Guidelines for the antiviral therapy of hepatitis C virus carriers with normal serum aminotransferase based on platelet counts.
OBJECTIVE
We aimed to identify the candidates for antiviral therapy, among patients who are hepatitis C virus (HCV) carriers with normal serum aminotransferase (ALT), focused on the inhibition of hepatocellular carcinoma (HCC).


METHODS
Four hundred and sixty-four HCV carriers with normal serum ALT and 129 HCV carriers with persistently normal ALT (PNALT) and platelet (PLT) counts >/=150 000/muL who received liver biopsies were enrolled. HCV carriers with normal serum ALT were divided into four groups according to their ALT levels (</=30 U/L or 31-40 U/L) and PLT counts (>/=150 000/muL or <150 000/muL).


RESULTS
In 129 HCV carriers with PNALT, the rate of progression of fibrosis stage was 0.05/year and no HCC was detected during the follow up for 10 years. Approximately 20% of patients with ALT </=40 U/L and PLT counts >/=150 000/muLwere at stage F2-3; however, approximately 50% of patients with ALT </= 40 U/L and PLT counts <150 000/muL were at stage F2-4. An algorithm for the management of HCV carriers with normal serum ALT was advocated based on ALT and PLT counts.


CONCLUSIONS
The combination of ALT and PLT counts is useful for evaluating the fibrosis stage in HCV carriers with normal serum ALT. Most patients with PLT counts <150 000/muL are candidates for antiviral therapy, especially those with ALT levels >/=31 U/L when we focus on the inhibition of the development of HCC.
Okanoue
Takeshi
T
Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Itoh
Yoshito
Y
Minami
Masahito
M
Hashimoto
Hiroaki
H
Yasui
Kohichiro
K
Yotsuyanagi
Hiroshi
H
Takehara
Tetsuo
T
Kumada
Takashi
T
Tanaka
Eiji
E
Nishiguchi
Shuhei
S
Izumi
Namiki
N
Sata
Michio
M
Onji
Morikazu
M
Yamada
Gotaro
G
Okita
Kiwamu
K
Kumada
Hiromitsu
H