authors.initials: SA
authors.lastname: Gonzalez
authors.forename: Ruei-Che
authors.initials: RC
authors.lastname: Liu
authors.forename: Brian R
authors.initials: BR
authors.lastname: Edlin
authors.forename: Ira M
authors.initials: IM
authors.lastname: Jacobson
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Talal
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000097:blood / Q000150:complications*; D015497:HIV-1 / Q000235:genetics; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007249:Inflammation / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012016:Reference Values; D012307:Risk Factors; D019562:Viral Load
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase