title: Liver biopsy findings for HIV-infected patients with chronic hepatitis C and persistently normal levels of alanine aminotransferase.
abstract: BACKGROUND
  Severe liver fibrosis is common in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) who have a high alanine aminotransferase (ALT) level. However, little is known about the frequency, liver biopsy findings, and significance of a persistently normal ALT level in coinfected patients.
  
  
  METHODS
  We analyzed clinical data and histological findings for 256 patients coinfected with HIV and HCV, 24 (9.4%) of whom had an ALT level within the normal range on > or =2 separate occasions within a 6-month period.
  
  
  RESULTS
  The proportion of patients demonstrating advanced stages of fibrosis (F3 and F4) was 78 (33.7%) of 232 patients in the high ALT level group, compared with 0 (0%) of 24 patients in the persistently normal ALT level group (P<.001). Among patients with persistently normal ALT levels, 23 (96%) had any grade of fibrosis, and 7 (29%) had stage F2 of fibrosis. No differences were found between both groups with respect to age, sex, HIV transmission category, Centers for Disease Control and Prevention clinical category, CD4+ cell count (both nadir and baseline values), type of antiretroviral therapy, years since onset of HCV infection, alcohol use, or HCV load. However, the proportion of patients infected with HCV genotype 3 was significantly higher among patients with high ALT levels than in patients with persistently normal ALT levels (61 [26.9%] of 232 patients vs. 1 [4.2%] of 24 patients; P=.04).
  
  
  CONCLUSIONS
  Histological abnormalities are significantly milder in patients coinfected with HIV and HCV who have persistently normal ALT levels than those found in patients with high ALT levels. However, a subgroup of patients with persistently normal ALT levels may have significant cases of fibrosis. Liver biopsy may be recommendable in patients coinfected with HIV and HCV who have persistently normal ALT levels, to determine the extent of liver fibrosis and, consequently, to assess suitability for treatment.
authors.affiliation: Infectious Diseases-HIV Unit, Hospital General Gregorio Marañón, Madrid, Spain.
authors.forename: Matilde
authors.initials: M
authors.lastname: Sánchez-Conde
authors.forename: Juan
authors.initials: J
authors.lastname: Berenguer
authors.forename: Pilar
authors.initials: P
authors.lastname: Miralles
authors.forename: Federico
authors.initials: F
authors.lastname: Alvarez
authors.forename: Juan
authors.initials: J
authors.lastname: Carlos Lopez
authors.forename: Jaime
authors.initials: J
authors.lastname: Cosin
authors.forename: Catalán
authors.initials: C
authors.lastname: Pilar
authors.forename: Margarita
authors.initials: M
authors.lastname: Ramirez
authors.forename: Isabel
authors.initials: I
authors.lastname: Gutierrez
authors.forename: Emilio
authors.initials: E
authors.lastname: Alvarez
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D000431:Ethanol; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D013997:Time Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D000431:Ethanol; D000410:Alanine Transaminase